Health IT: Slipping on Hill Agenda?

While both parties on Capitol Hill maintain a strong interest in passing a health care information technology bill, other legislative priorities and a lack of funding could delay or prevent action this year, congressional aides said Monday.
Reauthorization of the State Children’s Health Insurance Program (SCHIP), dealing with a scheduled 10 percent cut in Medicare payments to physicians, and oversight of the Medicare prescription drug benefit are among the health care issues that will likely dominate this year’s legislative agenda according to the aides, who asked not to be identified.
Speakers at a Capitol Hill forum sponsored by Erickson Retirement Communities said matters will be further complicated by differences in past House and Senate approaches to the legislation, such as disagreements over anti-kickback language and the time frame for implementation of new health care billing codes known as ICD-10. There also may be splits over whether to provide federal grants encouraging providers to use “health IT” and how to ensure the privacy of consumers’ data.
“I’m not sure how far we’re going to get moving towards health IT” this year, one aide said, citing time and money as major obstacles. Another aide added, “We remain optimistic Congress can move health IT legislation this year or next year.”
{The polls cited in this story show again that consumers remain very concerned about both security issues (data theft) and privacy issues (use of personal health information by employers and insurers without consent). ~ Dr. Deborah Peel, Patient Privacy Rights}

To Find a Doctor, Mine the Data

Now that millions of consumers are surfing the Web to research their own medical symptoms, many are taking the next step: comparison-shopping online for hospitals and doctors.
When Kirk Emerich, a bank executive in West Bend, Wis., needed knee surgery for a volleyball injury earlier this year, for example, he researched the local doctors and hospitals, using a Web site provided by his employer’s insurer, Humana. The comparative data included the number of patients that the hospitals treated annually and the complication rates after surgery.
“Both our hospitals were pretty good,” said Mr. Emerich, a senior vice president for West Bend Savings Bank. “But the doctor I ended up with had an edge: she was more focused on sports injuries.”
As their out-of-pocket health care expenses continue to grow – through rising medical costs, higher insurance premiums and heftier co-payments – many people are using consumer skills well honed by online research on everything from digital cameras to S.U.V.’s. And their employers and insurers, intent on getting the best value from their own health spending, are arming those consumers with increasingly detailed searchable databases.
The data come from medical records that insurers are pressing doctors and hospitals to provide, and in some cases from patient surveys.
“We believe American consumers should know as much about the medical care they receive as they do about the vehicles they purchase,” said Sharon Baldwin, a spokeswoman for General Motors, the nation’s largest private purchaser of health care. Next month, G.M. plans to brief its salaried employees about their health benefit options for 2006, and will provide online information to help them make choices.
So far, the various consumer databases, many available only to individuals enrolled in insurance plans, have some gaps.
“We’ve got terrific measurements information in some areas, but in other areas we don’t have good measurements at all,” said Dr. Carolyn Clancy, director of the federal Agency for Healthcare Research and Quality, which is working to standardize the way health care data are reported.
At this point, there is much more quality-of-care information available about hospitals than about individual doctors, except in nine states including Florida, Pennsylvania and Wisconsin that make statistics available on the numbers of procedures that surgeons perform.
And pricing information still tends to be scarce. But the databases can grow only more robust, now that the full weight of the health insurance industry is behind the trend and the federal government is beginning to wield its influence.
Anyone, insured or not, can now log on to the federal Department of Health and Human Services’ Web site called Hospital Compare (hospitalcompare.hhs.gov), which uses Medicare and Medicaid data to assess the track records of more than 4,000 hospitals around the country.
Want to know which hospitals in your city to go to for treating heart attacks or pneumonia? Log on to Hospital Compare, plug in the step-by-step particulars, and judge for yourself, based on criteria that include whether the hospitals provide appropriate medicines when patients are admitted and discharged.
The government also plans to begin reporting on complications after surgery and whether doctors and nurses make clear to patients how to take care of themselves after a hospital stay, said Dr. Mark B. McClellan, administrator of the federal Centers for Medicare and Medicaid.
Private health plans typically provide more comparative data than the federal Web site. Yesterday, Wellpoint, the nation’s largest commercial health insurer, announced that its 28 million members would be able to log on to an expanded list of health care information services. The service is to include software to help members compare their own potential costs under various health plans. Wellpoint began providing consumer information for comparing hospitals several years ago.
