WV Environmental Law

A welcome to West Virginia's newest law blogger, Dave Yaussey, who is blogging at the WV Environmental Law. Dave is a partner at Robinson & McElwee in their Charleston office.

I use to practice law with Dave and consider him to be one of the go to environmental lawyers in West Virginia. During a conversation a few months ago talked to him about blogging and suggested that he start one on environmental law. He took up the challenge and is off and running. Congrats Dave!

California HealthCare Foundation: Social Media's Impact on Health Care

The California HealthCare Foundation has issued a new report, The Wisdom of Patients" Health Care Meets Online Social Media, authored by Jane Sarasohn-Kahn, a health economist, management consultant and fellow health care blogger at Health Populi.

The report covers a lot of territory and provides a great overview of the quickly evolving and developing health care social media and health 2.0 movement. The report highlights how health care consumers are becoming empowered by social media and the overall impact the live web is having on patients, providers, insurers, etc.

Online health care is moving from one based on "health information retrieval" to patients and providers generating and sharing content online. This growing online collaboration is leading to unique approaches to care and a larger value proposition of harnessing the collective wisdom for other purposes including -- coordination of care, clinical insight, higher quality, prevention, etc. In the end, this may even lead to more cost efficient care.

A special thanks to Jane for interviewing me and acknowledging me in the report for my insight on some of the health care legal implications .

To borrow a quote from Secretary Leavitt courtesy of Fred Fortin who I have been following as he micro-blog via Twitter at the World Health Care Conference, "pong and Wii. We are just leaving the pong era in health care . . . "

For more on the new report check out CHCF's Press Release and a summary of the report (download full report).

Dr. Val Emotes Her Way Through Grand Rounds 4.31

Val Jones, M.D. at Dr. Val and The Voice of Reason does a great job hosting this week's edition of Grand Rounds, titled: "How Do You Feel About That?"

Great job and thanks for adding one of my posts. Don't miss the photo links to the various emotion categories (click on the category headings). Reminds me of my Flickr linked Grand Rounds 3.5: A Visual Tour.

Happy Earth Day!

Happy Earth Day courtesy of Google. Take a few minutes and check out the environmental features of Google Earth from the Google Earth Blog.

For my West Virginia readers (and those who may consider a get away to West Virginia) check out this earth day idea by fellow Charleston blogger, Rebecca Burch, who highlights the new project called Picture West Virginia . . the way West Virginians picture it. Go here for more info on how the PWV collaborative blog works and how you can participate. The current topic is "my town".

Consumers' Checkbook v. HHS Update

The WSJ Health Blog, "Feds Fight to Keep Doctor Data Secret," has the latest on the Consumers' Checkbook v. HHS matter involving whether or not Medicare physicians claims data should be made publicly available. Consumers' Checkbook, a nonprofit consumer information and service resource, wants to use the data to rate physicians and health care services.

Last week the DOJ filed its appeal and HHS released this statement regarding appeal of Consumers' Checkbook Decision explaining the basis for opposing (and supporting) release of the data. The press release states:

HHS is appealing this decision because of two conflicting court opinions that control HHS’ release of data. Release of certain Medicare claims data is currently governed, in part, under an existing order issued by a federal court in Florida in 1979. That order, which is still in effect, prohibits Medicare from releasing physician reimbursement data in a manner that would enable the user of that data to identify individual physicians. The court order states that this information is protected by the Privacy Act of 1974. The data sought by Consumers Checkbook, when combined with other publicly-available data on Medicare fees, could lead to the disclosure of annual Medicare reimbursement amounts for individual physicians. Release of the data would, therefore, result in a violation of the existing Florida court order. On the other hand, HHS faces the decision rendered last year by the District of Columbia court ordering the release of the data. HHS argues in its appeal that the recent decision is based on an erroneous application of the Florida court order and of the Freedom of Information Act’s exemption that protects privacy. The Department seeks resolution of this conflict from the Court of Appeals.

Beyond the legal issues that must be resolved, HHS recognizes and shares the goals of Consumers Checkbook. Like Consumers Checkbook, HHS seeks to support consumers and providers with quality performance and cost information for a variety of providers and plans. For many years, HHS has worked closely with providers and other stakeholders in developing and reporting quality information, including the use of national consensus-based quality performance measures. While Consumers Checkbook seeks to post the number of times a provider has performed a specific service, the quality measures used by HHS generate more valid, specific, and comprehensive information on the quality of care delivered.

For background on the legal saga check out my prior post.

Blawg Review #156 Virtually Hosted at Virtually Blind

This week's edition of Blawg Review is hosted by Benjamin Duranske at Virtually Blind.

Don't miss this edition if you are intrigued by (or just want to better understand) what is happening in the legal world (including the virtual legal world).

National Healthcare Decisions Day (April 16)

Today (April 16, 2008) is “National Healthcare Decisions Day”, a collaborative effort of national, state and community organizations committed to ensuring that all adults with decision-making capacity in the United States have the information and opportunity to properly communicate and document their healthcare decisions.

