NEW YORK (Reuters Health) - A web-based decision-making tool that alerts heart doctors when diagnostic tests would not be useful for a specific patient can curb wasteful procedures, according to a new study.

"This educational tool helps doctors determine the best test for any particular patient," said lead author Dr. James Min, director of cardiac imaging research at the Cedars-Sinai Medical Center in Los Angeles.

Imaging tests help detect disease and motivate doctors to focus their care, but expensive diagnostic tests can be a financial drain if overused, experts said.

"Even if you didn't care about money, there are reasons not to be tested unnecessarily, including false positive tests and having something found that is not really relevant," said Dr. Gilbert Welch of The Dartmouth Institute for Health Policy & Clinical Practice in New Hampshire, who was not involved in the current study.

That kind of overtesting and overdiagnosis can also lead physicians to pursue treatments that are unnecessary and potentially dangerous for patients, according to Welch.

Researchers noted that in many cases overtesting comes from a physician's inability to keep up with the constantly changing world of diagnostic tools.

In an effort to reduce the use of unnecessary tests, Min and colleagues created an online questionnaire that helped doctors participating in the study to decide whether a test was appropriate.

Physicians took around two minutes to enter details into a web form, then the program gauged the appropriateness of the test against recommendations from the American College of Cardiology (ACC).

The study ran from mid-2010 to early 2011, and the researchers tracked doctors' decision-making at three large cardiology practices in St. Louis. All the patients involved had private insurance through United HealthCare, which agreed to suspend its usual prior authorization requirements to give the doctors free rein to decide which diagnostic tests to give their patients.

During the study, 100 physicians used the decision-aid for 472 heart patients, who were mostly middle-aged men with existing coronary artery disease.

The researchers focused on three common cardiac imaging tests: MRI, as a method to show heart muscle function; stress echocardiography, an ultrasound view of how the heart works when exercised and CT angiogram, a high-resolution X-ray that reveals blood vessel blockage.

Over an eight-month period, inappropriate tests decreased from 22 percent to 6 percent, according to the researchers. During the same period, studies deemed appropriate by ACC criteria increased from 49 percent to 61 percent, Min's team reports in the Journal of the American College of Cardiology.

Reducing unnecessary tests could save a lot of money for the cash-strapped U.S. healthcare system, experts noted. Two of the three heart tests monitored in the study together cost Medicare over $1 billion in 2008 in physician payments alone.

"It's a good study; it reinforces and replicates what others have shown in the same area of clinical decision support for imaging: it can be done and it works," said Dr. Chris Sistrom, a radiologist and health economist with Partners HealthCare, at the University of Florida.

Sistrom was not involved in the current study, but he found a similar trend when he studied a doctor feedback system at Massachusetts General Hospital. The number of inappropriate CT scans decreased from about 20 percent to around 10 percent within a month.

Welch said he expects hospital systems will adopt more of these real-time feedback systems as doctors increasingly use computers to store clinical information and order tests.

"It becomes very useful to have algorithms help physicians," he told Reuters Health.

But he cautioned that such tools will have to strike a balance between giving doctors useful feedback and becoming another time vacuum for busy physicians.

"The balance is not to nickel and dime and overwhelm the physicians with algorithms in the process of what's already a busy job," Welch said.

Dr. Elliot Fishman, professor of radiology, surgery and oncology at Johns Hopkins Hospital, said he sees potential for wider application of decision support tools integrated right into the electronic forms doctors use to order diagnostic tests for a patient.

They would operate something like the feedback and recommendations that pop up when a customer orders a product on Amazon.com, only the programs would guide doctors towards the most appropriate test, Fishman said.

The ideal is always to be able to talk with other doctors for advice, Fishman told Reuters Health, but when that's not possible, technology can be helpful.

"If I'm the patient, anything the physician can do to help me get the right study as fast as possible is a great thing," he said.

SOURCE: http://bit.ly/ZxVjdo Journal of the American College of Cardiology, May 21, 2013.

SAN FRANCISCO — The Affordable Care Act, aka health care reform, aka Obamacare, is spurring a massive creation of new business opportunities.

So says Bryan Sivak, the chief technical officer and entrepreneur-in-residence at the Department of Health and Human Services, the cabinet-level agency that regulates the $2.8 trillion U.S. health care market. Sivak joined the HealthBeat conference here, which VentureBeat is producing, via a video conference (see photo above).

Just one of the areas that’s becoming fertile ground for entrepreneurial innovation: the health insurance exchanges mandated by the law.

These exchanges bring a level of transparency and openness to the insurance market that hasn’t been easy to find until now, Sivak said. The new exchanges will be large, consumer-facing marketplaces, and the insurance industry hasn’t been exactly nimble about embracing the latest consumer tech trends — so there will be lots of opportunities for startups to bridge the gap.

They’ll increase competition, because people will be able to see and compare insurance plans more easily. Now, any qualified, licensed insurer will have access to a market of potential customers via the exchanges.

Also, he said, the act will bring 30 million to 50 million more people into the ranks of the insured, creating a new pool of customers to market to. And there will be lots of data

“You have no idea what’s possible, and you have no idea what people are going to come up with, so that’s what I’m really looking forward to,” Sivak said.

Apart from the ACA, Sivak also said that government has an important role to play in facilitating health care innovation.

Government can help spur technology in three ways, he said:

• Facilitation: ”Governments at all levels are interested in seeing citizens do great things.” At the federal, state, and local levels, he said, there’s a lot of interest in helping people create new ventures, improve existing health care systems, or create new systems.
• Convening: “We’re really, really good at getting people together,” Sivak said. So if a big problem needs tackling, governments are well-positioned to gather people to talk about it.
• Incentivizing: Governments can be very effective at spurring change through relatively small incentives or through mandates. For example, he said, the adoption of electronic medical records (EMRs) stagnated until it was mandated by the Affordable Care Act in 2012.

“Just think about that: A small government intervention has caused EMR adoption to go from under 15 percent to over 70 percent,” Sivak said.

What’s more, government sits on top of a lot of data. Sivak estimates that HHS has about 1,000 data sets, 400 of which have been catalogued on the agency’s HealthData.gov website. Some of the datasets aren’t free, though HHS is working to bring the costs down. So there’s a long way to go, still.

Sivak, a former entrepreneur who cut his teeth in San Francisco during the dot-com days, says his attitude toward government’s role is a new perspective for him.

“The only time I interacted with government was when I needed to file my incorporation paperwork with the State of California,” Sivak said of his experience in the 1990s — not atypical of many tech entrepreneurs.

But if he’s right, techies — at least those who want to do business in the health care field — would do well to pay a lot more attention to what’s going on in government.

This article originally appeared on VentureBeat

In a move that may reflect a growing interest by the U.S. Food and Drug Administration in asserting its regulatory muscle in the mobile health app space, the regulator recently sent a letter to mobile app maker Biosense Technologies Pvt Ltd. indicating that it needs 510(k) clearance for its urinalysis diagnostic, uChek Urine analyzer.

Biosense‘s uCheck urinalysis system includes an iPhone app and a kit and uses Siemens’s and Bayer’s test strips, which have been cleared by the FDA. The company outlines several uses for urinalysis on its website such as pregnancy, urinary tract infection, hepatitis and malaria, to name a few.  On the uChek website, the Mumbai India-based company presents the system as a “semi-automated” device. It acknowledges on the website that uChek is a medical device and adds that Biosense is an FDA registered facility.

In the letter the FDA explained that because the app “allows a mobile phone to analyze the dipsticks, the phone and device collectively function as an automated strip reader” triggering the need for 510(k) clearance.

“…Therefore, any company intending to promote their device for use in analyzing, reading, and/or interpreting these dipsticks need to obtain clearance for the entire urinalysis test system (i.e., the strip reader and the test strips, as used together).”

An article by Mobihealth News noted that uChek came up during the Congressional hearings discussing the parameters of FDA regulation of mobile health apps when it was highlighted as an example of an app the FDA might be not be regulating appropriately. It has also gotten press attention after Biosense Technologies co-founder Myshkin Ingawale demonstrated the app during a TED talk in California earlier this year.

The FDA has given the company 30 days to write a letter to justify why its app doesn’t require 510(k) clearance that other medical  devices typically need. Despite the letter, the app is still available on iTunes, after it was released at the end of April. In another month, that could change. Watch this space.

[Photo Credit: sheelamohan]

That what’s-next approach drives MedCity ENGAGE, MedCityNews.com’s executive summit on patient engagement and healthcare delivery on June 5-6 in Washington, D.C. We’re just a few weeks away from the event. Nearly 300 leaders from the federal government, health systems, insurance companies and other sectors are already registered to join us.

I want to make sure you get the chance to be a part of the event too. Here’s why you should come.

