The Economist and Health 2.0

The Economist takes a glimpse at Health 2.0.

Thanks to Scott Shreeve, MD for pointing out the article. Scott has great insight on what changes might be happening to health care as this new technology and social networking begins to invade traditional models of health care delivery. Scott is working on a white paper styled after Tim O'Reilly titled, What is Health 2.0? Enabling Technologies and Reform Initiatives for Next Generation Healthcare.

I'm looking forward to talking with Scott, Matthew, Indu and others who will be attending the Health 2.0 conference later this month. Congrats to Matthew and Indu Subyaiya, MD, co-organizers of the event, for their effort in putting together a fantastic agenda and selling the event out.

For a little more insight into the ideas behind the conference check out Indu's post from May 2007, Health 2.0: The Conference, the debate. Indu's vision for the conference:

If you don't come for Google, Esther Dyson, Revolution Health, Intuit, Sermo...come because this will be the most straight-up conversation on health care and technology you've participated in. No vested interests, no long-winded podium anesthetics, no oversized Vegas-style booths. Rather a close examination of organic and disruptive trends outside the top-down control of organizations, a reflective look at how each of us as interacts with various aspects of our health care and the demands we are going to increasingly place on the system to become more transparent, interactive and humane.

Note: If you are planning on attending the conference you may want to join the Facebook Group around the conference that hopefully others will use to generate discussion around the event. Also, if you plan to attend I would like to get together post a comment or send me an email. I will be arriving in the afternoon on the 19th.

Lets Go Mountaineers . . .

Everyone in West Virginia is excited about the start of the WVU college football season. There is a a lot of buzz about the Mountaineers, its #3 AP ranking and Heisman hopefuls, Steve Slaton and Pat White (check out his Pitt growl). Good luck to the Mountaineers as they start there season this weekend. Go Mountaineers and their #1 rated fans!

This clip is a year old but I just saw it after my dad sent it to me. What a great commercial. For those of you who don't get the commercial check out this Google search.

Learning: Privacy and Security Monitoring, Audits and Investigations

On November 13, 2007, I will be speaking at a Lorman Eduational Services seminar to be held in Charleston, West Virginia. The seminar topic is "Health Care Information Privacy and Security Monitoring, Audits and Investigations: How to avoid an investigation and what you should expect if the state or federal officials call". You can register online here.

Also speaking at the seminar will be (read full bios):

• Terri Barrett, the assistant chief privacy officer at the West Virginia Health Care Authority in Charleston

• Mike Harmon, compliance officer for the West Virginia Public Employees Insurance Agency who oversees HIPAA compliance for PEIA and the Department of Administration

• Jack Shaffer, CIO for the Community Health Network of West Virginia who has experience in all aspects of technology, including systems development, enterprise application integration, networking, telecommunications, data center operations, database administration, disaster recovery, security and mobile computing.

Below is a copy of the seminar agenda:

9:00 am – 10:30 am	Legal Overview of HIPAA Privacy and Security Enforcement
	Robert L. Coffield, Esq.
	HIPAA Refresher on Enforcement Rules and Penalties OCR Privacy Investigation Statistics Best Practices on Conducting Internal Investigations Responding to OCR/CMS Investigation
10:30 am – 10:45 am	Break
10:45 am – 11:30 am	Preparing for an Audit
	Michael T. Harmon, CIPP/G
	Auditing vs. Monitoring Other Governmental Auditors – e.g., OIG, Legislature Elements of the OIG Audit of Piedmont Hospital in Atlanta New Kennedy/Leahy Legislation and Changes to Current Practice Privacy and Security Accreditation
11:30 am – 12:30 pm	Lunch (On Your Own)
12:30 pm – 2:30 pm	Technologies and Procedures for HIPAA Compliance
	Jack L. Shaffer Jr.
	Acceptable Use Policies and Enforcement Protecting PHI With Encryption Technologies Auditing and Monitoring Tools
2:30 pm – 2:45 pm	Break
2:45 pm – 3:45 pm	The Role of the Privacy Officer
	Terrisita Barrett, CIPP
	The Changing Privacy and Security Landscape Role and Responsibilities: Past, Present and Future Challenges Affecting the Privacy Officer Role
3:45 pm – 4:30 pm	Panel Discussion, and Questions and Answers
	Terrisita Barrett, CIPP, Robert L. Coffield, Esq.,
	Michael T. Harmon, CIPP/G, and Jack L. Shaffer Jr.

