HealthLawProf Blog

Editor: Katharine Van Tassel
Akron Univ. School of Law

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Friday, February 28, 2014

Continued Skepticism re "Wellness Programs"

A big part of the job of being a Health Law Prof is to help students understand the intersection of the many legal specialties that comprise the big tent of "Health Law."  Wellness Programs are a good way of doing that because one of the key features of the Affordable Care Act is the flexibility it provides employers to link the cost their employees pay for health insurance with the individual employee's participation in a company sponsored "welleness program."  Here's an article I wrote explaining how PPACA went about doing that.  Here's a link to the Department of Labor's summary of the current rules and a good overview by the law firm Nixon-Peabody.  This report from Rand is an overview of what these programs are and how companies have increasingly fallen in love with them.   At this point just about every insurance company is offering to create one--here's some information from Aetna.  

The problem is, there's very little evidence that these programs do anything to demonstrably improve health (whatever that may mean).  And quite a bit that they may promote many different kinds of social injustice.

 This article in the Harvard Business Review does a great job describing the kinds of programs that are now descending on employees and how they are creating disatsifaction without any scientifically supportable improvement in "health."

There is also a growing literature suggesting that these programs may disproportionately discourage workers who employers aren't that unhappy to see go--but might not legally be able to actually fire.  Here is some very interesting testimony by Jennifer Mathis Director of Programs, Bazelon Center for Mental Health Law
On Behalf of the Consortium of Citizens with Disabilities.

Michelle Mello at Harvard has coined the term "life-style discrimination" to describe the ways Wellness Programs may target individuals employers may perceive as undesirable because they are obese, smoke or have other non-job related characteristics.

Studying Wellness Programs--and the issues they raise--can be an accessible entry point for students who can easily be intimated by the regulatory complexity of health law and can also be a bridge to understanding how fundamentally the Affordable Care Act has affected the way health care will be paid for and delivered as our students begin their careers in advising those struggling to implement these new regulations.

 

 

 

 

February 28, 2014 in Access, Affordable Care Act, Consumers, Coverage, Disabilities, Effectiveness, Employer-Sponsored Insurance, Genetics, Health Care, Health Care Costs, Health Care Reform, Health Law, Health Reform, HHS, Insurance, Mental Health, Obesity, Policy, Politics, PPACA, Prevention, Public Health, Quality, Reform, Workforce | Permalink | Comments (0) | TrackBack (0)

Thursday, February 27, 2014

Welcome to Guest Blogger Associate Professor Ann Marie Marciarille

HealthLawProf Blog extends a warm welcome to the second of our two guest bloggers for March, Associate Professor Ann Marie Marciarille:

MarciarilleAnn Marie Marciarille is an associate professor of law specializing in health care law. Her research interests are in health care regulation and finance with a particular interest in health care reform. Before joining UMKC, she had a long career as health law attorney, including 10 years as a health care antitrust prosecutor for the California Attorney General’s office and several years as a legal services attorney specializing in health care matters.  

Professor Marciarille is a summa cum laude graduate of Amherst College and a cum laude graduate of Harvard Law School, where her studies were focused on public interest representation.  She also holds a Masters in Theology, specializing in ethics, from Harvard Divinity School. 

She has published articles on Medicare reform, health care finance reform and health care provider quality issues. Professor Marciarille taught Health Law, Health Care Reform, Elder Law, Disability Law,  and Public Health Law at the University of California, Hastings College of the Law, Boalt Hall/Berkeley Law School and Pacific McGeorge School of Law.

[KVT]

February 27, 2014 | Permalink | Comments (0) | TrackBack (0)

Welcome to Guest Blogger Professor Jonathan Kahn

HealthLawProf Blog is very pleased to welcome the first of our two guest bloggers for the month of March, Professor Jonathan Kahn:

KahnJonathan Kahn is Professor of Law at Hamline University School of Law.  He holds a Ph.D. in U.S. History from Cornell University and a J.D. from the Boalt Hall School of Law, University of California, Berkeley.  His current research focuses on the intersections of law, race, and genetics, with particular attention to how regulatory mandates intersect with scientific, clinical and commercial practice in producing and classifying genetic information in relation to racial categories.  He is the author of Race in a Bottle:  The Story of BiDil and Racialized Medicine in a Post-Genomic Age (Columbia University Press, 2012). 