ENGAGE will have constant #realtalk conversations on everything from using data and managing accountable care organizations to implementing gamification and adopting a retail approach to healthcare.

The agenda will be set by the likes of Mayo Clinic, members of Congress, Walgreens, Pfizer, Health and Human Services, UnitedHealth, Humana, Partners HealthCare, Angie’s List, the U.S. Department of Veteran’s Affairs, Cleveland Clinic and beyond. Those established groups will be coupled by fresh voices — whether they are consumers or new thinkers within the medical industry — who have been regularly working to empower underserved patients; create new, tech-driven solutions to help foster patient engagement; or make policy mandates work at the grassroots level.

Plus, nearly two dozen innovative companies will be part of an Innovation Showcase full of unique solutions to create better patient engagement.

Those who come will be actively joining the discussion. Your ideas will be recorded so we can continue the conversation about what should be done around patient engagement. ENGAGE attendees will take part in an on-site poll answering key questions around patient engagement. Meanwhile, a video booth will capture attendees’ points of view on what’s working and needs to be done to better engage patients.

All those thoughts — along with other aspects of the conference — will be shared and kept on MedCityNews.com to embolden the rest of the healthcare industry.

It’s not too late to take part. Buy your tickets and join in a chorus of those dedicated to acting now to improve healthcare.

When movie stars become unbankable, they’re no longer a slam dunk at the box office. When investments become unbankable, they’re relegated to the junk pile. For ordinary Americans deemed unbankable, those who don’t have a traditional checking or savings account, it can be hard to simply pay bills. And that is about to become a big problem for those who also lack health coverage -- and for the health insurance companies trying to sell them coverage. After all, how do you sell a product to a customer who has no way to pay you?

One in five households in the United States, or about 51 million adults have only a tenuous relationship with a traditional bank, relying instead on check-cashing stores and money lenders, according to the Federal Deposit Insurance Corporation.

The new federal health law which requires most Americans to carry health insurance starting in January presents a particular problem for those households, since most health plans accept a credit card for the first month’s premium payment and then require customers to pay monthly with a check or an electronic funds transfer from a checking account.

Those options won’t work for the so-called “unbankables” looking to purchase health coverage with federal subsidies through online insurance marketplaces, said Dan Schuyler, a director at Leavitt Partners, a firm that is advising private insurers and states on how to comply with the law. “You don’t want to take these millions of unbankable people through the entire enrollment process and then at the end of line say, ‘Ok the only way you can pay for your share of the premium is with a bank account number,’” he said.

The consequences could be severe: After all, when your cable gets turned off, you miss The Walking Dead or Pawn Stars. When your insurance is canceled, starting next year, you’ll be breaking federal law and liable for any medical bills.

Researchers who study consumer financial behavior say people have good reasons to spurn banks. New immigrants, for example, may have distrusted the banks in their home country and brought that skepticism with them to the U.S., and moderate income earners on tight budgets have been stung, they say, by bounced checks when banks unknowingly re-order their transactions. The overdraft fees and checking account fees charged by traditional banks can upend the delicate, and often precarious, financial balance of these households.

“The bank account is extremely stressful when you don’t have a job that’s reliable,” said Tran, a 25 year-old community organizer and Ivy League graduate who lives south of San Francisco, California.

Her current employer does not offer her health benefits, and she was turned down, she said, when she applied for health coverage on her own. Tran hopes to get hired to a full-time position and asked that we use just her last name so it didn’t give her bosses a bad impression.

Tran said when she took her new job and no longer had direct deposit, Bank of America began charging her, up to $12 a month. “I was not happy with the charges,” she said.

Consumers who will be required to purchase health coverage will need payment options that are simple, easy and affordable, say consumer advocates and health care experts.

“I think there is a dawning awareness that this is a large problem,” said Brian Haile, senior vice president for health policy at Jackson Hewitt Tax Service. Up until last year, Haile was wrestling with this problem on behalf of the state of Tennessee where he served as director of the Insurance Exchange Planning Initiative. “We raised these issues with the federal government well over a year ago and in a series of about four or five letters.” Haile said he did not get much of a response then.

Indeed, neither the Affordable Care Act, nor any other federal health laws, require health insurers to accept all forms of payment, including credit cards or the cash-loaded, pre-paid debit cards that people without bank accounts often rely on. Federal officials are wary of doing anything to discourage insurance companies from selling plans on the exchanges, say current and former state health officers who have pressed the U.S. Department of Health and Human Services for a ruling.

One of the largest players on the new exchanges is likely to be WellPoint, a Blue Cross and Blue Shield licensee. In an email, a WellPoint spokesperson said the company was “evaluating expanded payment options to members.” Other health plans, including Cigna and UnitedHealthCare, urged state officials in planning documents to allow companies to set their own payment policies.

Federal health officials issued a letter in April stating that all health plans selling coverage in the federally-run insurance marketplaces in 28 states will have to accept payments in ways that do not discriminate against their customers, but did not prescribe what those payments should be.

Insurance carriers are in a pickle since the transaction fees for credit cards and pre-paid debit cards can run as high as 4 percent. If only one company takes the plunge, its costs are likely to be higher, scaring away customers.

Pre-paid cards, popular with low-wage workers, come with other potential hazards. “If you accept re-loadable debit cards, are you in fact getting folks with lower health status?” said Haile. “That’s a real risk when you’re in the insurance business. So you can’t be the only one picking up those risks.”

Haile has called on federal official to set a uniform national standard requiring all insurers to accept all forms of payment, including credit cards, pre-paid cards and money orders.

Massachusetts, several years ahead of the rest of the country on health insurance reform, prohibited credit cards on its online marketplace because the fees were too high, said Jon Kingsdale, former executive director of the Massachusetts Health Connector. Consumer advocates who want moderate-income families to have easy payment options are themselves wary of credit card late fees and high-interest charges for those who can’t pay off their monthly balance.

For now, it is a problem with no elegant solution. Pre-paid debit cards and credit cards could be options if the federal government steps in to negotiate lower rates with the card companies as it did for tax payments to the Internal Revenue Service, say consumer advocates.

As for Tran, she pays her student loans with a money order, and figures she might do the same when she’s required to buy health insurance starting in January. “I hope I’ll get a permanent job with benefits by then,” said Tran. “You hope for the best and plan for the worst.”

Lisa Suennen and John Stenson moderated a great discussion among three payers and one provider: Paulus. His needs were very different from the rest of the group, ranging from imminent cost cuts to the acceptable timeline for ROI. His comments show the pressure hospital systems are under to change almost every aspect of business from working with surgeons to implementing new technology to working with patients.

One of his most interesting comments was in reply to moderator Suennen’s question about how much doctors get involved in cost decisions. Paulus gave an example of how doctors are already stepping to the table on the cost side.

He said his hospital system works with an orthopedic practice of 75 doctors who have their own surgery centers and who also do surgery in the Allina hospitals.

“When they do hip-replacement surgery at one of our hospitals, they require us to offer 13 different hips,” he said.

He attended the group’s board meeting recently and asked how the surgery centers were doing.

“I asked them how they made any money on hip replacements because we can only break even,” he said.

The answer? By offering only one type of hip implant. Paulus renegotiated.

“Suffice it to say, I said, ‘We can’t make it with 13 hips, and if you don’t work with us, we’ll hire our own surgeons,’” he said. “We are now offering two hip implants.”

The group also talked about the return on investment for smoking cessation programs and weight-loss surgery. Most of the payers agreed that they could invest the money in patients now and wait for reduced healthcare bills several years later. Paulus said that the exact opposite is true with hospital systems.

“I’m looking for very quick turnaround, like 12 to 24 months, so if you have something that can do that, it will get a lot of attention,” he said. “We have to take $350 million to $500 million out of the system in the next couple years.”

Dr. Richard Migliori of UnitedHealth recommended everyone in the room read the IOM report on healthcare spending and high-value care. Paulus confirmed one of the report’s conclusions that saving money on drugs and devices is the low-hanging fruit of healthcare cost cutting.

“Folks could give away their devices at cost and it wouldn’t help because we can save money there without redesigning the system,” he said. “Anyone who can help us redesign will make a lot of money.”

[Image of the word NOW illustrated with a speedometer from BigStock]

President Barack Obama is known for running one of the most tech-savvy political campaigns in the history of US politics. The chief scientist of the Obama campaign’s data analytics team, Rayid Ghani, shared some insights on how that campaign worked at the TiEcon 2013 conference yesterday, an event aimed at entrepreneurs.

Ghani said he and his team applied advanced data-mining and machine-learning techniques to create new tools for voter turnout, fund raising, advertising, social media outreach, and email campaigns.

You’d think the team would have worked with huge amounts of data to come up with simulation models that would shape the outcome of an election, but Ghani said “it was the smallest dataset,” he’d ever used in a real problem.

