CMS last week announced Google, HealthTrio, NoMoreClipboard and PassportMD will populate PHRs with Medicare claims data in a pilot program in Arizona and Utah.

Medicare recipients in these states will have claims data automatically added to their PHRs as part of the pilot. Of course, claims data is not the way to compare care. We need this to be done with clinical data.

As many as 750,000 Americans went “offshore” for health care last year according to the Deloitte Center for Health Solutions. By 2010, that number could be closer to 6 million. Nearly 40 percent of survey respondents said they would travel outside the country for medical treatment, if the quality was comparable and the cost was cut in half.  

And for those of you who think it’s just plastic surgery bargain hunters engaging in medical tourism, think again. Increasingly, U.S. patients are leaving the country for treatment for cancer, cardiovascular disease and other serious illness. A CABG at a top rate facility in India can cost as little as $1350. Labor and facility costs are much cheaper offshore -- where the physicians providing care are sometimes commuting from the US.

 ***Image from Flickr (Scott Christian)***

Stephen Friend, M.D., of Merck has proposed that pharmaceutical companies create a massive, publicly accessible database including every cancer drug on the market, as well as patients (anonymous, of course) taking the drug, and results and side effects they have noted. Dr. Friend is frustrated by cancer drugs that are relatively ineffective but cause unwelcome -- and sometimes severe -- side effects.

He has launched a pilot of the database at H. Lee Moffitt Cancer Center in Tampa, Fla., where more than 5,000 patients already have submitted genetic material, tumor samples and are being followed on their medications. Dr. Friend believes this type of data collection could yield key evidence for developing pharmaceuticals that really work for cancer -- especially by allowing genetic personalization of care to reduce harmful effects and improve survival.

We could do the same in CV medicine -- it will happen most effectively when a majority of our members participate in the IC³ Quality Improvement program. We would have most of the CV data when that occurs. What a world of good we could do for patient care when having both inpatient and outpatient NCDR and IC³ data means we can do clinical data searches on almost any issue; and we can give real time feedback to members about adherence to guidelines, outcomes, and value. It’s not science fiction for us. But we need to get the IC³ challenge moving.

A lot of hard hitting press about imaging costs manifested last week. A new Health Affairs study finds that imaging is contributing to dramatically higher annual costs to Medicare. The authors of the study, however, say it’s hard to address the “value” of imaging because of intangible benefits like ruling out disease. But their spin was about higher costs. They reported that the number of MRI procedures per 1,000 Medicare beneficiaries more than tripled from 50 in 1995 to 173 in 2005, the report found. The number of CT scans more than doubled in that period to 547. Of course morbidity and mortality went down during that same period, but no mention of that.

Meanwhile, MedPAC is considering recommending a change to physician reimbursement for imaging services out of their concern that the current structure offers an incentive to order unnecessary procedures. Commissioners at the November meeting discussed changing the equipment use rate for MRI and CT machines to either 75 percent or 90 percent of current rates.

The financial crisis is already cost-shifting to health care. To conserve cash, General Motors will cut lifetime health care for previously-salaried retirees at the end of this year (union contracts preclude cutting health benefits for former factory workers). I’m sure many of you saw this announced. But more is coming from other automakers. The company estimates that the move, along with cuts in staff, will save about $1.5 billion a year, but GM retirees are none too happy about the change. Of course GM could tank completely in the next 6 months.

This is just more evidence of how deeply intertwined the current economic crisis and the health care crisis are. Addressing the economy means finding a viable way to help employers and employees with the skyrocketing costs of health care. This will only fuel health system reform.

***Image from Wikipedia Commons***

No surprise here, but all the major unions are encouraging Sen. Ted Kennedy (D-Mass.) and his staff to structure his health care reform legislation around a single payer model, similar to H.R. 676. In a recent letter to Sen. Kennedy, the All Unions Committee for Single Payer Healthcare argued against multiple payers, saying

Any plan that keeps the profit-making insurance companies in the mix will add layers of bureaucracy, will not be able to control costs, and will fail in the noble effort to bring good care to all.

Kennedy will have his plan ready after the first of the year sometime. But it was rumored that Senate Finance Chair Baucus was working with him. Apparently not so. Baucus says Kennedy didn’t work on his plan, but has read it and ‘likes it.’ Time will tell there -- and whether the unions are having any influence on Mr. Kennedy.

But, Sen. Baucus released what he calls his Call to Action—Health Reform 2009 report independently. His is based on a mainly employer-based concept, where employees or employers can opt, with consequences. He demands universal coverage be the goal (Obama has not gone there as of yet).

ACC has a detailed summary of Baucus’ strategy with annotations according to our policy views. Baucus did not propose this as a bill. The bill or bills will come later after the first of the year. But here are the essentials of his 89-page proposal from my read: More...