You may view his research on his SSRN Author page:  http://ssrn.com/author=180388 

[KVT]

 

February 27, 2014 | Permalink | Comments (0) | TrackBack (0)

Petrie-Flom Seeks to Hire Sr. Law & Ethics Assoc. for New NFL Players Assn. Project

From the Petrie-Flom Center:

In connection with our work on a sponsored research project with the National Football League Players Association, the Petrie-Flom Center seeks to hire a Senior Law and Ethics Associate immediately; please note that this is a distinct position from the one we recently advertised working with Harvard Catalyst on clinical and translational research.  

We are seeking a full-time doctoral-level hire (J.D., M.D., Ph.D., etc. in law, ethics, public health, social science, or other relevant discipline) with extensive knowledge of and interest in legal and ethical issues related to the health and welfare of professional athletes.  The position will be funded for at least two years, with renewal likely for an additional year or more.

View the full job description and apply here

Please share this announcement with interested candidates. For questions, contact petrie-flom@law.harvard.edu or 617-496-4662.

February 27, 2014 | Permalink | Comments (0) | TrackBack (0)

Guest Blogger Associate Professor Laura Hermer: A Return to Hard Paternalism

Hermer1As I wrote in an earlier post, Pennsylvania is seeking to predicate an agreement to participate in the Affordable Care Act’s Medicaid expansion on receipt of a federal waiver that would allow the state require “able-bodied” members of its proposed Medicaid expansion population to be either employed or actively seeking work. A number of Missouri legislators are now making a similar, harsher proposal in a new expansion bill. HB 1901, co-sponsored by Reps. Torpey, Barnes, Grisamore, Hampton, Higdon, Molendorp, and Walker, would extend benefits to adults under the age of 65, but directs the department to “apply for a Section 1115 waiver to require workforce participation of individuals otherwise eligible for MO HealthNet such that eligible individuals who are not elderly, disabled, or medically frail shall provide proof of workforce participation. Individuals who fail to provide proof of workforce participation shall be deemed ineligible.”

While the provision is apparently intended to apply only to the expansion population, the language used to describe that population – “all individuals otherwise eligible for MO HealthNet” – renders that interpretation ambiguous. But regardless of its actual referent, work ought never to be an appropriate requirement to impose upon Medicaid beneficiaries. While not all uninsured individuals in the national expansion population work, most do. And employment may not be reasonably feasible for at least some of those who are unemployed, due to disability, caretaking responsibilities, or other issues.

One might argue that a work requirement ought not to be any hardship to those who in fact are employed. However, imposing a work requirement for Medicaid is offensive to all Medicaid beneficiaries. It assumes that, unlike those who have some other source of health coverage, Medicaid beneficiaries are lazy, freeloading, or irresponsible – that if only they lived their lives appropriately, they would be able to get coverage on their own through a respectable and more generously compensated job. It is akin to state laws requiring drug testing for cash welfare applicants. Even though at least one study found that a smaller percentage of welfare recipients in Florida tested positive for drugs than the general population, all welfare applicants are damned as suspected drug addicts through the requirement. The U.S. District Court for the Middle District of Florida recently struck down Florida’s drug test requirement for cash welfare applicants, holding it to impose an unconstitutional warrantless and suspicionless search. While obviously not constitutionally analogous, work requirements share a number of similar, spurious policy justifications, and as such should be rejected.

-Guest Blogger Associate Professor Laura Hermer

February 27, 2014 | Permalink | Comments (0) | TrackBack (0)

Tuesday, February 25, 2014

Fifth Annual Legal Scholars Conference

On March 14-15, 2014, Arizona State hosts the Fifth Annual Legal Scholars Conference:

The purpose of the conference is to gather together “juniorish” academics (generally, those who have been in the academy for fewer than 10 years) to receive constructive feedback on their scholarship, to network, and to enjoy Arizona’s March weather!