Vivian Johnson is a Wellpoint enrollee who works for the Banta Corporation, a national printing company. When she transferred to Lancaster, Pa., from Utah earlier this year, Ms. Johnson used a Wellpoint system to research doctors for herself and pediatricians for her 2-year-old daughter, Averie.
“I relied heavily on certain statistics,” Ms. Johnson said, like “how many patients the doctors treated, where they were located and in some cases feedback from consumers.”
Besides Wellpoint and Humana, most of the big insurance companies – including United Healthcare, Aetna and Cigna, as well as many state and regional Blue Cross and Blue Shield insurers – provide this type of information. One of the most recent to join the wave was Michigan Blue Cross and Blue Shield, which on Sept. 1 started offering online hospital and doctor comparisons to its 4.7 million members.
“The insurance carriers are all headed in this direction,” said Dale Whitney, corporate health and welfare manager for United Parcel Service, which offers plans from all the big national health insurers to its 328,000 employees across the country. “A lot of employers are trying to get people to say, ‘Yes, I have some responsibility to take care of my health.’ “
The raw material for the information on the Web systems is typically assembled from data that include medical payment claims, hospitals’ reports to Medicare and health care information from employers who belong to an alliance known as the Leapfrog Group.
Companies that collect and organize the information include Subimo, a privately held company that supplies data for Wellpoint and Michigan Blue Cross, among other insurers; HealthShare Technology, which was recently acquired by WebMD; and Health Grades, based in Golden, Colo.
In May, Wellpoint bought Lumenos, a data compiler. And last year, UnitedHealth Group bought Definity Health, a company that, like Lumenos, operates high-deductible health savings plans and provides comparative data for consumers.
The ability to compare costs is especially important for a growing number of employers seeking to interest their workers in high-deductible health savings plans that offer lower premiums at the onset but require plan members to assume more of the financial burden when they need care.
The Detroit auto companies, which spend billions of dollars annually on employee health benefits, are among the large employers considering making such plans an option. DaimlerChrysler said last week that it would offer a high-deductible plan along with online information about the quality and costs of certain doctors.
Specialists say that, so far, the sources of information are far from perfect. Data based on medical claims payments can be particularly sketchy and unreliable, said R. Heather Palmer, a professor of health policy and management at the Harvard School of Public Health. “The hope,” she said, “is that as we move toward electronic medical records, we will get data with more clinical detail.”
The data collecting companies make no claim of perfection. “In the absence of perfect information, we help equip people so they know what questions to ask to be smarter consumers of health care,” said Ann Mond Johnson, chief executive of Subimo, a five-year-old company based in Chicago.
Most specialists agree that improvements depend on achieving a standardized, computerized approach to collecting and assembling medical data at all levels, from big hospitals to small doctors’ offices – a long-range goal of the Bush administration.
Until information technology is more widely available, “it is extremely difficult to collect this information, and it is expensive,” said Charles N. Kahn III, president of the Federation of American Hospitals, a trade group of for-profit hospitals.
But others say that, technology questions aside, medical care providers need to be more forthcoming with information.
“For the last 15 years, the hospital industry has resisted public reporting,” said Dr. Mark D. Smith, president of the California Health Care Foundation, a nonprofit research organization. Doctors and hospitals are still reluctant, he said, “but they are increasingly comfortable with the inevitability and desirability of public reporting on performance.” He added, “It’s a huge improvement.”
The foundation has a Web site (calhospitals.org), which uses patient survey data to enable anyone to compare California hospitals within a county or metropolitan region on a wide range of performance criteria.
Margaret O’Kane, president of the National Committee for Quality Assurance, which certifies health plans, said the hospitals had a lot to answer for. “There are huge issues out there in the number of people being harmed by hospitals,” she said, referring to statistics indicating that tens of thousands of hospital patients die each year from avoidable medical errors.
Publishing more quality data can help change that. “No hospital wants to have data out there that makes them look like poor performers,” she said.
Mr. Kahn, of the hospitals federation, acknowledged that “consumer education is part of the future.” But, he added, “we are only at the beginning of knowing what information to collect to get a meaningful reflection of the quality of specific institutions.”
Even so, Mr. Emerich, who found his knee surgeon online, says the information already available is helpful. His operation turned out well. “I’m fully active, with no restrictions,” he said. But, he conceded, at age 42 it might be time to think about giving up volleyball.

Medicare Law Prompts a Rush for Lobbyists

The new Medicare law has touched off explosive growth in lobbying by the health care industry, whose spending on advocacy here far exceeds that of consumer groups and other industries like defense and banking.