My law partner, Sam Fox, who serves on the West Virginia State Bar's Law & Medicine Committee sent out an email a few weeks ago asking lawyers in West Virginia to participate in promoting this important initiative. To do my part I thought I would blog some information.

Frist, check out the resources page on the NHDD website for more information on advanced directives and advanced care planning.

Second, for more information on West Virginia advanced directives go to the WV State Bar's resource page and the West Virginia Center for End of Life Care which includes a variety of downloadable forms and information.

Third, today there are a number of businesses and organizations around the state who will be offering assistance in completing advanced directives. Check here for a complete list of locations.

As always I would also recommend that you consult your attorney in the process.

After Tax Day Thought: Intuit CEO Returning To Speak In West Virginia

West Virginia claims its share of high profile thinkers leading and funding some of the most innovative companies and businesses in the world. Add to this list Brad Smith, President CEO of Intuit, Inc.

Last week I learned from Matt Ballard, President of the Charleston Area Alliance that Mr. Smith will be returning to West Virginia to serve as the keynote speaker for the Charleston Area Alliance's Annual Celebration on May 6 from 5:15pm to 8pm at the Clay Center.

Mr. Smith is a native of Kenova, West Virginia and graduated with a degree in business administration from Marshall University. According to his bio, Mr. Smith became Intuit's president and chief executive officer in January 2008, culminating a five-year rise through the company in which he successfully led each of its major businesses. Before being named CEO, Smith was senior vice president and general manager of Intuit's Small Business Division, including being responsible for the company's portfolio of QuickBooks, Quicken and Payroll products. Prior to this he ran the company's QuickBooks Group from May 2005 to May 2006.

I look forward to hearing Mr. Smith's keynote speech and hope to talk to him about Intuit's efforts to bring the Quicken approach to health care reimbursement/payment through its product, Quicken Health. Last year I attended the Health 2.0 conference and learn about Quicken Health from Mike Battaglia.

As a member of the board of the West Virginia Health Information Network I would like to brainstorm on how Quicken Health might be incorporated into West Virginia's efforts to provide better and more affordable health care for West Virginians.

The CAA Blog post on the upcoming event mentions that this ties in well with Governor Manchin's "Come Home to West Virginia" concept (listen to another native West Virginian's version). Recent story on the effort from the State Journal, Bringing Our Children Home.
Here is the except from the Governor's State of the State mentioning the concept:

However, we can’t continue down this path without help. As everyone knows, our best resource has always been our people – and not just those who are here today living and working in West Virginia, but those who were born or raised in West Virginia and have left the state because they felt they had no other choice in order to make a living. Unfortunately, we are all guilty of teaching an entire generation that they couldn’t find a good job in West Virginia, so don’t even bother trying. Well, that’s absolutely not true today, and now our challenge is to reverse these thoughts and show those who have left that this is the perfect time to come home.

Some of the most successful people in the country are native West Virginians – Sylvia
Matthews, chief operating officer of the Bill and Melinda Gates Foundation; Wes Bush, president of Northrop Grumman; Ralph Baxter of Orrick, Herrington & Sutcliffe who has come home to West Virginia to co‐chair our 21st Century Jobs Cabinet and, of course, as previously mentioned, John Chambers, CEO of Cisco Systems. And I know there are many, many more success stories out there, both large and small, that most of us aren’t even aware of – except for the proud mothers, fathers, brothers and sisters who deep‐down wish their loved ones were achieving success here in West Virginia.

Regardless of your field of expertise, we need you, and your intellectual capital, ingenuity and work ethic, now more than ever. We need those of you who have an entrepreneurial spirit, or those who have accomplished your goals and are looking for a place where you can teach others all that you have learned. You’ll recognize much of what you left behind, but you’ll also find a work force and a business community that have made tremendous advancements.

While your coming home will help us to make this an even better place to live and work, it will also be rewarding for you as well, because you’ll be able to give something back to this place that I know you’ve always carried with you in your heart and is such an important part of who you are.

So to get the word out, we are going to start a “Come Home to West Virginia” campaign this year through our Department of Commerce. This recruiting campaign will be aimed at bringing former West Virginia residents back home to either work in West Virginia’s growing industries or to expand in West Virginia the businesses they have started in other places.

These West Virginia born knowledge leaders bring a new direction that I hope West Virginia takes to transition itself into a state for the creative class to grow and thrive.

For more check out the blog posts at the CAA Blog and Skip Lineberg at Maple Creative.

Proposed Changes to the Hospital Inpatient Prospective Payment System Rule

CMS posted on its website yesterday (April 14, 2008) the Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 (CMS-1390-P).

The proposed rule includes changes to the Physician Self Referral law (Stark law) regulations and seeks comments on the Disclosure of Financial Relationship Report.