The key data points were voter registration data – information that is publicly available – and data around people who supported Obama by either volunteering or making contributions to the campaign.

With a year and a half to put the data to work, Ghani didn’t have the luxury to recruit and train a team of engineers on a new technology, or for that matter “install, figure and implement a new technology.”

“We were heavily focused on open source, did a lot of coding ourselves, used a lot of databases, used Hadoop, R, Strata and worked with 20 different vendors,” said Ghani.

The campaign also used Facebook’s social graph search function in a big way, Ghani said.

Based on experiments, the team came up with predictive models that became the basis of a $300 million TV ad-spend and five billion emails sent out by the Obama Campaign.

A machine learning graduate from Carnegie Melon, Ghani worked with Accenture for 10 years before joining the Obama for America campaign.

After helping to get the president re-elected, Ghani now works as chief data scientist at University of Chicago. He’ll be running a three-month summer program on “Data Science for Social Good” at the university for which he’s currently accepting applications from students across the country. Ghani is also working on a social good analytics startup called EdgeFlip.

Photo Credit: Chitra Rakesh/VentureBeat

This article originally appeared on VentureBeat

To understand both the simplicity of disparities in health care and the complexity of eliminating them, consider this:

In the late 1970s and early '80s, black and white death rates for breast and colorectal cancer, two of the biggest killers, were more or less the same. They've been diverging ever since, with African Americans now one-third more likely than whites to die from either disease.

The reason is simple, said Otis W. Brawley, chief medical officer of the American Cancer Society: Detection and treatment dramatically improved about 30 years ago.

"When treatments didn't work, it didn't matter," he said. "We've gotten a lot better in medicine, is what happened."

"As treatment becomes more and more effective and as technology becomes higher and higher tech" -- and pricier and pricier -- "the group of people who are less likely to get that treatment are the poor and the disenfranchised," Brawley said in an interview after speaking Thursday at a cancer disparities symposium that was ironically subtitled "We've Come So Far, But Where Are We Going?"

Disparities in health care have long befuddled physicians. Looking to their own futures, third-year residents in family and community medicine at Thomas Jefferson University Hospital asked a panel of physicians, researchers, and clergy to examine the issues.

Brawley, the keynote speaker, led off with a bit of context. "Race is a sociopolitical and not biological categorization," he said, that is periodically redefined by the U.S. Office of Management and Budget. Barack Obama was classified as white earlier in his life because the government then linked a person's race to his mother's.

There's no question that race and ethnicity play a big role in medical care. A 2000 study, for example, found that 7.5 percent of black women in Atlanta who were diagnosed with a localized, highly curable breast cancer did not get surgical removal of the tumor, compared with 2 percent of white women.

Masked by color, however, are cultural differences such as acceptance of treatment, lack of access, disparities in multiple conditions that make treatment more difficult, and, perhaps most important, socioeconomic status.

People with higher education have better outcomes. When researchers manipulated statistics to model what would happen if all African Americans with cancer died at the same rate as black college graduates did, more than 80 percent of the racial difference disappeared, Brawley said.

Ronald E. Myers, a medical sociologist at Jefferson who spoke on the panel, recalled that when doctors mailed out notices urging patients to get screened for colorectal cancer in the 1980s, whites responded much more strongly than blacks. When they got additional help, like someone walking them through how to set up a test, the rates evened out.

"It is the social part of health care that we often forget," Brawley said.

--

Contact Don Sapatkin at 215-854-2617 or dsapatkin@phillynews.com. ___

Here are some industry insiders who offer a wide variety of perspectives on genetic testing and genome analysis from professors and public health directors to scientists and entrepreneurs.

Misha Angrist (@MishaAngrist) is an assistant professor with the Duke Institute for Genome Sciences & Policy.

Daniel MacArthur (@dgmacarthur) heads a lab at Massachusetts General Hospital and the Broad Institute @broadinstitute to extract information from human DNA sequence data.

Justin H. Johnson (@BioInfo) is director of bioinformatics at @EdgeBio and tweets about genomics, biotech and science as a service.

Dr. Muin Khoury (@DrKhouryCDC) is the director of the Centers for Disease Control and Prevention’s Office of Public Genomics.

Kenna Shaw (@kennamshaw) is the director of The Cancer Genome Atlas program. Set up by the National Institutes of Health, it’s a collection of multidimensional maps of genomic changes in major and subtypes of cancer, and serves as a resource for researchers to develop better ways to diagnose, treat and prevent these cancers. It’s jointly led by the National Cancer Institute and the National Human Genome Research Institute.

Deanna Church (@deannachurch) is a staff scientist at the National Center for Biotechnology Information at the National Institutes of Health with a focus on genetics and genomics.

Saskia Sanderson (@SCSanderson) is an adjunct assistant professor at @IcahnInstitute and @MountSinaiNYC who does research on the psychological impact of personal genomics.

Dr. Michael Pellini (@MichaelPellini) is the CEO of Foundation Medicine, a cancer diagnostics company bringing comprehensive cancer genomic analysis to routine clinical care.

Dr. Stefan Gruenwald (@sgruenwald) is a co-founder and chief technology officer for Diagnomics, a genome-sequencing service provider.

Healthcare providers have to give patients the capability to electronically view, download and transmit relevant information from electronic health records such as lab test results, a list of current medications and hospital discharge instructions.

Sana Fe, New Mexico-based Seamless Medical Systems is addressing health literacy by focusing on information, education and communication and working with partners to harness their content.

CEO and founder David Perez told MedCity News in an interview: “Part of the challenge with health literacy has been…the content has been so dry and academic, it’s too hard to absorb and understand,” said Perez. “We’re looking to utilize technology in a way that overcomes literacy issues and simplifies concepts. We need to make the content suited for the technology so it’s easy to understand for all patients.”

It views multimedia tools as a vital way to help patients better understand their health. Although it tailors content through demographic information like sex, age, geographic location, language and health conditions, it also wants to add more context such as the length of time patients have lived with a particular condition. For example, the kind of information you’d provide a patient who has just been diagnosed with diabetes would differ from the content a patient who has lived with the condition for several years would receive to raise awareness about new or more effective ways to manage their blood glucose levels or weight.

Its SNAP Practice channel uses digital forms on iPads to guide patients through intake and registration to avoid jamming up waiting rooms and to reduce denied claims. If practices opt for it, this information can be transmitted to an electronic medical record through one of its three partnerships. Otherwise it can be transmitted to the practice’s dashboard.

Another version of the SNAP Practice platform, its enterprise system, can be integrated with electronic medical records. Seamless currently works with three different EMR vendors and claims its program is platform agnostic.

Once patients complete the cloud-based forms, they’re directed to a patient-education platform. Users can test their health literacy, or choose from Mayo Clinic content, health assessments, games, infographics along with wellness and lifestyle channels. Patients can also email items that spark their interest to themselves.

Practices can also use the platform for reference in the exam room. Patients can record notes from their physician visit. Perez said it wants to deepen that experience by adding animation and video so physicians can give patients a better understanding of anatomy in, say, the run-up to surgery. It could give them an overview of what they will undergo to better understand the procedure, make them feel more involved in the process and hopefully reduce their anxiety.

Perez said, “Our vision is that SNAP is integrated into the clinical experience” with targeted information for each user.

Launched in October 2011, the early stage company focuses on primary care practices of five or more physicians. But it also sees opportunities in specialty areas. So far, it is working in urology and ambulatory care, but it plans to expand into oncology this year with an eye to adding women’s health in 2014.

Although it has generated interest from veterinary practices and at least one military hospital, it wants to avoid falling into the trap of expanding too fast so it is currently focusing on a few areas and gradually scaling up.

Perez sees its content platform as a way to help practices grow since it can help them improve work flows and raise patient satisfaction.

Mary Agnes Carey talks to Joanna Kerpen, a partner at the law firm McDermott Will & Emery, about the role of the IRS in implementing and enforcing provisions of the health law after recent revelations the agency inappropriately targeted conservative groups that were seeking tax-exempt status.

>> Listen to audio of this interview.

MARY AGNES CAREY: Good day, this is Health on the Hill. I’m Mary Agnes Carey. The role of the Internal Revenue Service in implementing the 2010 health care law has come under fire on Capitol Hill. Recent revelations that the IRS has inappropriately targeted conservative groups seeking tax-exempt status has caused some Republicans to say that the agency can’t be trusted to implement the health care law. Many Americans may not even realize that the IRS has a role in the health law, also known as the Affordable Care Act. With us today to discuss the issue is Joanna Kerpen of the law firm McDermott Will & Emery. Thanks so much for joining us.

JOANNA KERPEN: Thank you for having me.

MARY AGNES CAREY: Before we talk about the IRS, we should say that it’s not the only federal agency overseeing the health care law. What are the other agencies and how do they interact with the IRS?