We charge no registration fees and provide for free: (1) dinner and drinks the night before (Friday March 14th); (2) a spring training game (Cubs vs. Dodgers) or outing to the PHX Zoo for interested attendees; and (3) breakfast and lunch the day of the conference (Saturday March 15th). Attendees, however, must cover all travel and hotel costs.

Each registrant will be asked to submit something for comment and feedback. The paper can be a draft of a work in progress, a recently accepted piece, or even just a half-baked idea; the only limitation is that it should not be a piece that is already published (because the whole point of the conference is to get feedback to improve the piece). Based on the subject of the paper, each conference attendee will be assigned to a group of other attendees with similar scholarly interests. The members of each group will read the papers of the other members of the group, and then provide feedback on those papers. In the past five years, we have had more than 200 law professors from around the country attend and exchange ideas—join this ever-growing group and come to the conference on March 14 & 15th!

If you have any other questions, feel free to email Dean Doug Sylvester at douglas.sylvester@asu.edu.

Hat tip Paul Caron

February 25, 2014 | Permalink | Comments (0) | TrackBack (0)

Global Health Governance: Call for Submissions for special issue on Framework Convention for Global Health

Global Health Governance will be publishing a special issue on a proposed Framework Convention on Global Health (FCGH) in December 2014. The proposal for an FCGH would create a new international framework, grounded in the international human right to health, that would support health at the national and global levels.

For this FCGH special issue, Global Health Governance invites submission of theoretical and empirical policy research articles that examine and analyze how the FCGH could improve health through improved governance and realization of the right to health. We have particular interest in articles on 1) defining and articulating the underlying normative aspects of the FCGH and the prospects of implementing these norms across global, national, and local levels; 2) global health diplomacy and the process of drafting a Framework Convention; 3) institutional and political implementation concerns; 4) the roles of and relationship between state and non-state actors in the formulation and implementation of the FCGH; 5) the connection between existing norms and institutions and the FCGH; 6) strategies and challenges for integrating the norms of the FCGH into existing global, national, and local institutions; 7) accountability under the FCGH; and 8) strategies and challenges for using the FCGH to reshape or build on existing global, national, and local institutions to advance health equity and realization of the right to health. We welcome diverse perspectives on the FCGH, including articles that are supportive or critical of this proposed Framework Convention, as well as articles that propose innovative or alternative models to address global governance for health.

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February 25, 2014 | Permalink | Comments (0) | TrackBack (0)

Monday, February 24, 2014

Guest Blogger Associate Dean and Professor Elizabeth Pendo: Consumer Ratings of Accessible Health Care Offices and Facilities

PendoLearning where people with disabilities seek care, as well as the physical, equipment, and attitudinal barriers they face there, is important.  Section 4302 of the Affordable Care Act (ACA) requires the Department of Health and Human Services (HHS) to identify locations where individuals with disabilities access primary, acute, and long-term care, the number of providers with accessible facilities and equipment, and the number of employees trained to care for patients with disabilities. Unfortunately, there has been little progress on this requirement.

Surveys and interviews with patients with disabilities should play a role in this effort.  Last week, I shared a study that used a secret shopper method to quantify the lack of access to subspecialists for people with mobility impairments.  Other studies of health care offices and facilities, summarized in my prior work here and here, have documented similar barriers, including architectural obstacles and a lack of accessible medical and diagnostic equipment.  The studies also reveal a lack of awareness and knowledge about the American with Disabilities Act’s (ADA) requirement of equal access in the health care setting.  Accordingly, HHS should not rely on surveys of providers alone, and instead should incorporate other methods, such as surveys and interviews of patients and independent, on-site inspections.