The Beauty of West Virginia

Our state receives a lot of negative national news - lately its been about the business climate and our weight problem. However, here is the reason I live in and love West Virginia. Another terrific shot (large image) from local photo blogger, Rick Lee.

CMS Stark III Regulations Now Available

Today CMS released the final Stark III physician self-referral rule available on the Physician Self Referral section of the CMS website and will be published in the September 5 Federal Register. 516 pages of light health care regulatory reading for the Labor Day Holiday.

The Phase III Stark Final Rule (CMS-1810-F) is officially titled, "Medicare Program; Physicians' Referrals to Health Care Entities With Which They Have Financial Relationships (Phase III)". The regulations will be effective 90 days after the publication date which is expected to be September 5, 2007. Read the CMS press release.

UPDATE: CMS has also provided an unofficial redline version of the Stark regulations showing the existing regulations and incorporating in the new Stark III changes.

UPDATE (7/5/07): The official version was published in the Federal Register on September 5, 2007. A complete copy of the regulations can be found here. The effective date of Phase III Final Rule is December 4, 2007.

UPDATE (11/11/07): David Harlow reports that certain provisions of Stark III will be delayed for up to a year (December 4, 2008).

Below is a copy of the rule summary and the table of contents directly from the final rule:

Summary: This final rule is the third phase (Phase III) of a final rulemaking amending our regulations regarding the physician self-referral prohibition in section 1877 of the Social Security Act (the Act). Specifically, this rule finalizes, and responds to public comments regarding, the Phase II interim final rule with comment period published on March 26, 2004, which set forth the self-referral prohibition and applicable definitions, interpreted various statutory exceptions to the prohibition, and created additional regulatory exceptions for arrangements that do not pose a risk of program or patient abuse (69 FR 16054).

In general, in response to public comments, in this Phase III final rule, we have reduced the regulatory burden on the health care industry through the interpretation of statutory exceptions and modification of the exceptions that were created using the Secretary’s discretionary authority under section 1877(b)(4) of the Act to promulgate exceptions for financial relationships that pose no risk of program or patient abuse.

I. Background
II. General Comments
A. General
B. Compliance with the Anti-kickback Statute
III. Definitions--§411.351
A. Employee
B. Entity
C. Fair Market Value
D. “Incident to” Services
E. Physician in the Group Practice
F. Radiology and Certain Other Imaging Services and Radiation Therapy
G. Referral
H. Rural Area
IV. Group Practice--§411.352
V. Prohibition on Certain Referrals by Physicians and Limitations on Billing--§411.353
VI. Financial Relationship, Compensation, and Ownership or
Investment Interest--§411.354
A. Ownership
B. Compensation
C. Special Rules on Compensation
VII. General Exceptions to the Referral Prohibition Related
to Both Ownership/Investment and Compensation--
§411.355
A. Physician Services
B. In-office Ancillary Services
C. Services Furnished by an Organization (or Its Contractors or Subcontractors) to Enrollees
D. Reserved
E. Academic Medical Centers
F. Implants Furnished by an Ambulatory Surgical Center
G. EPO and Other Dialysis-related Drugs Furnished in or by an End-Stage Renal Dialysis Facility
H. Preventive Screening Tests, Immunizations, and Vaccines
I. Eyeglasses and Contact Lenses Following Cataract Surgery
J. Intra-family Rural Referrals
VIII. Exceptions to the Referral Prohibition Related to
Ownership or Investment Interests--§411.356
A. Publicly-traded Securities and Mutual Funds
B. Hospitals Located in Puerto Rico
C. Rural Providers
D. Ownership Interest in a Whole Hospital
IX. Exceptions to the Referral Prohibition Related to
Compensation Arrangements--§411.357
A. Rental of Office Space
B. Rental of Equipment
C. Bona Fide Employment Relationships
D. Personal Service Arrangements
E. Physician Recruitment
F. Isolated Transactions
G. Remuneration Unrelated to Designated Health Services
H. Group Practice Arrangements with a Hospital
I. Payments by a Physician
J. Charitable Donations by a Physician
K. Nonmonetary Compensation
L. Fair Market Value Compensation
M. Medical Staff Incidental Benefits
N. Risk-sharing Arrangements
O. Compliance Training
P. Indirect Compensation Arrangements
Q. Referral Services
R. Obstetrical Malpractice Insurance Subsidies
S. Professional Courtesy
T. Retention Payments in Underserved Areas
U. Community-wide Health Information Systems
X. Reporting Requirements--§411.361
XI. Miscellaneous (Other)
XII. Provisions of the Final Rule
XIII. Technical Corrections
XIV. Collection of Information Requirements
XV. Regulatory Impact Analysis
A. Overall Impact
B. Anticipated Effects
C. Alternatives Considered