JOANNA KERPEN: Well, because the health care reform law made such sweeping changes to not only the Internal Revenue Code, which the IRS is responsible for, but also to ERISA and the Public Health Services Act, the Department of Health and Human Services and the Department of Labor have been, and will continue to work with the IRS in implementing the changes made by the health care reform law and enforcing a lot of the provisions. However, that being said, because there have been such a great amount of changes to the Internal Revenue Code, the IRS has a very substantial role in implementing the changes under the health care law and enforcing them.

MARY AGNES CAREY: So moving to the IRS, what are the agency’s  responsibilities concerning individuals and the health care law?

JOANNA KERPEN: Well, for example, in 2014, individuals are going to be required to carry a minimum level of health insurance coverage or be subject to a penalty. The IRS will be the agency that is responsible for enforcing that penalty and collecting the amounts from the individuals. In addition, as part of the minimum coverage requirement for individuals and the minimum coverage requirement that employers be required to provide to individuals, there will be the need to determine whether or not individuals are eligible for a health insurance premium tax credit, and the IRS will have the responsibility for determining who is eligible for the health insurance premium tax credit.

MARY AGNES CAREY: The law also places some new responsibilities on employers.  What are they and how is the IRS involved?

JOANNA KERPEN: There are several new requirements for employers that interplay with the IRS’s enforcement provisions and governing provision. In 2014, for example, employers are now going to be required to provide coverage that is affordable to employees. And if they do not provide this coverage, they will be subject to a penalty. The IRS is responsible for setting out the rules and guidance for employers in providing this coverage as well as enforcing the rule and collecting the penalty payment from the employers. 

In addition in 2018 there will be a tax on what they call Cadillac plans, the high value cost coverage that can be provided to individuals, and the IRS will be responsible for enforcing that rule and collecting any penalties for coverage in excess of the Cadillac plan tax limit. In addition, starting in 2012, which would have been the W2 that was provided in January 2013, employers were now required to include certain information on annual W2s, specifically the value of the group health plan benefits. So beginning with that W2 that was provided in 2013, the IRS has now been tasked with  recording all the values of the group health plan benefits that have been recorded on the W2s.

MARY AGNES CAREY: Republicans on Capitol Hill have said that the current controversy over excessive IRS scrutiny of some conservative nonprofits means that the IRS can’t be trusted to implement the Affordable Care Act in a fair manner. Do you think that those arguments will have any lasting impact on implementation of the health care law?

JOANNA KERPEN: I can't speak to whether or not the arguments will have any impact on the implementation. However, I just think that the recent events and disclosures by the IRS of the conduct shows that it is in fact possible for the IRS to behave in this manner. However, that doesn’t mean that they are going to in the future and with regards to the future requirements that are coming out.  But you never know.

MARY AGNES CAREY:  That's absolutely true. In Washington, you never do know.  Thanks so much Joanna Kerpen of the law firm McDermott, Will & Emery.

JOANNA KERPEN: Thank you.

In the new world of healthcare, it’s new voices that can be the most helpful. The medical industry is lucky to be filled with thought leaders who are regularly offering their ideas to the industry. But without new thinking and new points of view, healthcare – facing big challenges in areas like patient engagement and healthcare delivery – is sunk.

Here are six people you need to hear more from. Each one joins the chorus of unique thinkers taking part in MedCity ENGAGE, MedCityNews.com’s summit on patient engagement and healthcare delivery June 5-6 in Washington, D.C. They have been building accountable care organizations from the ground up, working shoulder-to-shoulder with patients navigating the healthcare system, pushing doctors and other stakeholders to think differently and, in one instance, is a patient herself.

Without new approaches nothing will change for the better in healthcare. So read about these six people and consider: why haven’t you heard more from them?

1. Dr. Ivor B. Horn, associate professor of pediatrics, Children’s National Medical Center

Horn has spent time researching healthcare communication and child health disparities, while examining how social media and mobile health can be used to help young patients. She’s become a regular on social media, sharing insights from @drivorhorn, while championing underserved patients’ place in the engagement discussion.

“I love my practice and I love my research, but I’ve come to realize that all the things I’ve learned through my research has been going into a medical journal that will never be read by the families I’m trying to help,”she once wrote in her regular column on MyBrownBaby.com. “Yes, it’s improved my resume, but it hasn’t done squat for the families I serve. I could use the information with the few families that I see in practice, but what about all those other folks? I wondered, how could I share that information beyond the exam room?”

2. Bob Finuf, vice president and PCN Executive Director, Children’s Mercy Hospitals & Clinics

Finuf resists the ACO-approach for his health system. Instead, at Children’s Mercy, it’s an integrated pediatric network, an important difference in approach that avoids requirements around enrolling adult patients. Plus, Children’s Mercy has created what it called a “financials first” model.” It focused more on issues such as risk sharing over developing a model for managing care.

“We are developing the care delivery model, shifting away from admits and days to community-based population health, primary care medical homes and wellness,” Finuf said in a case study.

3. Dr. Adrienne Boissy, medical director, Cleveland Clinic Center for Excellence in Healthcare Communication

Boissy spends her time on the front lines equipping doctors with skills to better treat patients. She leads a team at Cleveland Clinic that has leveraged data and other research to create a program to strengthen physician and provider communication skills throughout the health system. She also serves as the experience officer for Cleveland Clinic’s Neurological Institute, where she leads a Neurological Institute Patient Advisory Council and develops programs aimed at improving the experiences of patients, employees and staff.

4. Sarah E. Kucharski, CEO, chairman and founder, FMD CHAT

Kucharski started blogging soon after she was diagnosed with intimal fibromuscular dysplasia. She has expanded those efforts into FMD Chat, which helps patients, families and healthcare providers involved with fibromuscular dysplasia (FMD) understand what it means to be a patient with FMD.

“How can patients be expected to participate in their own healthcare, to engage in improving the healthcare system as a whole, if the majority of the medical establishment continues to shut patients out of the dialogue?” Kucharski said. “To my fellow patients I say, ‘They are talking about us, but they are not talking with us.’

“An included patient is a compliant patient,” she added. “And including patients – the constituency providers serve – thereby engages providers to put caring back into healthcare and work in collaboration to achieve better outcomes.”

5. Roys Laux, general manager, health vertical, Angie’s List

Laux is charged with expanding the health offerings at Angie’s List, which gives customers power over prices and, through feedback, transparency in industries ranging from plumbers to painters to physicians. Before Angie’s List, Laux worked at both Indiana University Health and Eli Lilly.

“Health systems and individual physicians who embrace unstructured feedback in multiple channels and effectively engage patients on their terms will be best positioned to succeed,” she said. “Furthermore, most studies show that the level of trust between doctor and patient plays a big role in recovery and overall health. Think of it as preventative care. Staying engaged in the conversation will make it much easier to fix whatever ailments come your way.”

6. Lanie Abbott, senior communication and outreach specialist, Eastern Maine Healthcare Systems

“As the communication and outreach specialist for the EMHS accountable care effort, I spend a great deal of time listening,” said Abbott, who focuses on improving the communication skills at Eastern Maine Health Systems, which in 2010 was one of 17 federal Beacon communities and, last year, became one of 32 federal Pioneer accountable care organizations.

Abbott also helps with a section of EMHS’ site that highlights patient success stories and other viewpoints on how new approaches to healthcare are working.

“We know change can be difficult,” Abbott said. “However, by sharing these personal stories, EMHS is successfully reinforcing that our patients are in good hands. Providers, staff, patients, and our communities see change, in this case, as a good thing when they see how it’s improving the life of someone they know or someone who lives in their community. ”

These are just six of more than 50 empowering and insightful speakers taking part in MedCity ENGAGE, MedCityNews.com’s summit on innovations in patient engagement and healthcare delivery on June 5-6 in Washington, D.C. Review the agenda, look at all the speakers and then join us in Washington D.C. in June.

OLYMPIA, Washington (Reuters) - Key officials helping to create Washington state's potentially lucrative recreational pot market say its success may hinge on preventing consumers from choosing to get high on readily available medical cannabis because of low and sometimes nonexistent taxes on it.

The officials say it may be necessary to raise taxes or impose more stringent rules on medical pot to avoid undercutting the new recreational market and the tax dollars it is expected to inject into state coffers. Many "patients," they say, are in reality heavy recreational users who fake or exploit their maladies.

The idea of changing the rules for medical marijuana alarms some patients and providers of the drug as medicine.

Under current state law, a range of medical professionals, including naturopaths and even some nurses can recommend marijuana for health problems ranging from cancer to persistent pain. While Washington state has no patient registry for the drug, officials in Colorado, which also has medical marijuana, have said the overwhelmingly male and relatively young demographics of their patient population line up with statistics for recreational consumers of the drug.