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February 24, 2014 | Permalink | Comments (0) | TrackBack (0)

Published This Week

Guest Blogger Professor Sharona Hoffman: Privacy vs. Data Use - How to Balance Competing Goals

Sharona HoffmanI am spending a sabbatical semester as a scholar in residence at the Centers for Disease Control and Prevention (CDC).  Several CDC employees have told me that they worry that the public outcry against the National Security Agency’s (NSA) surveillance practices will transform into public opposition to the government’s efforts to use medical records for research and public health purposes.  Indeed, long before revelations about NSA surveillance, privacy advocates expressed grave concerns about the privacy implications of health information technology.  What I want to emphasize in this posting is that while informational privacy must be safeguarded in every possible way, we ought not prioritize it to such an extent that it prevents us from enjoying the considerable benefits of data analysis.  Rather, we should promote both privacy protection and data use simultaneously.

 

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February 24, 2014 | Permalink | Comments (0) | TrackBack (0)

Friday, February 21, 2014

Tax credits in federal exchanges upheld in Virginia

In a concise opinion, Judge Spencer of the Eastern District of Virginia upheld the IRS regulations facilitating tax credits for insurance purchased through federally-run health insurance exchanges.  The decision in King v Sebelius cited frequently to Halbig v. Sebelius (which I wrote about briefly here) and proceded much as that decision did.  The plaintiffs were individuals who would have been exempt from purchasing health insurance on the Exchanges but for the tax credit offered by the federal government for purchasing health insurance.  Their argument was that the ACA only permits tax credits for insurance purchased on state-based exchanges, not federally-run exchanges.  Judge Spencer, like Judge Friedman, analyzed the IRS regulations under Chevron's first prong and found that the statute was clear in its intent to create premium tax credits for all Americans purchasing health insurance, regardless of the purveyor of the exchange.  Although the court found the statute to be unambiguous, it analyzed the second Chevron prong and found that deference would be appropriate if it were at issue.  The court noted that the plaintiffs' claims rendered many absurdities in the ACA that were too tenuous to bear serious consideration, and it granted the United States' request for summary judgment. 

The Halbig and King decisions are on solid legal footing, and they have both noted the absurdity of the statutory interpretation being driven by Adler and Cannon.  Once again, the real question is what will happen next.  Briefs were already submitted in the Halbig appeal.  An appeal in King would not be surprising.  And, the decision in NFIB v. Sebelius revealed that the Supreme Court is not above absurd statutory interpretation.  (Refresher: the Medicaid expansion was not "Medicaid enough" to pass the Court's new coercion doctrine, but it was "Medicaid enough" for the remedy of severing the Secretary's power to enforce the Medicaid expansion against the states, which was found in the original Medicaid Act.  See my co-authored work with Weeks Leonard and Outterson, here.) 

February 21, 2014 | Permalink | Comments (0) | TrackBack (0)

Thursday, February 20, 2014

Max Mehlman: 2014 McDonald Merrill Ketcham Awardee for Excellence in Law & Medicine

The Hall Center for Law and Health at Indiana University McKinney School of Law is proud to welcome Professor Maxwell Mehlman to receive the McDonald Merrill Ketcham Award for Excellence in Law & Medicine for 2014. For more details please see here.

Professor Mehlman serves as Distinguished University Professor, Petersilge Prof. of Law and Director of the Law-Medicine Center, Case Western Reserve School of Law, and Professor of Biomedical Ethics, Case Western Reserve School of Medicine. His lecture is entitled "Are Physicians Fiduciaries for Their Patients?" Professor Mehlman will then join a panel discussion on the topic. The panelists are Mary Ott, M.D., M.A., AssociateProfessor of Pediatrics, Indiana University School of Medicine, Joshua Perry, J.D., M.T.S., Assistant Professor of Business Law and Ethics and a Life Sciences Research Fellow, Indiana University Kelley School of Business (Bloomington) and Mark Rothstein, J.D., Herbert F. Boehl Chair of Law and Medicine, University of Louisville Louis D. Brandeis School of Law, and Director of the Institute for Bioethics, Health Policy, and Law, University of Louisville School of Medicine.