A recent survey by Modern Healthcare and the Commonwealth Fund shows more than two-thirds of health care leaders believe fee-for-service payment is a fundamental flaw in our health system.

Respondents supported bundling payments for an episode of care, which they believe will support more effective, high-quality care -- rather than high-quantity care.

Payment reform is coming, and our members aren’t ready for it. This needs to be a huge focus of the College NOW. It could be an opportunity or a nightmare.

There are clearly a lot of folks who are still adjusting to the fact that Senator Obama is our next President. Two-thirds of the country -- a much higher percentage of people than voted for him -- say they are optimistic. Of course, that means one third is worried. But, so far the man is acting very Presidential, particularly in laying low, staying out of D.C. and the limelight, and allowing George Bush to finish his term. That shows some class -- and wisdom. For ACC, and given that we don’t know yet who the HHS appointment will be -- or even who will be leaders of the health transition team -- we’re mainly watching. There have no new reliable hints to report in these regards as yet.

We’re hoping for bipartisan positioning, and for appointees in HHS and CMS who can bring all parties together. But, some interesting things have already been noted by the election pundits. Most of the Dems elected to Congress are of the moderate Blue Dog breed, many of whom, for example, are opposed to abortion. Only bipartisan leadership will overcome gridlock on many issues.

While there is still the reality of racism in this country (and certainly much more so in the world at large), this election could hopefully put a lot of those negative attitudes in retreat. Further, during the campaign there was some attempt to negatively paint Obama as an intellectual -- as contrasted to a Joe Six-Pack regular guy. John Kennedy may have been the last powerful Dem considered an ‘intellectual,’ and William F. Buckley Jr. was often cited as the intellectual influence on the Republican side. Now that Obama’s actually the President and the election rhetoric is over, hopefully more folks (Dem and Moderate) are thinking it may not be such a bad thing to have a smart, analytical mind in the Oval Office, and a President who is not threatened in surrounding himself with intelligent people to challenge him as Cabinet heads.

I have confirmed that the transition team is seriously considering both Drs. Nissen and Califf as possible FDA appointees (good news for cardiology); and here’s a new and positive additional rumor to consider also:

Governor Tim Kaine of Virginia has nominated ACC Past President and U of VA Provost Tim Garson to be Surgeon General. We plan to get behind this nomination as best we can. That prospect would be terrific for ACC and for the country. Don’t yet know what other names may be floated there. More later…..

"Saving time, saves lives" – that's been the motto for the ACC's door-to-balloon (D2B) campaign. Since the launch of the "D2B: An Alliance for Quality" at AHA in 2006, more than 1,000 hospitals in the U.S. and abroad have signed up to reduce their D2B times to the guideline-recommended 90 minutes or less.

During my time at AHA there has been lots of talk about D2B and the next steps – and why shouldn’t there be? The D2B campaign has helped spark change in the practice habits of hospitals around the world and is continuing to push hospitals to make evidence-based improvements in the care they provide. These changes have had a measurable impact on patient outcomes, including the most important patient outcome of all: mortality.

The ACC is keeping up its efforts to encourage participation in this initiative; in fact, there was significant interest from our cardiovascular colleagues in China at last month’s Great Wall International Congress of Cardiology. We’re keeping up the good work! So is the AHA – they have a similar program called "Mission: Lifeline" that tackles reducing door-to-reperfusion times.

As I head back to Washington, D.C., where talk of reforming the health care system has reached a loud crescendo, it’s initiatives like D2B and events like AHA and ACC.09 that we need to promote as tools for reform. All are keys to bridging the gaps between science and practice and providing tools and strategies to improve quality. Congratulations to everyone who helped make AHA happen. I’m looking forward to the same success in just a couple of months at ACC.09!

Workforce issues are another big topic at AHA – and a big topic in the overall health care reform debate as well. Yesterday, I attended a meeting of the Women in Cardiology Council. This Council works on workforce issues specific to female cardiologists and encourages women in medical school to enter the field of cardiology by providing mentors. Despite the growth in the number of female medical school graduates, there has been little growth in the number of women entering cardiology. Given the problems in our health care system with disparities in care, this is a significant problem, especially as growing numbers of female heart disease patients request female physicians!

Today, I met with members of the Cardiology Training & Workforce Committee. We discussed how to encourage more medical students to enter cardiology. One suggestion was to reduce the length of training for fellows – this could make specializing in cardiology a less daunting task, but this needs to be balanced with making sure that fellows receive enough training to provide the highest quality of care. Concerns among members about the supply of cardiovascular specialists are growing, given the large number of practitioners who are on the verge of retirement. Something like 43% of general cardiologists are over the age of 55! Combine that with an aging population and you have a recipe for disaster.