The higher tax rate for recreational marijuana would effectively create two markets - an example of the type of obstacle officials must navigate as they work to allow sales of pot to recreational users 21 and older, something no state has done.

"We as a state will fail unequivocally at a well-regulated and well-taxed system if we don't treat it as one market," said state Representative Reuven Carlyle, a Democrat representing Seattle and chair of the state House Finance Committee. "I appreciate and acknowledge the sensitive position that medical marijuana patients are in, but there are ways to support them without providing a blanket exemption from all taxation."

On Thursday, Washington state is set to release proposed rules on who can grow, process and sell the drug, and on how to obtain licenses.

Voters in Washington state and Colorado in November became the first in the nation to approve ballot measures legalizing recreational weed. The federal government considers cannabis to be an illegal narcotic, and U.S. officials say they are studying how to respond to the moves by the two states. Washington state has allowed medical marijuana since 1998 and Colorado followed suit in 2000.

Because the medical marijuana industry in Washington state exists in a legal gray area, many storefronts selling the drug pay no taxes, while the recreational-use industry faces a voter-approved mandate to tax the drug at a rate of 75 percent, in addition to standard state and local sales taxes.

The state's marijuana consultant, Mark Kleiman, and other observers, including some state lawmakers in Washington and some of the other 17 states with medical marijuana, say that many people treated as patients are actually recreational users.

Most pot will likely continue to be consumed by a minority of price-conscious heavy users, so their ability to buy significantly cheaper medical cannabis will make it hard for the recreational market to take hold, he said.

Kleiman, a professor of public policy at the University of California, Los Angeles, said that in his view one approach to solving the threat posed to the recreational market would be to raise taxes on medical marijuana.

"Another would be limiting medical marijuana to people who are actually sick," said Kleiman, who was appointed to his position with the state in March and has been popularly dubbed the state pot czar, a term he dislikes.

Kleiman is the co-author of the book "Marijuana Legalization: What Everyone Needs to Know" and has also written about crime policy and incarceration.

NO SALES BEFORE 2014

Last year, the Washington state Office of Financial Management estimated that taxes on the drug sold for recreation could generate up to $532 million in fiscal year 2015, the first full year legalized sales could occur.

Marijuana legalization backers touted the potential windfall for the state, but Kleiman has cautioned that, largely because of the availability of cheaper medical pot, actual tax collection could be less than half that projection.

Sales of the drug to recreational users are not expected to occur before March 2014.

Brian E. Smith, spokesman for the state's Liquor Control Board, the agency tasked with overseeing the recreational pot industry, agrees that competition from medical pot will pose "a challenge" to the viability of the new system. Washington's medical marijuana industry, which has its roots in a 1998 voter-approved measure, is among the most lightly regulated in the country.

There is no provision under the law allowing for the sale of medical marijuana, but dispensaries collect "donations" from authorized patients of about $10 per gram of the drug.

Estimates vary for how many medical-pot storefronts exist statewide, but in Seattle alone officials estimate they have over 150 such storefronts.

Some Washington state dispensaries have sought to gain legitimacy and lessen the chances of authorities shutting them down by following state Department of Revenue instructions to pay taxes. As a result, the department reports collecting $1.2 million from 52 providers of the drug in fiscal year 2012, mostly in the form of sales taxes.

But because of the gray zone in the law that medical marijuana occupies, Department of Revenue spokesman Mike Gowrylow said some dispensaries were not paying taxes on the advice of their lawyers.

State lawmakers are considering legislation to direct the Liquor Control Board to recommend ways to create a single marijuana market with defined tax rates for medical pot.

State Representative Chris Hurst, a Democrat, calls the state's medical cannabis industry "a sham" that he predicts will not long survive once recreational-use stores open. He anticipates that federal or state authorities will crack down on unlicensed dispensaries.

"All you have to do is make examples of five or six people and the entire industry collapses almost immediately," Hurst said. "You have to have something to replace it, and that's what the recreational market is."

Such talk horrifies many medical marijuana providers.

"Legalization (of recreational use marijuana) will be exactly what we were afraid of," said Steve Sarich, a medical marijuana entrepreneur who helped lead the campaign against the November ballot initiative.

(Editing by Alex Dobuzinskis and Prudence Crowther)

KHN's Mary Agnes Carey talks with Jennifer Haberkorn of Politico Pro about the Senate's confirmation Wednesday of Marilyn Tavenner to head the Centers for Medicare and Medicaid Services and what awaits her.

>> Listen to audio of this interview.

MARY AGNES CAREY: Welcome to Health on the Hill, I’m Mary Agnes Carey. Today the Senate confirmed Marilyn Tavenner to lead the agency that oversees Medicare and Medicaid. Tavenner now becomes the first confirmed head of the Centers for Medicare & Medicaid Services since 2006. With us to discuss this development is Jennifer Haberkorn of Politico Pro. Thanks Jennifer for being with us.

JENNIFER HABERKORN, POLITICO PRO: Thanks for having me, Mary Agnes.

MARY AGNES CAREY: Marilyn Tavenner had a much easier time than her predecessor, Don Berwick, who was President Obama’s first nominee to head CMS. Why?

JENNIFER HABERKORN: You’re right. It was really like night and day. Don Berwick ran into a ton of opposition once it became public that he made comments in support of the British health care system. Marilyn Tavenner, on the other hand, did not have a history of controversial statements. If there are skeletons in her closet, no one has really found them yet. She had a relationship with the Hill; she was at CMS for several years before her confirmation hearing at Senate Finance [Committee], which went swimmingly. 

There was also a significant amount of time between the health law’s passage when politics, particularly over health care, was at its peak on Capitol Hill. Don Berwick on the other hand, came up shortly after the health law passed, when emotions were very raw. So, it really was night and day – totally different situations.

MARY AGNES CAREY: While many Republicans supported Marilyn Tavenner’s nomination today on the Senate floor and House Majority Leader Eric Cantor also supported her, before the Senate could vote on Marilyn Tavenner’s nomination, she had to overcome objections of a key Democrat. Can you tell us about that

JENNIFER HABERKORN: That’s right. Tom Harkin, one of the health law’s greatest supporters on Capitol Hill objected because the Obama administration keeps taking money out of the Prevention and Public Health fund, which is kind of his baby in the health care reform law. And he put a hold on Tavenner’s nomination, meaning it couldn’t come up for a vote on the Senate floor for about a week. 

He made it clear that he supported Tavenner’s nomination, but wanted to do this to make a point. And senators have done before on other nominations. He wanted to make a point that the Prevention and Public Health Fund should not be touched anymore.

MARY AGNES CAREY: Why hasn’t CMS had a confirmed administrator since 2006? What’s been the hold up there?

JENNIFER HABERKORN: It's mostly been politics. There was a Republican nominee who came up at the end of the Bush administration. It looked like he was about to get confirmed and then at the last minute a Medicare regulation came out that angered some Senate Democrats and they effectively stopped his nomination. 

There was Don Berwick, who we talked about, was nominated by President Obama and ran in to Republican opposition. Health care is an easy target, politically. The Centers for Medicare & Medicaid Services has one of the largest budgets in the federal government and has a lot of authority. With that there is a lot of things to criticize. So those nominees have gotten hung up. And there's also been moments when presidents have decided not to nominate anyone at all. When President Obama was first elected, it took him several, several months before he put up a nominee.

MARY AGNES CAREY: What difference do you think Marilyn Tavenner's confirmation will make in the implementation of the health care law?

JENNIFER HABERKORN: I don't think it will make a significant difference, particularly because she has been in this job in acting capacity for about a year and half already. But at the same time, these Republican senators, particularly the ones who voted for her, can now call her up and say "Where are you on such and such provision?" and "I have problems with the health law on this aspect, what are you going to do about it?" 

And just having her in that confirmed role makes it a more even-handed conversation. She's been confirmed. She's gotten that senator's vote and they need to have a conversation. But in the grand scheme of things, it won't change too much.

MARY AGNES CAREY: Speaking of the health care law, Department of Health and Human Services Secretary Kathleen Sebelius has caused some concern on Capitol Hill about her efforts to raise money to implement the law. What's the latest there?

JENNIFER HABERKORN: Right now a lot of Republican senators are paying a lot of attention to the issue and expressing concerns that it could be illegal for her to go to companies that she regulates. HHS has said it has contacted providers and religious groups to promote the health care law and that it is legal under the Public Health Service Act to encourage programs that promote public health. I think we are going to see continued attention on the issue. It's not going to go away. Right now a lot of the oxygen on Capitol Hill is taken up by Benghazi and the IRS. But definitely they are going to come back to this and we might see Secretary Sebelius have to answer questions publicly about what happened.

MARY AGNES CAREY:  Thanks so much Jennifer Haberkorn of Politico Pro.