February 20, 2014 | Permalink | Comments (0) | TrackBack (0)

Wednesday, February 19, 2014

ERISA and cutbacks in retiree life insurance

Life insurance provides important financial support for surviving family members when income-providers die.   Although the surviving spouse is entitled to a Social Security widow(er)’s benefit—the Social Security benefit amount of the deceased spouse, if greater than the benefit amount of the surviving spouse—death may bring a significant drop in Social Security income.  If couples were each receiving equal Social Security benefits, for example, the survivor will receive only half of what they were receiving as a couple—but it is unrealistic to expect that expenses will be cut in half by the death of one spouse.  Yet life insurance receives far less statutory protection than health insurance; for example, the Genetic Information Non-Discrimination Act does not apply to either life or disability insurance.  A recent 6th Circuit decision concluded that ERISA did not protect retirees against cutbacks in life insurance when employer promises were ambiguous. Haviland v. Metropolitan Life Ins. Co., 730 F.3d 563 (6th Cir. 2013). 

The plaintiffs in Haviland were General Motors retirees who had been salaried employees.  GM reduced their life insurance benefits to a maximum of $10,000. Some 42,000 of these retirees, those retiring between October 1, 1997, and December 1, 2011, have also faced pension plan changes; on June 1, 2012, these retirees were offered the choice of taking a lump sum benefit (supposedly calculated to be the actuarial equivalent of their prior defined benefit plan) or an annuity purchased by GM from Prudential.  These retirees and their surviving spouses also lost GM health care benefits and Medicare part B payments at the age of 65, although with an offset of $300/month presumably to cover increased health care costs.  So it is understandable that they were concerned about the additional cutback in the financial buffer provided by life insurance in case of death.

GM’s promises to retirees sent conflicting messages.  On the one hand, GM reserved the right to make changes in the plan.  On the other hand, the letter from Metropolitan Life, the issuer of the life insurance policy, stated that the plan “will remain in effect for the rest of your life,” without any further payment.  The plaintiffs contended that MetLife had violated its obligations under ERISA when the plan changed.  As important background, ERISA preempts state law claims, so plaintiffs’ state law claims such as breach of contract were dismissed; and ERISA does not provide vesting standards for life insurance, health insurance, or other benefits coming under the “welfare” plans provisions of the statute rather than the pension provisions.  The 6th Circuit rejected all of the plaintiffs’ claims.  For example, although recognizing that promissory estoppel claims can be brought against ERISA plan fiduciaries, the court limited this possibility to cases in which the plan documents did not unambiguously reserve the right to alter plan benefits.  The court also concluded that GM had not violated ERISA fiduciary duties in what plaintiffs had been told; at the time the letters were sent, they correctly represented the plan in place at the time, even though the plan was subject to later change.

Retiree benefits impose costs that in many cases are considered to be unsustainable.  However, individuals cannot undo retirement; once retired, they and their spouses are stuck with the circumstances of their retirement.  Employers, by contrast, are not stuck, at least with welfare plans when they have reserved rights to change or discontinue.  This asymmetry with respect to retiree welfare plans will only continue to exacerbate the impoverished economic circumstances of many retirees.

[Leslie Francis]

February 19, 2014 | Permalink | Comments (0) | TrackBack (0)

Monday, February 17, 2014

Published This Week

Institute for Law Teaching and Learning 2014 Spring Conference: Assessment Across the Curriculum

“Assessment Across the Curriculum” is a one-day conference for new and experienced law teachers who are interested in designing and implementing effective techniques for assessing student learning.  The conference will take place on Saturday, April 5, 2014, at the University of Arkansas at Little Rock William H. Bowen School of Law in Little Rock, Arkansas.

Conference Content:  Sessions will address topics such as

·         Formative Assessment in Large Classes

·         Classroom Assessment Techniques

·         Using Rubrics for Formative and Summative Assessment

·         Assessing the Ineffable: Professionalism, Judgment, and Teamwork

·         Assessment Techniques for Statutory or Transactional Courses

By the end of the conference, participants will have concrete ideas and assessment practices to take back to their students, colleagues, and institutions.

Who Should Attend:  This conference is for all law faculty (full-time and adjunct) who want to learn about best practices for course-level assessment of student learning.

