Health Provisions Slipped into Stimulus Package

Home Health Columnist / Guide · Feb 10, 2009

current bill language:

. american recovery and reinvestment act of 2009 (amendment in senate)[h.r.1.as2]

section:title viii--departments of labor, health and human services, and education, and related agencies department of labor

under office of the national coordinator for health information technology

(including transfer of funds)

for an additional amount for `office of the national coordinator for health information technology', $3,000,000,000, to carry out title xiii of this act which shall be available until expended: provided, that of this amount, the secretary of health and human services shall transfer $20,000,000 to the director of the national institute of standards and technology in the department of commerce for continued work on advancing health care information enterprise integration through activities such as technical standards analysis and establishment of conformance testing infrastructure so long as such activities are coordinated with the office of the national coordinator for health information technology: provided further, that funds available under this heading shall become available for obligation only upon submission of an annual operating plan by the secretary to the committees on appropriations of the house of representatives and the senate: provided further, that the secretary shall provide to the committees on appropriations of the house of representatives and the senate a report on the actual obligations, expenditures, and unobligated balances for each major set of activities not later than november 1, 2009 and every 6 months thereafter as long as funding under this heading is available for obligation or expenditure.

fyi, this position been in existance for 4yrs created by president bush:

the office of the national coordinator for health information technology (onc) provides counsel to the secretary of hhs and departmental leadership for the development and nationwide implementation of an interoperable health information technology infrastructure. use of this infrastructure will improve the quality, safety and efficiency of health care and the ability of consumers to manage their health information and health care.
http://www.hhs.gov/healthit/onc/mission/
in 2004, the president issued an executive order establishing the position of the national coordinator for health information technology within the office of the secretary of hhs. the primary purpose of this position is to aid the secretary of hhs in achieving the president’s goal for most americans to have access to an interoperable electronic medical record by 2014. http://www.hhs.gov/healthit/onc/background/

go to thomas (library of congress) , click latest daily digest to locate bills currently being voted on and latest admendment language

then email your congress person regaring your thoughts language tweek or desire to see passage/rejection...

they do listen to you and trust me omeone in the office is keeping scorecard on comments received.

seen if first hand on my trips to us senators office and meetings with state senator/reps in pa's harrisbug capital bldg.

contact info available: 2/4/09: nursing activism primer-- legislation, lobbying/ contacting elected officials

Home Health Columnist / Guide · Feb 10, 2009

Please go and READ the actualy language and healthcare legislation being proported along with stimulus spending.....

Just don't take one newspapers /websites interpretation of pending legislation.

For the political novice:

Most major bills in congress contain legislation on several seemingly unrelated areas ....don't think this is the only bill to do so.

allnurses Guide · Feb 10, 2009

current bill language:
. american recovery and reinvestment act of 2009 (amendment in senate)[h.r.1.as2]
section:title viii--departments of labor, health and human services, and education, and related agencies department of labor
under office of the national coordinator for health information technology
(including transfer of funds)
for an additional amount for `office of the national coordinator for health information technology', $3,000,000,000, to carry out title xiii of this act which shall be available until expended: provided, that of this amount, the secretary of health and human services shall transfer $20,000,000 to the director of the national institute of standards and technology in the department of commerce for continued work on advancing health care information enterprise integration through activities such as technical standards analysis and establishment of conformance testing infrastructure so long as such activities are coordinated with the office of the national coordinator for health information technology: provided further, that funds available under this heading shall become available for obligation only upon submission of an annual operating plan by the secretary to the committees on appropriations of the house of representatives and the senate: provided further, that the secretary shall provide to the committees on appropriations of the house of representatives and the senate a report on the actual obligations, expenditures, and unobligated balances for each major set of activities not later than november 1, 2009 and every 6 months thereafter as long as funding under this heading is available for obligation or expenditure.
fyi, this position been in existance for 4yrs created by president bush:
go to thomas (library of congress) , click latest daily digest to locate bills currently being voted on and latest admendment language
then email your congress person regaring your thoughts language tweek or desire to see passage/rejection...
they do listen to you and trust me omeone in the office is keeping scorecard on comments received.
seen if first hand on my trips to us senators office and meetings with state senator/reps in pa's harrisbug capital bldg.
contact info available: 2/4/09: nursing activism primer-- legislation, lobbying/ contacting elected officials

thank you katren!

clearly the original editorial opinion was an interpretation only.

i absolutely oppose any software that over rides the professional judgment of an rn or physician.

too many of the computerized charting systems we have now do just that.

i also don't think we need more than word processing to avoid difficult handwriting.

i've read that the va has an excellent computerized medical records system. that patients can go to any va and their records can be available.

then i've read that there are problems.

but the editorial opinion piece is over reacting, fear mongering.

that said i'm still not for this addition and hope it is not in the stimulus bill presented to the president.

bagladyrn, RN · Feb 10, 2009

Thanks Karen - I was going to look up the actual bill after reading this. I don't trust anyone else to do the "interpreting" as it's hard to find someone without an agenda.