Comments on the new regulations:

• Brian Peterson at his West Virginia Legal Weblog provides insight into the new regulations clarification of physician recruitment agreements and restrictive covenants in physician employment agreements.
  

Thanks to the AHLA Stark Law listserve for the tip on the final rule.

Physicians vs. Patient: Rating-Permission Contracts

Interesting post from the WSJ Health Blog on Medical Justice's new ratings-permission contracts (press release on service).This new service offered by Medical Justice appears designed to attempt to control the evolving growth of health care consumer driven rating information provided through companies like RateMDs.com.

According to Medical Justice's CEO the goal is to "regain control of the flow of information." Just more evidence of the dynamic shift we are seeing in the health care industry as a result of some of the health 2.0 initiatives.

New models are being developed to allow patient/consumers to rate, report and compare the quality and cost of health care services. As these services become more widely adopted and used by consumers, traditional health care delivery system models and the perceptions of health care professionals are being challenged.

Note: Don't miss reading the reader comments in the WSJ Blog post.

UPDATE: More from Dr. Val on the potential value of online physician rating. I completely agree with her comment that sometimes all that is available is a "health insurance company's list of in network professionals."

HHS Secretary Leavitt Joins The Blogosphere

A warm welcome to Secretary Mike Leavitt (blog bio) who last week launched his blog at Secretary Mike Leavitt's Blog. It is wonderful to see the United States top health care official join the blogospere and create a vehicle to share his personal observations and have an open conversation about health care and the challenges that that we all face.

I am impressed by his goal to keep the blog personal (not relying on staff or the PR department to write his posts) outlined in his About this Blog summary and introductory post. I'm hoping that he enjoys the experience and has the time to continue to blog past his initial trial phase. In my mind he gets the idea behind blogging -- a communication utility which is used to think and understand, share his observations, engage ideas and as he says, create a "dynamic online conversation." These characteristics are what makes blogging something more than just another way to create traditional media/PR web content. It's the reason why I enjoy the blogging process.

Question to readers: Is Secretary Leavitt the highest ranking U.S. official to date to have a blog which is personally written? Are there any other Federal Executive Department Secretary level bloggers?

Thanks to iHealthBeat for its article announcing Secretary Leavitt's blog.

Latest on CMS's Challenge to WV Oxycontin Settlement

Larry Messina provides the latest on CMS's challenge to the $10M Oxycontin settlement by the West Virginia Attorney General's office against Purdue Pharma. Last month the West Virginia Bureau of Medical Services received from CMS a $4.1M notice of disallowance stating that the state failed to share a portion of the settlement with federal Medicare.

Larry Messina's article in today's Herald Dispatch, "Feds threaten $4.1M in Medicaid funds over Oxy Settlement".

Why We Need A Health Care Revolution

Dr. Val Jones' road to revolution provides her personal perspective on the current state of our health care system and why we all need to work for change.