Almost every week the federal government issues new rules or guidelines to carry out the 2003 law, which provides a drug benefit starting in January. To keep track of the new rules and to decipher their meaning is a full-time job for hundreds of lawyers and lobbyists, who regularly seek changes advantageous to their clients.
With hundreds of billions of dollars at stake, health care providers, insurers, drug makers and pharmacies are continually trying to influence rules for the drug benefit and other initiatives authorized by the law.
“You see a real surge in health care lobbying because that’s where the money is,” said Frederick H. Graefe, a lobbyist for hospitals and makers of medical equipment. “Twenty years ago the defense industry was dominant and had the most lobbyists, the big players. Now it’s health care.”
Last year alone, the health care industry spent $325 million – more than any other sector – in its efforts to influence Congress and federal agencies, according to Political Money Line, a nonpartisan group that studies reports filed with Congress by lobbyists and their clients.
Drug companies led the way. They reported spending $86.9 million on lobbying last year, followed by hospitals with $55 million and doctors with $35.4 million.
Lobbying Congress nowadays often means persuading lawmakers to make telephone calls to Bush administration officials on behalf of clients concerned about specific issues, like the Medicare payment for a drug or a medical device.
The pinpoint focus of much lobbying is illustrated by the case of Lexapro, an antidepressant made by Forest Laboratories. The Bush administration has said that Medicare drug plans must cover “substantially all” antidepressants, but not necessarily Lexapro, a drug widely prescribed for depression and anxiety among older adults. Claudia Schlosberg, a lawyer with Blank Rome who represents Forest Laboratories, has been pressing Medicare officials to reverse that decision and has obtained letters from several members of Congress supporting the company’s position in favor of covering Lexapro.
“Every health care interest has a voice on Capitol Hill,” said Elizabeth J. Fowler, a lawyer who recently left the Democratic staff of the Senate Finance Committee to join a consulting firm. “What you lose in the process is consumer and beneficiary voices. We heard a lot more from industry interests than from beneficiaries.”
Chris Jennings, who became a lobbyist after serving as health policy coordinator for President Bill Clinton, said: “The proliferation of health care lobbyists produces specialization. The broader good is often lost as people focus on next year’s Medicare reimbursement rate for a specific group of health care providers, or a regulation to be issued next month.”
The health care industry is subject to pervasive federal regulation, and the government sets prices for many goods and services provided to the elderly under Medicare. But the Bush administration and the Republican majority in Congress are receptive to advice from the industry, including private insurers who will deliver the drug benefit.
“The success of the new Medicare law depends on a robust partnership between government and the private sector,” said Stacey Hughes, a partner in the lobbying firm established by former Senator Don Nickles, Republican of Oklahoma.
Health policy experts and officials said the growth of health care lobbying reflected several trends:
¶Congress earmarks more and more money each year for specific hospitals, medical schools and health care projects. Health care providers and local officials have a better chance to obtain such largess if they retain lobbyists to plump for their projects on Capitol Hill.
¶Lobbying has become more substantive. To buttress their arguments, lobbyists need data, cost estimates and economic analyses of health policy proposals. They retain expert consultants to prepare such reports.
¶Lobbyists have adopted many techniques of political campaigns. They hire pollsters and buy advertising to sway public opinion and pressure Congress.
¶Many lobbyists have carved a niche for themselves by focusing on one party, one house of Congress, one Congressional committee or a handful of influential lawmakers.
Carol A. McDaid, a health care lobbyist at Capitol Decisions, a subsidiary of the Van Scoyoc Companies, said, “It’s become so sophisticated that, in preparation for a critical vote, a big health care or pharmaceutical company will hire a different firm to lobby each key member of an important committee, like the Ways and Means Committee.”
The Pharmaceutical Research and Manufacturers of America reported spending $15.5 million on lobbying last year, while two of its members, Pfizer and Bristol-Myers Squibb, spent $5.6 million apiece and Johnson & Johnson spent $4.5 million.
Other heavyweight lobbies included the American Medical Association, which spent $18.5 million last year, and America’s Health Insurance Plans, which spent $5.6 million, about the same amount as the Blue Cross and Blue Shield Association.
By contrast, AARP, the lobby for older Americans, spent $8 million. The American Cancer Society spent $2.6 million, the American Heart Association spent $1 million and Families USA, the liberal group that calls itself a voice for health care consumers, reported spending $40,000.