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February 17, 2014 | Permalink | Comments (0) | TrackBack (0)

Guest Blogger Associate Professor Laura Hermer: Getting Reform Through Reform: “Let’s Make a Deal”

Hermer1Bill Sage and David Hyman offer an interesting proposal in “Let’s Make a Deal: Trading Malpractice Reform for Health Reform,” in last month’s issue of Health Affairs. Traditional tort reform is a perennial issue that will surely arise again during the next medical liability insurance crisis. Rather than wait for that crisis, why not use traditional tort reform now, when we have the luxury to think about it, and use it as a bargaining chip with which to attain other, arguably far more important, systemic concessions from American physicians? We could, they argue, institute traditional liability reforms (hewing, e.g., to California’s MICRA) in exchange for substantial payment and/or delivery reform, such as replacing fee-for-service with bundled, episodic payments and mandating participation in accountable care organizations or other coordinated care delivery models, requiring greater public transparency concerning medical errors, or setting aside opposition to provision of primary care services by non-physician providers. Improvements to payment and delivery systems are not inevitable, and so offering liability reforms would help sweeten the deal.

I wonder, though, if such concessions would be productive. They may indeed yield the results Sage and Hyman hypothesize. Many physicians view MICRA-style reforms as the “gold standard,” and would like to see them instituted nationwide. Such measures have been found by a number of researchers to reduce liability insurance premiums. However, physicians in states that have instituted them or measures like them report that they still worry about lawsuits, even if perhaps less so than physicians in other states. They still practice defensive medicine. And health care costs remain as high as ever.

MICRA-style reforms, in other words, may sound good to physicians but ultimately offer far less than they promise. The reforms suggested by Sage and Hyman, on the other hand, have real potential to improve health care quality and costs, yet at the same time will also likely produce substantial changes in how physicians practice and are compensated – changes that many physicians will likely experience as negative.  It is true that major physician organizations have been quite supportive of changes proposed to the SGR and have expressed support for certain ACA demonstration projects. Yet individual physicians appear more skeptical. According to a 2010 Physicians Foundation survey, for example, a substantial majority of individual physicians expressed negative views about the impact they expected the ACA to have on their workload and earnings, and about specific ACA demonstration projects such as bundled payments. These fears might not be misplaced, as it is quite possible that some of these reforms may result in not only changes in physician revenue and incentives, whether positive or negative, but also, in the worst case, a burdensome bureaucratization of clinical practice and strictures on innovation.

Giving physicians what they want – traditional liability reform – in exchange for payment, delivery, and other reforms won’t likely make them happy, at least not in the long run. Would a genuine possibility for greater autonomy and substantially decreased administrative burdens offer a better route to success? Will we have to wait for a generational change among practicing physicians before we see a more general acceptance, let alone embrace, of reform?

Guest Blogger Associate Professor Laura Hermer

February 17, 2014 | Permalink | Comments (0) | TrackBack (0)

Guest Blogger Professor Sharona Hoffman: The Costs of Falling When Elderly

Sharona HoffmanAt the age of 93, my mother-in-law, who lives alone, fell and broke her ankle in three places.  We knew that after her hospitalization, she would need to be in a rehabilitation facility until, hopefully, she regained mobility. 

 But on her first full day in the hospital we received terrible news:  my mother-in-law was under observation rather than admitted, and thus was considered to be an outpatient.  What this meant, was that she would incur co-payments for doctors’ fees and hospital services and would have to pay for the many drugs she ordinarily takes at home that were now being provided by the hospital.  Worst of all, my mother-in-law would not be eligible for Medicare coverage for her follow-up rehab care in a nursing home because Medicare patients must spend three consecutive days as admitted patients in a hospital to be eligible for  such coverage.  In some sense, we were lucky to find out that she was only under observation, because hospitals are under no obligation to inform patients of this consequential fact.  After much begging and pleading, the hospital admitted her, much to our relief.