HM2VikingRN, RN · Feb 10, 2009

1. there have been problems with cprs software but humans in the system do catch them as they have occurred and get the problems resolved. (overall va patients do get excellent care.)

critics will say that the vha is not significantly cheaper than other american health care, but that's misleading. in fact, the vha is also proving far better than the private sector at controlling costs. as longman explains, "veterans enrolled in [the vha] are, as a group, older, sicker, poorer, and more prone to mental illness, homelessness, and substance abuse than the population as a whole. half of all vha enrollees are over age 65. more than a third smoke. one in five veterans has diabetes, compared with one in 14 u.s. residents in general." yet the vha's spending per patient in 2004 was $540 less than the national average, and the average american is healthier and younger (the nation includes children; the vha doesn't).

at http://prospect.org/cs/articles?article=the_health_of_nations

2. evidence based reimbursement is hardly denying care:

problem is, studies show that individuals are pretty bad at distinguishing necessary care from unnecessary care, and so they tend to cut down on mundane-but-important things like hypertension medicine, which leads to far costlier complications. moreover, many health problems don't lend themselves to bargain shopping. it's a little tricky to try to negotiate prices from an ambulance gurney.
a wiser approach is to seek to separate cost-effective care from unproven treatments, and align the financial incentives to encourage the former and discourage the latter. the french have addressed this by creating what amounts to a tiered system for treatment reimbursement. as jonathan cohn explains in his new book, sick:
in order to prevent cost sharing from penalizing people with serious medical problems -- the way health savings accounts threaten to do -- the [french] government limits every individual's out-of-pocket expenses.
in addition, the government has identified thirty chronic conditions, such as diabetes and hypertension, for which there is usually no cost sharing, in order to make sure people don't skimp on preventive care that might head off future complications.
the french do the same for pharmaceuticals, which are grouped into one of three classes and reimbursed at 35 percent, 65 percent, or 100 percent of cost, depending on whether data show their use to be cost effective. it's a wise straddle of a tricky problem, and one that other nations would do well to emulate.

http://prospect.org/cs/articles?article=the_health_of_nations

Quark09 · Feb 10, 2009

I'm sure I'll get myself in trouble with my opinion, but it isn't always necessary to take the worst case scenario. This is just my opinion. (and yes, Angie, having just run headlong into the insurance company's brick wall, it doesn't sound much different to me)
We do sometimes carry out heroic measures on someone who's quality of life will not benefit from it. I remember a gentleman in ICU, his kidneys were shot, his liver was failing, he was on a respirator. He'd been in ICU a month, but his relatives were begging to keep him alive just a little longer...until the first of the month when his social security check would come in.
I don't ascribe to life at any and all costs. When I get to a certain state of decrepitude, ill health, or multiple organ failures, let me go. Cremate me and use me as fertilizer. I don't want to be a burden to my family, and I don't want to sit forgotten in some corner, unable to enjoy life, just marking time until my heart stops.

Amen to that! I think I read a joke on this site somewhere that said "you know you're a nurse when you vow to have DNR tattooed on your chest! :yeah:

Quark09 · Feb 10, 2009

all pt's deserve care. even if they are overweight, smoke, drink, w/e. its not up to me if their life is worth living. its up to them. if someone wants treatment, i can not judge weather or not they deserve it based on their lifestyle. the gov is now putting a dollar amount on something that has always been priceless. if someone i love is sick, i dont care about the costs. they dont care about me or my loved ones, i do. they wont put the time or money into saving ppl they dont think are worth saving. so sad.

The point I was trying to make earlier was that some (not all) people are not taking an active role in their health; they are expecting to be fixed while continuing to engage in detrimental behavior. Yes, your health is priceless to you, but to the entities who provide the care, they must put a value on it to be able to provide that care. Someone who is smoking and not trying to quit, who is sedentary and obese and eating unhealthy foods/amounts of foods is not placing much of a value on their own health; why should healthcare providers do so?

