Kansas Conservatives Preemptive Strike

Coming out of the national news today, the heartland has seen enough. They are taking their power and running with it to a level where they know it will stay. That's the state of Kansas.

For those interested in understanding the political history - maybe strife is a better word - "What's the Matter with Kansas" details the political climate of the state through the years. If there were a place for conservatives to take their stand against Harry Reid and Nancy Pelosi, they seem to have picked their hill to die on (no, not Capitol Hill).

Staying largely apolitical here, the fact of the matter is that the right of Washington have worn out the ears of their constituents, largely because of the complexity of the issue. Over the last couple of months, the climate throughout the country that was once spitting rage has cooled, and once again turned to attention grabbing waste (i.e. Balloon boy).

Kudos, therefore, to Peggy Mast, R- Emporia, and Mary Pilcher Cook, R-Shawnee, for drafting a "freedom isn't free" amendment that, according the Witchita Eagle, calls to:

"...nullify any law passed by the federal government that would require individuals to buy health care or force employers to provide it.

"The proposed amendment also would guarantee that health care providers could continue to receive direct payment from patients without being liable for fines or penalties."

Interestingly enough, the "individual mandate" was adopted into the bill largely based on the model created in Massachusetts by Mitt Romney back in 2005 initially brought on to force people to pay their health care bills. This largely was seen as unsuccessful, and simply just was seen as a way of forcing people to have a - any - health insurance plan, or lose an exemption on their state income tax. This article, although somewhat biased, goes into more detail.

So what happens when Kansas gets more attention as a result of this state initiative? Probably another, smaller, tea-party rally. Until then, look forward to watching Reid and Lieberman duke it out.

WalMart Promotes itself to Health Service Authority

The Walton's have a way of surprising even themselves sometimes. From their move into small towns, to their takeover of consumer spending in America's backyard, to their documented transition to foreign marketplaces, WalMart continues to push the envelop on what is capitalistically possible. Now, urged by the sweet incentives the Obama administration has placed within the American Economic Recovery & Reinvestment Act, WalMart has officially entered the health record business. And by business, I mean business opportunity.

With today's announcement, WalMart believes there is an opportunity to make money by contracting out healthcare software while maintaining ownership of personal electronic health records (EHRs).

But what are we really talking about here? WalMart purchased the rights to offer up the use of a health care software much like a health care service authority would. The only difference is that WalMart doesn't have experience handling medical records, it's security, HIPAA regulations, health care implementations, or health care vendor relations. Other than that, no problem.

I don't see success happening with this any time soon. Sure, they will win contracts, but eClinicalWorks, although a great product, has a marginal implementation staff, and their training is geared towards software analysts, not providers. Is the program ready to use out of the box? No. So unless WalMart plans on contracting a real large experienced consulting effort, there's nothing driving this endeavor. Well, nothing but capitalism anyway.

HIT in the American Economic Recovery and Reinvestment Plan

Recently John Halamka outlined the potential impacts of several legislative acts that will change the face of national health care standards and information access. The House Ways and Means Committee completed a bill as part of the American Economic Recovery and Reinvestment Plan. Additionally, a bill completed by the House Appropriations Committee outlines several additional programs of the Ways and Means Committee bill.

Here some highlights of both of these bills:

-Outline of the Office of the National Coordinator (ONC). This position's ultimate responsibility, appointed by the head of the HHS, is to oversee and approve guidelines in the development of a national health information technology infrastructure. The conditions of this infrastructure is that patient's health information is "secure and protected", "improves health care quality", "reduces medical errors", "reduces health care costs", "improves the coordination of care among hospitals", and to satisfy the capitalist perspective, "promotes a more effective marketplace, greater competition, greater systems analysis, increased consumer choice and improved outcomes in health care services".

-Establishes the HIT Policy Committee and HIT Standards Committee with the ONC as chair.

-Notes that the National Coordinator in consultation with the Secretary of the HHS can opt out of the national health IT infrastructure if the needs are satisfied by the free market. Look for follow up on this topic.

-Establishes centers to conduct health care information technology research, overseen by the National Institute of Standards and Technology and the National Science Foundation. It will be interesting to see the means of data acquisition from the marketplace for this research.

-It outlines $20 billion in incentives to support HIT through Medicare and Medicaid funding and reimbersement. Medicare reimbursement incentives to eligible professionals and hospitals that demonstrate a level of use of a certified EHR product. It outlines Medicaid reimbursement incentives to eligible Medicaid providers that demonstrate a level of use of a certified EHR, as determined by CCHIT.

Halamka accutely identifies the needs to break down this implementation of the infrastructure to the state level, noting interoperability and implementation standards to be the key obstacles to success. Hopefully the implementation standards and policy makers recognize and push for project team funding in partnership with each state's medical association HIT branch.

So who will be the first National Coordinator?