It’s always interesting to see the final tallies for our monthly Quick Polls, because they so often provide a confirmation in aggregate of what we’re hearing from our individual sources. In the August poll we asked readers “Do you believe that Medicare and Medicaid programs will pay EHR meaningful use incentives as promised?”

 Lo and behold, 54 percent of poll respondents said neither program will pay as promised. Unfortunately, our Quick Polls right now don’t provide a mechanism for immediate audience feedback (though you can always e-mail me at greg.gillespie@sourcemedia.com) so it’s unsure if those respondents believe the programs won’t make incentive payments at all, or if they think those payments will be delayed, reduced, etc. Twenty-six percent of respondents believe both programs will pay as promised; 20% believe Medicare will pay as promised, but Medicaid won’t.

From the interviews I’ve conducted, group practices seem the most pessimistic about their chances of ever cashing a check, hospitals less so. Maybe it’s because if push comes to shove, federal legislators could sleep at night if they screwed practices out of $40,000 to $50,000 in incentives. But if they try to avoid writing multi-million dollar checks to hospitals, many of which are political heavyweights and large local employers, they risk getting politically drawn and quartered.

So let’s wait and see … I haven’t heard any rumors from the federal level about any modifications to the EHR incentive program, but no one in the health I.T. universe is really pulling the strings here … this is just one of many incentive programs cascading through the economy. But you have to wonder which programs are going to draw a new round of scrutiny after the November elections.

***

I came across an intriguing angle on the reform bill’s requirement that everyone obtain health insurance that I’d never really considered. In a recent column published in the Chicago Tribune, Jacob Sullum hashed out how compelling all citizens to have health insurance is at its heart an unprecedented interpretation of the federal government’s regulatory power using the commerce clause.

While some federal judges have declined to dismiss various challenges to the insurance mandate, U.S. District Judge George Caram Steeh did find grounds to dismiss a case filed by the Thomas More Law Center. His reasoning, reprinted by Sullum, was thus:  “By choosing to forgo insurance, plaintiffs are making an economic decision to try to pay for health care services later, out of pocket, rather than now through the purchase of insurance. These decisions, viewed in the aggregate, have clear and direct impacts on health care providers, taxpayers and the insured population who ultimately pay for the care provided to those who go without insurance.”

I can’t even begin to wrap my mind around the implications of that reasoning, but it can be applied to a dizzying array of individual choices and behaviors. Is this laying the foundation of a nanny state, or are we already living in one and didn’t realize it?

***

Another weekend of NFL and college football left another legion of young men concussed, fractured and otherwise in need of multiple imaging exams, crutches, casts and bed rest. Not until recently did I think about how many imaging tests these guys (kids, in many cases) undergo on a seasonal basis. Brett Favre must glow in the dark by this stage in his career. I’d be interested to hear if any studies are in the works about radiation exposure among young athletes.

The NFL is making a push to be cautious about head injuries, and caution (or call it defensive medicine) has been blamed as a root cause for the radiation overexposure in many patient populations. A 2009 study from the National Cancer Institute projected 29,000 excess cancers from the 72 million CT scans that Americans got in 2007 alone. Nearly 15,000 of those cancers could be fatal. This is a topic with legs because of the continual, explosive growth in the number of imaging studies and increasing use of clinical analytics to analyze the consequences of imaging studies.

I recently spoke with Paul Merrild, senior vice president of marketing and corporate strategy at Merge Healthcare, who mentioned that the Imaging eOrdering Coalition is working to develop standards for the appropriateness of ordering imaging exams, medical necessity and other issues surrounding the use of imaging. Merrild also noted that the lack of interoperability is a real obstacle when it comes to addressing overexposure because many providers, lacking access to prior exams, have to repeat the process. There are a lot of issues, from I.T. to physician practice patterns, that need to be addressed before health care gets a handle on this situation. Merrild said there’s a growing body of evidence that supports the benefits of increased image utilization—overall clinical cost savings, heading off invasive surgeries, catching cancers and other diseases in the early stages—but acknowledged at this juncture that's all easy to say yet still hard to prove.

 

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