Thoughts On Your Comments
I’m sitting at my desk with a bowl of soup for lunch. I have 30 minutes and I’m thinking this might be a good time to respond to a few comments you have sent.
First, let me say, I do read the comments. I just have a hard time finding the time to respond and make new postings too. So, I tend to concentrate on new postings.
Comment on Guatemala Inauguration
On January 18, Science Teacher wrote:
Can you tell us whether the topic of H5N1 came up with any of the representatives of Latin American countries? Is there concern?
Response:
I was in Central America about a year ago working on Pandemic issues with the health Ministers. We have helped them build lab capacity and actually trained more than 200 people from Central America on pandemic related issues. It is not a top of mind issue there, and they still have a ways to go on public health infrastructure. Gratefully, we haven’t seen any H5N1 positive birds in that part of the world.
Comment on Guatemala Inauguration
On January 22, David A. Haley wrote:
Instead of talking about "safe" topics such as India or Guatemala, why don't you address meaningful topics to the American people, such as what efforts you and the Administration are undertaking to fix our healthcare system? Hello. Is anyone home in Washington?
Response:
David, you are right in saying my writings have been fairly heavily oriented to international work lately. I think if you look back in past postings I have written about many different topics that fit the criteria you lay out. The concentration of recent writings on international work reflects the fact that I traveled fairly heavily while Congress was out of session. International work is an important part of my work and it has a direct reflection on the health of the Americas. The safety of imports is an example. Most of my time in India was focused on products Americans consume.
I should also confess that I use this blog as a way to keep track of what I learn on these trips as a journal of sorts.
I encourage you to keep reading as there will be lots of meaty issues to discuss.
Comment on Day 5 in India
On January 17m Robins Tomar wrote:
It would be great if you could write one more post about your overall experience, changes in feelings before and after your visit and some recommendations from your experience.
This is just a request if you get time from your busy schedule. Anyway I will be following your blog to know your opinions about what is happening around us.
Response:
I would say one of the most of the most important changes in my feelings were the kind of things that come when one actually sees a place rather than reflecting what you have heard or read.
Here are just a couple of examples:
- It is hard to adequately explain the challenges of population as large as India’s and how it impacts every public policy issue.
- I’m attracted to the people of India. I have lots of friends in the U.S. of Indian heritage and seeing India created a new context for our relationship.
In Utah there is a community of people with roots in India. They have become prominent in academic and financial circles. As governor, I was often invited to attend their celebrations and events. I always admired the way they worked to preserve their connection to an ancestral home even though many of them have become major successes in the U.S. Now that I have seen that home, it is easier for me to understand their view of America and India. - I found particularly helpful the understanding I gained of the small farmers in India and their political influence. I wrote some about this in one of my postings.
- The number and size of the drug and vaccine manufacturing facilities in India requiring FDA attention was an important actualization.
- The intellectual connection between the U.S. and India came as a pleasant surprise. I knew it existed but didn’t have a sense of scale.
I could go on and on, but this will give you a small sense of what the trip did for me.
Comment on Electronic Medical Records and the Medicare Sustainable Growth Rate
On December 3, Chris Farley wrote:
The US government/we the people already own an excellent EHR - the VA's VistA system. It is fast, simple to use, incredibly stable and a large portion of the work needed to make it viable in private practice is already done. Two organizations have taken it, "de-veteranized" it and gotten it CCHIT certified. With a small fraction of that cost, the system could be fully upgraded and modified to meet all of the needs of the commercial market-place and fully implement the quality measures and disease registries necessary to adopt pay for performance and improve the quality and lower the cost of healthcare
Response:
I am a big admirer of VISTA and the Veterans Administration. In fact, I borrowed the National Coordinator of HIT from the VA, Dr. Rob Kolodner. The problem comes in creating compatibility between other systems and the VA because most patients, even in the VA system, deal with multiple providers outside their system. We need to achieve interoperability. As you point out, there are some providers who are using the VA system as a foundation to develop smaller systems and we welcome that. This answer is short but in the press of time, I’ll leave it at that.
Comment on Electronic Medical Records and the Medicare Sustainable Growth Rate
On December 3, Chris Farley wrote:
It is very easy for the Sec of HHS to say that Electronic records are the answer to rising Medicare costs. It is very short-sighted to ignore the reality that the numbers of the Medicare-eligible are increasing every month. Besides, with increased litigiousness of society, has the HHS conducted an objective study of what percentage of procedures physicians carry out are just to protect themselves against frivolous law suits?
Response:
There are a number of studies that document the practice of defensive medicine. I would support reforms that would minimize the practice or perceived need. Many believe that the development of best practice quality measures will provide some protection.
Comment on Electronic Medical Records and the Medicare Sustainable Growth Rate
On December 3, Chris Farley wrote:
While agreeing that the current formula is an utter failure, I would like to point out that Physicians are now working at 2005 reimbursement levels (far from keeping pace with inflation). The moral of this horror story is that if professionals are paid their legitimate dues, they will not abuse the system. It is useful to remember that neither the gas nor electricity prices; employee salaries nor office rent; neither liability premiums nor cost of EMRs have stayed at 2005 levels - unlike Medicare payments under this convoluted SGR formula. I have yet to see any effort by Medicare or any other payee to actually interact with practices that have had extensive experience with EMRs to identify real world solutions to real world problems. Until that happens, it will be unreasonable for Mr. Leavitt to expect physician practices to voluntarily adopt Electronic records. So if HHS would like to push this idea, let there be a level playing field and objectivity in assessment of its impact.
Response:
I stand by my belief that the system doesn’t work well. You would be amazed at the amount of work Medicare does to estimate what things cost for doctors and therefore what the reimbursements should be. The truth is, command and control regulator systems rarely get it right. A well informed marketplace where consumers have information on quality and price will both make the relationship between doctor cost and charges far fairer.
In a previous entry, I talked about walking through a grocery warehouse with 50,000 items and asked the manager what would happen if the government started setting prices on every item. His answer was right, in my view: “fewer products, higher cost, and continual arguments.” I told him, he had just described Medicare reimbursement.
Well, the soup is gone and my time is up so I’ll conclude and post.