The description of the proposed rule reads:

Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Proposed Changes to Disclosure of Physician Ownership in Hospitals and Physician Self-Referral Rules; Proposed Collection of Information Regarding Financial Relationships Between Hospitals and Physicians

Practical Advice on the Death Spiral

The Death Spiral, courtesy of the WSJ Health Blog.

Great graphic which highlights advice from my dad, a retired physician in West Virginia, who always warns us of such risks. He says, "eat better, eat less, take small bites, drive defensively with two hands on the wheel, don't climb ladders and be careful with guns." Looking at the graph if we listened to this advice we would take care of most of the larger circles.

Is Prevention Cheaper than Treatment?

David Williams over at the Health Business Blog looks at this question and surprisingly answers it saying that studies show it's often cheaper to let people get sick. This perspective comes from a Washington Post article, In the Balance, Some Candidates Disagree, but Studies Show It's Often Cheaper to Let People Get Sick.

I have assumed (apparently wrongly) that creating a model system in the United States focused on prevention would help halt rising health care costs. Although I've not read all the links in David's post I still have to believe that focusing prevention efforts on chronic disease will have a positive benefits. I'm also wondering whether the study took into account the difficulty (and related costs) of getting people to change their habits which in turn results in prevention.

David makes some valid points in his post including his comment that "consumerism, quality and patient safety initiatives will bear fruit." Like David I'm not sure that prevention will solve the cost crisis but I still have to believe that teaching good health habits and preventative efforts especially early on in childhood before bad habits are formed will ultimately lead to cost savings for our health system.

If you are interested in where the presidential candidates stand on a variety of health care issues -- check out the Washington Posts PoliGraph covering topics on healthcare reform, uninsured, drug prices, prevention, technology and stem cell. Interesting graph.

The Value of Wiki Collaboration

A great graphic from Wikinomics of why wiki collaboration beats email collaboration. A picture says a 1,000 words.

For me the graphic also demonstrates where we may be headed with cloud computing.

Tip to Doug Cornelius' post "Wikis and Happiness" at KM Space.

Dartmouth Atlas Health Care Stats on End of Life Care Costs

The WSJ Health Blog posts (WSJ article, More Choices Drive Cost of Health Care) interesting statistics on end of life care costs according to the latest Dartmouth Atlas of Health Care edition (due out today).

The report shows:

. . . that the cost of individual medical services isn’t the big driver of Medicare spending, at least for chronically ill patients in their last two years. It’s the intensity of care, such as the number of specialist visits and days in the ICU. . .

According to the map graphic West Virginia comes in low in the "below $37,500" category showing the average Medicare Spending during the last two years of life for chronically ill patients.

As the costs of our health care system increase over the coming years we will likely see an increased focus on looking at the end of life care issue vs. costs of health care in those remaining years. These bring to the front a variety of medical, ethical and legal questions.

Virtual Medical Dangers of Web 2.0

Thought provoking post by Bertalan Mesko at ScienceRoll on one of the dangers of web 2.0. Bertalan is a Hungarian medical student who plans to become a clinical geneticist and specialize in personalized genomics.

Bertalan highlights a danger of virtual medicine and gives us a glimpse at what might be the reality of the future as real and artificial life start to merge and blend. His post raises practical implications regarding the potential liability of a health care professional offering artificial (but real) advice online. The post also highlights to potential of the virtual world for training.

I've not spent anytime understanding what happens in Second Life and have only a superficial view of what it is and how it works. For those who know even less - it is a 3-D virtual world entirely created by its residents. There is a vibrant virtual community (including health care and medicine) growing that most don't even know about.

Thoughts on HIPAA and Privacy: NYT Article on PatientsLikeMe

First, an apology to my regular blog visitors for the lack of posts over the last month. Busy, busy, busy at work and home. No time to blog. The last couple of days I have been experimenting a bit with micro blogging via Twitter as a result of a conversation with my firm's IT director and blogger.

Quick post to this interesting NYT article, Practicing Patients, about PatientsLikeMe. The article covers some ground on some of the questions that periodically swirl in my brain regarding HIPAA, privacy rights, who is (should be) the steward of medical information, pro/cons of patients (consumers) self treatment, etc.

I particularly found interesting Alan Westin's taxonomy of Americans' attitudes toward privacy. The article states:

In 1990, Alan Westin, a political scientist at Columbia University and an expert in privacy issues, offered a useful taxonomy of Americans’ attitudes toward privacy. On one end of the spectrum were what he called privacy fundamentalists — the 25 percent of Americans who feel that their privacy is paramount and that no one, not the government or corporations or their family, should have access to their personal information without explicit permission. At the other end of the spectrum were the privacy-unconcerned — about 15 percent of Americans — who paid no mind to privacy issues and didn’t figure they had anything to hide. In the middle were the vast majority, the 60 percent whom Westin called privacy pragmatists: those who felt that they could give a company they trusted some information — birth date, ZIP code, telephone number — for particular benefits.