Quark09 · Feb 10, 2009

Again, I am not trying to say that people who make those choices should not receive care at all, I am saying that when it comes to allocating resources, priority should go to those who aren't purposely causing a great deal of their own health issues.

SoundofMusic · Feb 10, 2009

Again, I am not trying to say that people who make those choices should not receive care at all, I am saying that when it comes to allocating resources, priority should go to those who aren't purposely causing a great deal of their own health issues.

Yeahbut -- WHO will "decide" WHO is "worthy" of receiving treatment, and who is not?

What if I don't smoke or overeat, am not overweight, yet I develop DM II? I see lots of folks who don't seem to be abusing themselves, yet they still have chronic conditions.

Where do we draw the line? Who decides if there are finite resources?

Quark09 · Feb 10, 2009

Yeahbut -- WHO will "decide" WHO is "worthy" of receiving treatment, and who is not?
What if I don't smoke or overeat, am not overweight, yet I develop DM II? I see lots of folks who don't seem to be abusing themselves, yet they still have chronic conditions.
Where do we draw the line? Who decides if there are finite resources?

As I have said (several times now): the resource priority should go to the person who is not engaging in self-destructive behavior. If you read my previous posts, I believe I've been quite clear. And yes, resources ARE finite. We actually don't have endless supplies of vaccines OR healthcare dollars.

SoundofMusic · Feb 10, 2009

As I have said (several times now): the resource priority should go to the person who is not engaging in self-destructive behavior. If you read my previous posts, I believe I've been quite clear. And yes, resources ARE finite. We actually don't have endless supplies of vaccines OR healthcare dollars.

How are you going to "prove" that they are engaging in self-destructive behavior? Follow them around at home? People could simply deny that they smoke or overeat. I mean -- I don't think folks like yourself are thinking this through. There WILL be a way of rationing with this -- and I shudder to think about the methods and who will be the "deciders" of who gets what in health care.

flightnurse2b, LPN · Feb 10, 2009

Yeahbut -- WHO will "decide" WHO is "worthy" of receiving treatment, and who is not?
What if I don't smoke or overeat, am not overweight, yet I develop DM II? I see lots of folks who don't seem to be abusing themselves, yet they still have chronic conditions.
Where do we draw the line? Who decides if there are finite resources?

well, let me throw my cents in on that question.

i used to work in a doctor's office part time a while back. do you know who decides who is "worthy" of receiving treatment? BCBS, United Health Care, Cigna, Aetna, WellPath, Great West and MedCost.

i used to have to call to pre-certify procedures such as nuclear stress tests and colonoscopies. some insurance plans do not even cover preventative care even with family hx or pre-exisiting.

i talked to a guy once who is a PA-C that worked in the intake dept @ an insurance company. he said it is actually cheaper for them to deny the claims for preventative care. he said if they put forward the $$ for screening care vs. the $$ for care after dx of disease/the amount of noncompliance because pts can't afford care, it is much more cost effective for them to deny the claims and pay for a few yrs of treatment post advanced dx. doesn't make much sense to me, but whatever.

for example, i had a pt recently in the hospital who was twenty six years old who was s/p bowel resection for colon CA. admitted with positive GI bleed a week prior with a hgb in the range of 5 or 6. positive family hx, positive heme cards for a few years, MD wanted colonoscopy but he put it off because his insurance company would not pay and he could not afford the out of pocket fee for a colonoscopy (which usually runs upwards of $2000 for the procedure alone, forget the hospital stay, IV supplies, anesthesia, etc). his case, yes, is rare. but because insurance co. denied the claim, his colon CA was much more advanced than it would have been if they had paid up front.

i had a nodule in my lung last year. MD suggested a bronch. however, bc i am in my mid-20's, i paid out of pocket for my bronchoscopy, because someone sitting behind a desk at Medcost said i didn't need the procedure done. there they had in front of them, pretty CT slices with a 3cm blob in the RLL. but they denied my claims. and out of my pocket came over $2,000.... which has put me into debt... i make payments every month but if i did not have a good job, i couldn't afford those payments, i would be on the street.

now, i know a guy who had no insurance who did losts of drugs and was in renal failure. had a transplant. did more drugs. went back into renal failure. got ANOTHER transplant. didn't pay a penny.

go figure?

you guys are jumping off saying that the govt is going to choose how we care for patients and how it's so wrong, etc etc. read the find print on your insurance policies. you may realize the idea is not as bad as it seems.