Don't miss the rest of this week's Grand Rounds hosted at Med Journal Watch.

NYT Looks At Dr. Google and Dr. Microsoft

Today's NYT article, Dr. Google and Dr. Microsoft, takes a look at how Google and Microsoft are focusing efforts on the health care industry and how to improve the traditional health care system by utilizing technology to allow patients greater access and control over their personal health information. Both companies are still in the planning phase and trying to determine what will work and what patients might want, use and need.

The entry of these two tech giants along with a slew of other health-technology companies are likely to cause disruption in the health marketplace traditionally controlled by historic models (physicians, hospitals, insurers, etc.) Whether there will be enough momentum to bring change and whether patients are willing to trust these new models is the question that has yet to be answered.

Interestingly, the article mentions a little more about what Google Health might look like. The Google Health prototype focuses on the health consumer:

The welcome page reads, “At Google, we feel patients should be in charge of their health information, and they should be able to grant their health care providers, family members, or whomever they choose, access to this information. Google Health was developed to meet this need.”

A presentation of screen images from the prototype — which two people who received it showed to a reporter — then has 17 other Web pages including a “health profile” for medications, conditions and allergies; a personalized “health guide” for suggested treatments, drug interactions and diet and exercise regimens; pages for receiving reminder messages to get prescription refills or visit a doctor; and directories of nearby doctors.

The article also mentions West Virginia native, David Brailer, former Bush administration National Coordinator for Healthcare Information Technology, who now heads up Health Evolution Partners. Note: Yesterday Matthew Holt posted at The Health Care Blog that Dr. Brailer will be joining the list of speakers at the Health 2.0 Conference to be held next month. Mr. Bosworth of Google will also be on the consumer aggregator panel being moderated by another top health care thinker, Jane Sarasohn-Kahn.

UPDATE: Interested in learning more about Google Health? Check out this post by Jeff O'Conner at the Health Care Information System Blog with links to the Clinical Cases and Images Blog with links to screen shots of the prototype.

Also check out what Doc Searls perspective at ProjectVRM Blog.

UPDATE2: Good insightful follow up post, Here comes Google and Microsoft, from Tony over at Hospital Impact. I especially agree with the last two paragraphs:

Of course, all the same old data issues have to be worked out - privacy, malpractice, storage, interoperability, and security . . . Plus, there's a little problem with funding and business model (hopefully we will never see a Google banner ad within our medical record!) . . . Make no mistake about it- this is not a continuation of the Google vs. Microsoft War that's been going on for years. This is Google or [insert brave company name here] against the most powerful force of them all: the healthcare industry status quo.

Almost Heaven . . . eBay

Almost Heaven West Virginia eBay.

Interesting survey results from Scarborough Research showing that Charleston, West Virginia is the #1 U.S. market for eBay visitors. 41% of adults in Charleston who accessed the internet in the last month are eBay visitors.

Skip Lineberg at Maple Creative has some additional thought on what this means for Charleston business? Jeff James at CreateWV provide more commentary in the post, "Is eBay the Killer App to Drive WV Broadband Adoption?"

YouTube Debate: WV's Mike Sharley's YouTube Video on Health Care

Great to see my law school classmate, Mike Sharley, asking the Democratic candidates at the YouTube debate about health care. Thanks to Larry Messina at Lincoln Walks At Midnight for the tip on the video. You can also get Hoppy's take.

Mike is an amazing individual with great creativity.

Injunction Halts WVHCA Cardiac Demonstration Project

Today's State Journal reports on Kanawha County Circuit Judge Stucky's granting of a preliminary injunction halting the West Virginia Health Care Authority from moving forward with a demonstration program that would enable three West Virginia hospitals to perform therapeutic angioplasties without having open heart backup services. The injunction was filed in seperate actions by St. Mary's Medical Center and St. Joseph's Hospital.

Details on the demonstration pilot project can be found under Section VII of the State Health Plan Cardiac Catheterization Standards.

MD Net Guide Article: Are Physician Blogs in a Legal and Ethical Twilight Zone?