JENNIFER HABERKORN:  Thank you.

The “Crowds Care for Cancer: Supporting Survivors Challenge” contest includes two parts. First, there’s the initial application in which participants submit wire frames to show a skeletal blueprint for the tool and documentation that describes how their tool or app is supposed to work and layout the plan to develop it. Up to three will be picked from this first phase and awarded $5,000. They’ll get feedback and support to improve their apps and will get promoted on Medstartr’s crowdfunding portal in the run-up to the second part of the contest.

In the second part, the competitors are judged and the winner gets $25,000.

Here are some of the areas the challenge seeks to address, according to the ONC’s website:

1. Optimizing patient-provider communication and customizing management of survivor care.
2. Follow-up care needs like medication tracking and adherence, health promotion, appointment and symptom tracking.
3. Improving communication across survivor care networks using tools to improve health data and interoperability standards such as Blue Button+.

Submissions will also be assessed on their ability to adapt to the evolving care needs of survivors, including the potential for integration with electronic care platforms and between family, friends and healthcare providers.

The deadline for the competition is May 28 at 11:59 pm Pacific time. To apply, click this link. The winners will be announced over the summer.

As a follow up to a $1 billion initiative last year that funded projects across the nation designed to improve outcomes and save money in the healthcare system, the Centers for Medicaid & Medicare Services today announced a second, $1 billion round of Health Care Innovation Awards.

According to CMS, funding will be awarded to provider groups, health systems, payers, states, public-private partnerships, for-profit organizations or any other parties that have developed innovative payment and delivery models to improve population health, quality of care and cost efficiency.

Models funded through round two of the awards will focus on four areas:

• Reducing Medicare, Medicaid and Children’s Health Insurance Program costs in outpatient settings
• Improving care for populations with specialized needs
• Testing approaches for providers to transform their financial and clinical models
• Improving the health of geographic, clinical or socioeconomic populations

CMS says new payment models are specifically important for this round and must be included as part of all applications, which will be accepted beginning June 14 through Aug. 15.

Last year’s awards funded 107 projects, including an expansion of the Partners for Kids program at Nationwide Children’s Hospital and a collaboration between the Trustees of Dartmouth College and 15 large health systems to hire patient and family activators.

[Photo from BigStock photos]

WASHINGTON (Reuters) - An Obama administration effort to raise private donations to help implement President Barack Obama's healthcare reform law came under fire on Monday from congressional Republicans who claim the action could violate the law.

As the Republican-controlled House of Representatives prepared to mount a new vote this week to try to repeal the law, House Energy and Commerce Committee Chairman Fred Upton asked the administration to identify the companies and organizations that have received fundraising calls from Health and Human Services Secretary Kathleen Sebelius.

The committee also sent letters to nearly a dozen healthcare companies asking if they have received solicitations from Sebelius. The list includes insurers Aetna Inc, Cigna Corp., Coventry Health Care Inc, Humana Inc, UnitedHealth Group Inc and WellPoint.

Meanwhile, Republican Senator Lamar Alexander called on Sebelius to end the fundraising, saying her actions could violate Congress' power to direct policy through appropriations.

Partisan gridlock has prevented Congress from funding the law since it was enacted three years ago.

Administration officials said that since late March, Sebelius has been calling companies in the healthcare field and other industries, as well as private foundations, healthcare providers and church groups, to promote the 2010 Patient Protection and Affordable Care Act.

Her aim is to win financial help for nonprofit groups that are mounting a private-sector effort to persuade millions of uninsured Americans to obtain health coverage in 2014 through new online marketplaces, known as exchanges, slated to begin enrollment for federally subsidized private insurance on October 1.

If the implementation and enrollment effort were to fail, it could lead to higher costs and jeopardize a cornerstone of Obama's presidential legacy.

Sebelius' Department of Health and Human Services (HHS) says the secretary has the authority to encourage support for nonprofit organizations under the Public Health Service Act.

VIOLATION OF THE LAW?

"This provision has been in place since 1976 and has applied to and has been used by previous secretaries," HHS spokesman Jason Young said on Monday. "It was even cited as part of President Reagan's establishment of the President's Council on Physical Fitness."

But Republicans in both the House and Senate have been quick to raise the specter of legal violation.

"I hope the secretary will stop this action," Alexander, ranking Republican on the Senate Health, Education, Labor and Pensions Committee, said on the floor of the Senate. He pledged to ask the Government Accountability Office, an investigative arm of Congress, to look into the matter later this week.

In a letter to Sebelius, Upton and five members of his House oversight committee expressed particular concern that the administration may have sought financial support from health insurance companies.

"Currently, health insurers are seeking HHS approval to qualify for the health exchanges ... so that they may attempt to sell their services to the public when enrollment begins in a few months. Your agency also has the power to review the insurance rates that providers wish to charge," the letter said.

The administration is scheduled to begin operating healthcare exchanges in 33 states beginning January 1.

House Republicans have voted three dozen times to repeal or defund the law. They are slated to do so again this week. None of the measures have succeeded in the Democratic-controlled Senate.

(Editing by Philip Barbara)

Here’s how its pharmacy dispensing technology works. New customers fill out an application and present a state issued medical marijuana card to pharmacists. They give a fingerprint sample so their ID can be verified with each purchase. Using biometrics, the dispensing units control how much is allotted to each customer.

About 18 states have passed legislation allowing for medical marijuana, so Bedrick sees a huge potential for the increased sale of its technology in the coming months and years. It is also advising companies on license applications such as in Colorado and Washington state where lawmakers passed legislation to legalize recreational use of marijuana. It’s expecting so much business that it has set up a dispensing management division to work with help dispensing units manage day-to-day operations for $10,000 a month for each location.

The company is listed on the volatile OTC market and its shareprice has bounced up and down in the past year from a high of $205 on November 15 to its current level of $30.

The volatility regarding the company has not been limited to the shareprice. Uncertainty over how medical and recreational marijuana is dispensed has forced the company to repeatedly clarify how its technology is used. Although its automated vending machines have been adopted by Michigan medical facilities to allow patients to obtain their prescription medication from the without stopping at a pharmacy, it does not currently offer that service for dispensing marijuana.

Although most of the focus has been on medical marijuana, Medbox CEO Bruce Bedrick also views its dispensing technology as a way to disrupt how pharmacies manage inventory and dispense drugs, by making the process faster. Last week it expanded its medication dispensing machines to Michigan medical facilities.

In March, Medbox’s deal for a 50 percent stake in Michigan-based MedVend paved the way for its expansion in the state. Last month, MedBox announced the MedVend machines are located in the waiting room of medical facilities in Michigan. The medications are available in the machines shortly after they’re prescribed. The idea is that patients can start taking their medication without having to make a separate trip to a pharmacy. The vending machines also use a smart billing technology, according to a company statement. If the co-pay for a medicine is more expensive than the actual medicine, the lesser cost will be charged to the patient.

In addition to pharmacies, the company works with urgent care centers, drug rehab clinics, hospitals, prison systems, hospice facilities and medical groups.

The medical marijuana business has been referred to as a modern day goldrush opportunity for entrepreneurs, and the size of the market is expected to grow to $5 billion by 2018.

[Photo credit: Finger Print Iris Scan photo from BigStock]

Version 2.0 of a plan to create an Office of mHealth in the U.S. Food and Drug Administration should be out soon. The office of  U.S. Rep. Mike Honda, Silicon Valley’s Democratic Congressman who authored the legislation, said the next draft will at the least fine-tune the way the office would work with other federal agencies.

But is the big-ticket item – a new office dedicated to adding more context and understanding of mHealth within the federal agency – the most interesting thing about the bill? I don’t think so. Read through the details and see if you agree.

How badly does the country need an FDA Office of mHealth? Honda has been outlining that vision with a Silicon Valley point of view in the past year (he’ll also elaborate even more on issues like the legislation, the future of mobile health, innovation and the power of healthcare as one of the keynote speakers at MedCity ENGAGE, MedCityNews.com’s summit on patient engagement and healthcare delivery on June 5-6 in Washington, D.C.)

“The tech community needs confidence in a consistent, reliable framework for wireless health,” Honda recently told The Wall Street Journal. “The FDA has a critical role to play. Today, there is no confidence [among] industry. It’s nonexistent. We’re still talking to technology associations, law firms, venture firms, caregivers, patient-safety groups. We want all these players to be involved.”