Recently, the Centers for Medicare and Medicaid Services issued its “two midnight rule,” which will be enforced starting in October of 2014.  The rule establishes that doctors should admit patients if they expect their stays to last through two midnights, but to list those expected to stay for less time as being under observation. Many have criticized this rule as arbitrary because it will advantage individuals who arrive shortly before midnight (they are more likely to stay a second midnight) and disadvantage those who arrive shortly after midnight, but the rule, at least, provides some clarity.

Were my mother-in-law’s financial concerns over once she was admitted?  Far from it.  Patients who meet Medicare requirements can receive 20 days of free nursing home care per benefit period and then pay a daily co-pay for days 21-100 (up to $152 per day in 2014), after which no Medicare funds are available until the next benefit period.  Those who “spend down” their assets may meet Medicaid eligibility for full nursing home benefits. But “spending down” is a fairly literal term and requires one to drain most assets other than one’s home, personal effects, and vehicle. Detailed guidelines determine Medicaid eligibility, but typically, single people must have no more than $2,000 in “countable resources” (cash, financial accounts, stocks, bonds, available assets in trust).

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February 17, 2014 | Permalink | Comments (0) | TrackBack (0)

Pit Crews with Computers: Can Health Information Technology Fix Fragmented Care?

I recently posted a new piece that uses technology as a lens for examining some of the fragmentation and coodination problems exhibited by the healthcare system. Here's the abstract.

Fragmentation and lack of coordination remain as some of the most intractable problems facing health care. Attention has often alighted on the promise of Health care Information Technology not least because IT has had such positive impact on many other personal, professional and industrial domains. For at least two decades the HIT-panacea narrative has been persistent even though the context has shifted. At various times we have been promised that patient safety technologies would solve our medical error problems, electronic transactions would simplify healthcare administration and insurance and clinical data would become interoperable courtesy of electronic medical records. Today the IoM is positioning HIT at the center of its new “continuously learning” health care model that is in large part aimed at solving our fragmentation and lack of coordination problems. While the consensus judgment that HIT can reduce fragmentation and increase coordination has intuitive force the specifics are more complicated. First, the relationship between health care and IT has been both culturally and financially complex. Second, HIT has been overhyped as a solution for all of health care’s woes; it has its own problems. Third, the HIT-fragmentation solution presents a chicken-and-egg problem — can HIT solve health care fragmentation and lack of coordination problems or must health care problems such as episodic care be solved prior to successful deployment of HIT? The article takes a critical look at both health care and HIT with those questions in mind before concluding with some admittedly difficult recommendations designed to break the chicken-and-egg deadlock.

February 17, 2014 in Electronic Medical Records, Health Care Costs, Health Care Reform, Health Economics, Health IT, Patient Safety, Quality Improvement | Permalink | Comments (0) | TrackBack (0)

Tuesday, February 11, 2014

Published This Week

2014 Call for Proposals: American Society for Bioethics & Humanities 16th Annual Meeting

The American Society for Bioethics & Humanities's call for proposals is now live.

Program Theme: Inclusive & Interprofessional: Bioethics & Humanities?

Bioethics and the health humanities purport to offer guidance on how to act ethically in collaboration with patients, their families and support circles, and within the health care system. As fields of study and practice, they call attention to power and disparities, from the classroom to the clinic. They expose injustice and act to right wrongs. But how well do bioethics and the health humanities truly recognize power and privilege? They are inclusive, but how well do they represent differences in identity, such as race and ethnicity, disability, sexuality, gender, and socio-economic status? They are multi-disciplinary, but are they interprofessional? This annual meeting is dedicated to three questions: 1. How inclusive and interprofessional are bioethics and the health humanities? 2. How inclusive and interprofessional can we become? 3. How can we improve practice, education, and health for all, through attention to inclusion and interprofessionalism?

The call for proposals will close at 11:59 pm Central Time, Thursday, March 6, 2014. No proposals or changes will be accepted after that time. The ASBH office closes at 5 pm CT and no live assistance will be available after that time.

Questions? Call 847-375-4745 or email info@asbh.org.

February 11, 2014 | Permalink | Comments (0) | TrackBack (0)