Last month I had the opportunity to collaborate with Fard Johnmar of Envision Solutions on an article for MD Net Guide, "Social Media Notebook: Are Physician Blogs in a Legal and Ethical Twilight Zone?" The article looks at the recent incident involving Dr. Lindeman, who blogged under the pseudonym "Flea," and the risks associated with physician blogging.

I shared some legal tips that physician bloggers should consider when blogging, including:

• Anonymous blogging does not guarantee your privacy
• Consider informing your employer about your blog
• Follow your HIPAA training
• Post a legal disclaimer
• Be cautious about giving advice to patients

Check out the current issue of MD Net Guide to read the complete article. Also, the complete article, "Social Media Notebook: Are Physician Blogs in a Legal and Ethical Twilight Zone?" can be accessed via the web (registration required).

West Virginia Lawyers Early Blog-dopters . . .

Great to see two West Virginia law blogs on the list of first lawyer blogs. Congrats to Rory Perry and Brian Peterson for being on the cutting edge of law and technology. I have been a reader of both blogs over the years and remember coming across when I started blogging in July 2004.

Wonder whether any other state has two lawyers on the list?

Inspired by Rick Lee . . . Bugs!

I haven't been posting a lot because I've been very busy at work. However, I was inspired by Rick Lee tonight. In tribute to Rick's "Friday the 13th bug post" I thought I better post what's been bugging me. After returning from the grocery store (Monday night is grocery night at the Coffield House) I found this guy hanging out in our kitchen.

Not sure what he is (maybe someone out there can offer assistance). I have saved him for the night in the kids bug catcher so they can check him out in the morning.

WVHCA Issues Proposed CT Standards

Yesterday, July 11, the West Virginia Health Care Authority issued proposed CON Standards covering computerized tomography (CT) services in West Virginia.

The proposed Computed Tomography Services CON Standards provide a new need methodology process for new, additional or replacement CT scanning services by hospital and non-hospital applicants. The proposed standards set forth a weighted need methodology threshold of 3,000 scans per year and provide an exemption for CT scanners costing less that $300,000.

Although I've not read anything official from the Authority, today's Charleston Gazette article indicates that the Authority will accept comments on the proposed standards during the next 30 days and the Authority's board will vote on the regulations at its September meeting. The new standards will then be sent to Governor Manchin for final approval. UPDATE: The Authority has now posted information about submitting comments. The deadline for submitting comments is August 10, 2007.

The Charleston Gazette reports on the new standards today in its article, "Doctors' offices to be allowed to buy CT scanners". Additional background information on the development of the CT Standards can be found on the Authority's CT Services Workgroup Meeting site. For comparison, the old 1992 CT Standards are available.

UPDATE 8/22/07: It appears that the Authority has extended the deadline for submitting comments until August 31, 2007 based upon the Notice of Public Comment listed on the Authority's website. Also the Authority has uploaded the comments submitted on the proposed CT Standards.

Disruptive Change Possible As Google and Microsoft Establish A Health Care Presence

Interesting article from today's iHealthBeat about Google and Microsoft's growing interest in the health care industry.

Check out the article, "Microsoft, Google Could Prompt Disruptive Change".

WV Pharmacies Are Not Health Care Providers

The West Virginia Supreme Court of Appeals ruled in a June 28 decision (Phillips v. Larry's Drive-In Pharmacy, Inc. No. 33194; Maynard, concurring opinion) that pharmacies do not enjoy the benefits of the 1986 amendments to the Medical Professional Liability Act.

The decision reversed the Circuit Court decision finding that a pharmacy is a health care provider under the Act. The Supreme Court found that that "a pharmacy is not a “health care provider” as defined by the Legislature in W.Va. Code, 55-7B-2(c)."

Further, the Court found that "where there is any doubt about the meaning or intent of a statute in derogation of the common law, the statute is to be interpreted in the manner that makes the least rather than the most change in the common law." (Syllabus Point 5).

The WV Record reports on the decision here.

Why WV Is A Great Place To Live . . .

Why is West Virginia a great place to live and work? A great visual perspective from Rick Lee.