The first version of the legislation proposes the following:

• An Office of mHealth that would “better clarify and simplify existing regulations while providing sorely needed expertise in this important field.” Honda later explained the The Wall Street Journal: “The situation today is kind of like the judicial system, back when there were early lawsuits about technology. No judge really knew about that stuff. They had to be trained. The FDA will have to find the expertise [both from inside and outside the agency]. As for staffing, it would be up to the FDA.”
• A mobile health developer support program in the Department of Health and Human Services. The program would provide educational materials to help developers create new products that meet privacy regulations.
• New grants, challenges and prize-driven contests – described as “The Disruptive Technologies Prize Program”  and a competition styled after the “X-Prize” – to help develop more mobile health products focused on improving quality of care and reducing reduce.
• A low-interest small business loan program to medical offices to buy new technologies, and grants to clinicians for workforce training around health IT.

Honda is correct – the FDA needs more context around health IT (it’s similar in some ways to the federal understanding of follow-on biologics). Plus, the money to the techies is fine – who doesn’t need more non-dilutive capital these days?

But the last bullet point is the most interesting. I’ve already gone on record saying one of the biggest bottlenecks in healthcare isn’t the federal government, but instead the risk-averse culture among clinicians who are on the front lines treating patients. If Congress can find the money to provide those loans and workforce grants, clinicians can combine their knowledge of healthcare with the tech savvy to implement the best and most important emerging health IT solutions.

The mHealth legislation makes it an opportune time to hear from the Congressman when he comes to ENGAGE on June 6 to give the Day 2 opening keynote.

U.S. Rep. Mike Honda is one of the a diverse chorus of empowering and insightful speakers taking part in MedCity ENGAGE, MedCityNews.com’s summit on innovations in patient engagement and healthcare delivery on June 5-6 in Washington, D.C. Review the agenda, look at all the speakers and then join us in Washington D.C. in June.

Identity Thief, the movie

The immigration reform measure that the Senate began debating this week would also create a national biometric database of American adults, according to Wired.

Immigration reform is a hot topic, but the bill before the Senate adds another layer of policy debate on top of it. Many have called for national identification systems in the past, but privacy groups oppose the step. Among the fears: as happened in the Holocaust, the system could be used to single out minorities for persecution.

The bill mandates a “photo tool,” or a massive federal database to be maintained by the Department of Homeland Security. It would contain names, ages, Social Security numbers, and photographs of everyone in the country with a driver’s license or state-issued photo ID. Employers would have to look up every employee in the database upon hiring them. The clause calling for the database is meant to curb hiring of undocumented workers.

But privacy advocates fear it will be used for all sorts of things, like registering at polling places, buying a gun, opening a bank account and other tasks.

“It starts to change the relationship between the citizen and state, you do have to get permission to do things,” said Chris Calabrese, a congressional lobbyist with the American Civil Liberties Union, told Wired. “More fundamentally, it could be the start of keeping a record of all things.”

This article originally appeared on VentureBeat

DENVER - Here's the question making the rounds in Colorado: Is the state asking for enough start-up money from the federal government for its online health insurance marketplace?

Consumer advocates are worried the answer is "no."

Statehouse Republicans, on the other hand, think it’s asking for far too much.

Colorado exchange CEO Patty Fontneau is playing Goldilocks, saying the $125 million federal grant request she wants to send to Washington is just right.

Colorado is bumping up against a May 15 deadline to apply for its third and final federal grant to launch its insurance exchange, recently re-branded as Connect for Health Colorado.

The $125 million request, if granted, would push total federal funding for Colorado’s exchange over $200 million.

Consumer advocacy groups, including the broad coalition known as the Colorado Consumer Health Initiative, think the request should include more than the current $10.5 million line item for a customer assistance network to help people buy policies in the exchange and figure out if they’re eligible for premium subsidies. Nationwide, funding for the online marketplace's consumer assistance will vary widely between states.

If Colorado’s network is underfunded, "frustration and withdrawal from a few will lead to withdrawal from the enrollment process by many as word spreads about long wait times or impersonal or inadequate assistance ultimately leading toward bad press for the exchange," CCHI wrote in one of three letters the state’s exchange board received from consumer groups criticizing proposed navigator funding levels. Navigators are the people who will provide help to individuals seeking to buy insurance through the exchange.

“The long-term viability of the exchange strongly depends on its success in the first year when Coloradans initial experiences will shape their impressions of the exchange for years to come,” echoed a letter from a second coalition that includes AARP, Boulder County and safety net health care provider Denver Health.

Exchange CEO Fontneau responded that Connect for Health Colorado is budgeting more for navigators than the $10.5 million in the federal grant request. She expects an additional $4 million to $6.5 million will be channeled to the exchange from administrative fees assessed on each policy sold, about $22 per year per policyholder. The exchange has also requested more than $2 million for the program from private foundations.

GOP Concerned About Tax Burden

Some Republicans have the opposite concern: that Colorado is requesting too much federal money.

Colorado’s exchange, "should be funded through operating revenue, it’s not fair to put the burden on the federal taxpayer," says Dr. Mike Fallon, a physician-entrepreneur Republican lawmakers appointed to Colorado’s exchange board. He’s angry that Colorado increased its grant request after learning in January that the grant could be used to fund operations beyond 2014.

“What we were going to pay for ourselves we’re now asking the feds to pay for,” he said.

Fallon doesn’t have enough allies on the board to modify its very pro-White House bent, but his opposition to the pending grant request this week stirred the body’s most fiery debate yet.

Other board members, including the head of the state’s Medicaid agency who serves in an ex-officio role, said the state should err on the side of asking for more money than it estimates it will need and return any unused funds.

But guessing the amount the state will need is difficult. If a relatively high number of people use the exchange immediately after it opens, a lot of revenue will be generated that can be used for operations. But if enrollment numbers are initially low, the state will need to lean on federal funding more to maintain the new infrastructure.

Fallon scoffed at suggestions that Colorado should ask for a high number and then pay back any unused federal funds.

“I believe your intentions are genuine,” he told a fellow board member, “but I’m cynical any government body will not spend” every dollar it has.

Fallon’s anger was echoed by Republican state lawmakers on a special exchange oversight board who reviewed the grant request Tuesday.

State Rep. Bob Gardner said the size of the request “leaves me fairly speechless."

“We were given to understand that we were running the leanest, most cost-effective exchange in the country,” Gardner said, “so it’s disappointing.”

Other members of the committee seemed incredulous that the exchange would need another nine-figure sum after Colorado’s legislature had only days earlier approved the $22 per policyholder per year fee, as well as agreeing to send it any remains from the state’s now-disbanding high risk insurance pool.

“If [the exchange] were a private concern I think you’d be looking for a job,” Republican Senator Kevin Lundberg told exchange leaders Tuesday. He and other oversight committee members were under the impression that the exchange wasn’t planning to request additional funding beyond that in the measures approved by the state legislature. Democrats on the committee said they never heard that as those bills moved through the legislative process.

Republican Senator Ellen Roberts was angry that the committee’s sole meeting this legislative session came just one day before the session ended. And being asked to sign off on an 80-page federal grant request just days before its submission deadline clearly displeased her.

“The timing is horrible,” she said, “I’m almost without words.”

Republicans on the oversight committee are essentially powerless to thwart exchange board decisions this year. The state law that created the oversight committee allows its co-chairs to approve exchange board actions. This year, with Democrats controlling the state House and Senate, that means both of those seats are held by Democrats.

And Democrats on the committee stood up to defend the grant request.

“We as Colorado taxpayers are paying” to fund exchanges nationwide, said Senator Jessie Ulibarri, “and if we choose not to use it, one of our neighboring states can apply for and receive those funds to set up their own exchanges, and then we’ll have an increasing cost for access to health care for our own residents.”

Colorado’s $125 million exchange grant request to Washington is still in draft form. The exchange board will hold a phone conference Friday to work out any details before submitting it in time to meet the May 15 deadline.

This story is part of a collaboration that includes Colorado Public Radio, NPR and Kaiser Health News. 

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

WASHINGTON - Despite a three-year-old order from Congress, Medicare has yet to begin an experiment to expand hospice services to allow beneficiaries to continue potentially lifesaving treatments to see if it would save money while improving the patients' quality of life.

The demonstration project would eliminate one major reason that people are reluctant to take up Medicare's hospice benefit: they have to first agree to forgo curative treatments such as chemotherapy. 

Many rapidly declining patients delay entry into hospice until their final days as they exhaust their treatment options, according to studies. 

Others end up dying in hospital intensive care units, which are expensive and generally not geared to making the terminally ill as comfortable as possible.

The 2010 health law required Medicaid to pay for joint hospice and curative treatments, called concurrent care, for children. More than half the states have taken steps to implement that in the joint federal-state program for low-income residents. It also instructed the secretary of Health and Human Services to select up to 15 sites to test concurrent care for patients in Medicare, which provides health coverage to seniors and disabled people. That test is to last for three years, but Medicare has yet to take any concrete steps toward beginning it.

"It is missing an opportunity," said Dr. Randall Krakauer, an Aetna executive who helped establish that insurer’s concurrent care program for people with private coverage. "Our own experience is when you do liberalize the hospice benefit, it does not cost you extra and it may actually cost you less."