Alan B. Mertz, president of the American Clinical Laboratory Association, said the advocacy budget for his group had more than tripled, to $2.5 million this year from $750,000 in 2002. “We had to beef up our advocacy to deal with threats to our Medicare reimbursement,” Mr. Mertz said, noting that Medicare payments for laboratory tests had been frozen through 2008.
Lobbyists said it made sense for their clients to pour money into lobbying because so much money was at stake. Health care accounts for more than 15 percent of the nation’s economy, and private insurers often look to Medicare as a guide in deciding what services to cover and how much to pay.
Moreover, the federal role is growing. Medicare and Medicaid will account for 37 percent of all spending on prescription drugs next year, up from 20 percent this year, said Stephen Heffler, an economist at the federal Centers for Medicare and Medicaid Services.
The Bush administration and the Congressional Budget Office say Medicare will spend more than $1 trillion on prescription drugs in the next 10 years, with outlays topping $100 billion a year after 2009.
Two linguistic changes show how health care lobbyists have emerged as a potent force. Lobbyists and trade associations, once seen as special interests, are now called “stakeholders,” with a legitimate claim to be heard in the policy-making process.
“Expanding coverage” used to mean providing health insurance to people who had none. But lobbyists now use the term in a different sense. When they speak of “coverage expansions,” they mean that Medicare should cover, or pay for, new technology like PET scans, implantable defibrillators and drug-coated stents to treat clogged arteries.
Political campaign contributions are frequently coordinated with lobbying campaigns. Lobbyists often hold fund-raisers at the request of members of Congress, as allowed by campaign finance laws. They are expected to contribute money from their own pockets and to raise money from clients.
“You increase your influence and access by doing fund-raisers,” said James C. Pyles, a lawyer and lobbyist for psychoanalysts and home care agencies. “If you’re not on the donor list, you don’t have much access.”
Ms. McDaid, who lobbies for hospitals and ambulance companies, said: “In the old days, the requests for political giving went mainly to your clients’ political action committees. Now health care lobbyists have to tithe personally. The bigger your client base, the more pressure there is to give. It’s not unusual for a lobbyist at a big firm to give $25,000 to $50,000 in personal contributions to Congressional candidates in a two-year election cycle.”
The growing prominence of health care issues on the national agenda has created an unquenchable demand for lobbyists. New issues include bioterrorism, stem cells, health information technology, the privacy of medical records, television advertising of prescription drugs and the importing of drugs from Canada.
Republicans are in demand at lobbying firms and trade associations, but so are knowledgeable Democrats.
John E. McManus, who formed his own lobbying firm after working for Republican members of the House Ways and Means Committee, received a total of $620,000 last year from the American Medical Association, the Advanced Medical Technology Association, the Pharmaceutical Research and Manufacturers of America and several drug companies, including Merck and Genentech. Mr. McManus can help them navigate the new Medicare law because, as a Congressional aide, he helped write it.
On the other side of the political spectrum, David H. Nexon, a health policy adviser to Senator Edward M. Kennedy for more than two decades, stepped down in February to become senior executive vice president of the Advanced Medical Technology Association, the lobby for makers of medical devices like Medtronic and Guidant.
Charles M. Brain, director of legislative affairs for President Clinton, reported that he got $240,000 last year for representing the Pharmaceutical Research and Manufacturers of America. Stephen J. Ricchetti, deputy chief of staff in the Clinton White House, lobbies for Eli Lilly & Company, Novartis and Pfizer.
Richard J. Pollack, executive vice president of the American Hospital Association, said health lobbying had become more partisan.
“We hire Republicans to lobby Republican members of Congress and Democrats to work Democratic offices,” Mr. Pollack said.
The Generic Pharmaceutical Association has retained Mr. Jennings and Mark W. Isakowitz to lobby for legislation to increase the use of generic drugs. As a White House aide, Mr. Jennings helped devise the Clinton plan for universal health insurance. As a lobbyist at the National Federation of Independent Business, Mr. Isakowitz, a Republican, helped defeat the Clinton plan.
As the costs of Medicare and Medicaid soar, federal prosecutors and members of Congress are investigating fraud and abuse with new zeal. Many health care companies find they need more lawyers and lobbyists to cope.
In a recent advertisement recruiting lawyers for its Washington office, Sidley Austin Brown & Wood, one of the nation’s largest law firms, said its health care practice had “experienced tremendous growth.”