Krakauer said several years ago, Aetna asked Medicare for permission to expand the program to the 448,000 elderly enrolled in its private Medicare Advantage plans—with Aetna promising to pay for any extra costs — but never got a response. "We are very interested in participating in this," he said.
Officials at the Center for Medicare & Medicaid Innovation, which is supposed to oversee the project, declined to discuss why the project has not begun or when it would start. "CMS has expressed its commitment to implementing a project that will test new ways of delivering hospice care to Medicare beneficiaries," the agency said in a written statement. "This demonstration would allow beneficiaries to receive both palliative and curative care at the same time, which could provide better overall care to the patient."

J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Association, said that in private conversations officials say they want to move ahead. "We are still very hopeful that they are interested in conducting the study," he said.

Even with its restrictions, hospice is one of the fastest growing parts of Medicare. In 2011, 1.2 million Medicare beneficiaries used the benefit, double the number a decade before. Medicare spent $13.8 billion on hospice, with an average per patient of $11,342. 

Hospice advocates have long argued that palliative care, which focuses on easing pain and not trying to prolong life, is not only more humane but also less expensive. A study, published in March in the journal Health Affairs by a team of researchers led by Dr. Amy Kelley, found that when patients enrolled in hospice three months or longer before they died, Medicare’s expenses were lower than for those who never used the benefit.

The average expense to Medicare of those patients enrolled between 53 and 105 days was $22,083 for those in hospice compared to $24,644 spent on those beneficiaries who did not elect the benefit.

It's not clear whether allowing Medicare recipients to receive curative and palliative treatments at the same time would save money. Aetna estimated it saved 22 percent on people under 65 who were part of its broad program with hospice and more curative care. But no one has been able to do a rigorous study of how it will play out for Medicare patients. The health law requires Medicare not to spend more money on the patients in the demonstration project than it otherwise would have.

In a report to Congress last year, the Medicare Payment Advisory Commission wrote that "it is uncertain whether this type of approach would yield savings" without closer management of the services that Medicare beneficiaries choose.

Some health policy experts privately fear that delay may have a political component. End-of-life care is an acutely sensitive subject given the hyperbolic accusations of "death panels" that some opponents lobbed at the health law during the debate in 2009 and 2010.

"Is it residual anxiety related to the whole death panel thing, or is it a matter of money? Who knows," said Dr. David Casarett, a professor at the University of Pennsylvania's Perelman School of Medicine and director of Penn's hospice and palliative care program. "The effect is very negative for end-of-life care in the country. The way hospice is designed now may have worked fine 30 years ago, but it doesn’t work now and we need to think about alternatives."

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

jrau@kff.org

SAN FRANCISCO - As state governments get ready for the Affordable Care Act coverage expansion, some are taking a close look at their networks of health care professionals to make sure they will be able to meet increased demands as more people gain health insurance. California is one of 15 states expected to consider legislation this year that would give advanced practice nurses more independence and authority.

Tina Clark is a nurse practitioner at Glide Health Services, a clinic in San Francisco's Tenderloin district, a low-income section of the city. Glide is run by nurses with advanced training. A physician visits the clinic 12 hours a week, to sign forms and consult on difficult cases. Even under current law, Clark can see patients without a doctor in the room.

Anastacia Casperson, who has struggled with homelessness and drug addiction, came to the clinic because she was alarmed about swelling in her legs. Clark spends a half hour with Casperson, gives her a prescription for a diuretic and talks to her about quitting smoking. Casperson says she's been coming to this clinic for a few years.

"They have compassion for a client. They have understanding for a client," Casperson says. "I like the nurses here because they're like one big family, and they all work together."

Right now, California law says nurses must follow procedures set after consulting a doctor. But lawmakers are considering eliminating that requirement. And that idea doesn't sit well with some doctors. 

"Nurses and nurse practitioners are a very, very important part of the health care team, but they are part of a team," says Dr. Paul Phinney, President of the California Medical Association.

Phinney’s group is opposed to allowing more independence for nurses. He says they don’t have as much training and may not know as much about testing and technology as doctors.

Plus, he says, there’s nothing in the bill that would require the empowered nurses to go where they are needed most.

"I would be very surprised if -- should this bill pass -- that all of a sudden, you'll see a massive egress of nurse practitioners out into medically-underserved areas. I just don't see that happening," he says.

But University of California San Francisco health care economist Joanne Spetz says research shows otherwise.

"Nurse practitioners are more likely to practice in settings that serve large shares of Medicaid patients, and they’re somewhat more likely to practice in rural communities," Spetz says.

Nurse practitioners can be trained much more quickly than a physician, and their compensation is lower, Spetz points out.

"So when a legislature is looking at the insurance of hundreds of thousands of people and the demand for care that those people are going to have, getting health professionals to meet their needs as quickly as possible and as cost-effectively as possible is a real need," Spetz says.

The next step for the California bill on nurses is a hearing in the state Senate Appropriations committee on Monday.

This story is part of a partnership that includes Capital Public Radio, NPR and Kaiser Heath News.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

WASHINGTON (Reuters) - U.S. hospital charges for the same procedure vary widely, in some cases by tens of thousands of dollars, even within a particular town or city, according to data the U.S. government released on Wednesday to boost consumer awareness.

In Denver, Colorado, for instance, treatment for heart failure ranges from $21,000 to $46,000 depending on the facility, according to the data on more than 3,000 hospitals that provide services through the government's Medicare program for the elderly and disabled. In Jackson, Mississippi, fees for the same treatment range from $9,000 to $51,000.

Hospital charges are viewed as a major reason U.S. healthcare costs are the highest in the world. Until now, consumers have not had access to such comprehensive price data that experts see as key to restraining healthcare inflation.

President Barack Obama's healthcare reform law aims to provide greater cost transparency on everything from health insurance plans to physician services. The data can be accessed at: http://go.cms.gov/16WaMfH

U.S. Health and Human Services Secretary Kathleen Sebelius said the data about hospital charges will help consumers make more informed decisions about treatment.

The Department of Health and Human Services announced that it would make about $87 million available to states to help fund rate review programs to encourage pricing transparency.

The Centers for Medicare and Medicaid Services, an HHS agency, released information on services provided for the 100 most common Medicare inpatient stays. The list includes the amount hospitals typically charge for joint replacements, gall bladder surgery and pneumonia.

(Reporting by David Morgan; Editing by David Gregorio)

Remember when Segway first came out and there was a rush of legislation to ban it from municipal sidewalks? Something similar seems to be happening to Google Glass.

West Virginia legislators, led by Gary G. Howell (R), hoped to ban motorists from using Google Glass while driving in March. And as it has been revealed that Glass wearers could take a picture just by winking, pundits talk about Google Glass creeping them out, bars that no Glass-wearing geek would enter start banning Google’s wearable computer, and Las Vegas casinos have declared the device persona non grata. Pit bosses, apparently, have cold sweats about poker games being recorded and transmitted, and players getting relayed instructions via Glass’ built-in bone subduction speakers.

Really, you wouldn’t have thought a proposal to Borg the entire human species would have met with such resistance.

Seriously, however, almost any individual thing Glass does now has been possible in the past.

Steve Mann’s computer-assisted vision system

Memoto, the camera that hangs around your neck and takes a picture every 30 seconds, blew through its Kickstarter campaign goal by a factor of 10. It’s tiny, unobtrusive, and has no on-off switch — a voyeur’s delight in public bathrooms, pools, and who knows where else. Head-mounted cameras are nothing new.

Motorola Solutions — the part of Motorola that is not owned by Google — demoed its wearable computing and  head-mounted mobile computer to our own Dean Takahashi last year. And glasses with cameras are available from multiple manufacturers.

It’s probably the full-meal-deal package that Glass presents that is the problem — and the fact that it houses all of its startling capability in probably the first somewhat attractive device which someone not on the Star Trek convention scene might actually wear.

We’ve already seen the panic and anger that always-potentially-on technology can cause, when Steve Mann, who wears a computer vision system, was assaulted in a Paris McDonalds for failing to take the device off, even though it is permanently attached to his head. Glass promises to ignite that same fear, worry, and concern over privacy, multiplied by millions of potential wearers.

“Welcome to a world through Glass,” Google says in its introduction to what Glass does. “Record what you see. Hands-free. Even share what you see. Live.”

There’s no doubt that Glass is awesome, cool, and empowering, but every power that an individual gains is a power that might infringe on others … and a power that governments tend to want to control.

“This is just the beginning,” LA privacy lawyer Timothy Toohey told the NY Times. “Google Glass is going to cause quite a brawl.”

Photo courtesy flickr user Antonia Zugaldia

This article originally appeared on VentureBeat