Monday, 18 December 2017

What Saying Goodbye to Net Neutrality Means for Healthcare

On November 12, the FCC put an end to protections that stopped service providers from charging different amounts of money to stream different kinds of content. Net neutrality protections bar internet service providers, or ISPs, from blocking, slowing, or providing preferred treatment to particular sites and services. The rules are designed to prevent ISPs from charging companies for transmitting their website and/or transmitting data to their customers, from censoring content, or even from blocking websites altogether. ISPs now have the right to control access and to discriminate.

These changes, therefore, will allow ISPs to charge healthcare service providers additional money for transmitting life-saving data ahead of movies, "snapchats", or any other content provided by those who pay a premium for faster internet access and services. Most of the recent legislation covering technology and healthcare focused on Electronic Medical Record system (“EMR”) implementation, the patient’s right to access their data, and the requirement that providers change from fee for service reimbursement to value-based care. All of these require data access to be successfully implemented. The emphasis on delivering services at home to patients also requires providers have access to data from remote locations. The assumption behind value-based care assumes real-time access to data through the internet. Implementation of these programs are a work in progress.

Today, most patient data is housed in electronic medical record systems. Each facility has its own EMR and, for the most part, none of these systems talk to each other. Even though the law clearly provides for a patient’s absolute right to their medical data, the siloed nature of these systems allows the EMR companies to believe that they have the right to control access to the patient data contained within them. Medical providers are given controlled access to their data only to data on an EMR they purchased. Anyone that does not have direct access to an EMR system, the patient and those involved with the care of the patient, only have access to their data if they physically retrieve it. The system works badly. Congress has made an attempt to fix this problem. Interoperability and electronic access to data has now been mandated. Though not surprising, EMR companies are fighting its implementation.

Congress also passed legislation that moved us from fee for service reimbursement to value-based care. The ability to calculate value requires large amounts of patient data. The ability to aggregate health system data from all disparate Electronic Health Records being used within a given health network is a requirement to determine the quality and the relative performance value of providers.

As part of the move to value-based care, patients are receiving more of their care at home and reporting on the results to their providers. Telehealth, health monitoring on site by the patient or by a caregiver, the use of apps to replace different types of therapy, all are being introduced to reduce costs and increase care quality.

Net neutrality meant that your healthcare data did not have to stand in line behind companies and service providers who pay for faster speed and priority access. It meant that the notification to the hospital from your home EKG unit that you are having a heart attack would not have to stand in line behind someone’s streaming video.

This will no longer be the case. Ability to access data, not on your own EMR system can be so slow, it is painful; patient portals to review data will not operate in real time. Use of applications that transmit data to providers will become less and less valuable without the ability to provide immediate feedback on a patient’s condition.

EMR companies are fighting tooth and nail to block interoperability and to prevent access to their systems by anyone but the provider who paid for it. Eliminating net neutrality gives them another tool in the box to block interoperability. Their ability to purchase the right to exclude shared data without paying a fee to them will make it more difficult for patients to have access to their own medical data.

Priority access will go to people who have the deepest pockets. In healthcare, insurance companies have the deepest pockets. It is extremely unlikely that insurance companies will reimburse providers for the cost of access to faster data. Since insurance companies are unwilling to increase reimbursements to hospitals for these increased costs and hospitals work on razor thin margins; hospitals are unlikely to be able to absorb the costs of priority access.

So if the consumer can’t pay more, and the hospital can’t pay more and the insurance company won’t pay more, priority data access is not going to be provided, even for life-saving communications.

Unless Congress acts, we the people have no recourse or no options to turn this around.

You can’t put supporting the poor and the rich and the government on the back of the middle class.

Minda Wilson

Author of Urgent Care

Follow me Minda Wilson on:

Twitter: https://twitter.com/_mindawilson

Facebook: https://www.facebook.com/MindaWilsonUSA

Instagram: https://www.instagram.com/mindawilsonusa/

Youtube: https://www.youtube.com/channel/UCr5xVaCsB82XJAsRvNmuThw

Sunday, 22 January 2017

Trump's Executive Order Could Dismantle Parts Of ACA Before Replacement Is Ready Minda Wilson responds

Trump's Executive Order Could Dismantle Parts Of ACA

Before Replacement Is Ready

President Donald Trump, fulfilling a campaign promise to start to repeal Obamacare on Day 1, signed an order directing federal agencies to waive enforcement of large swaths of the law.

The one-page order allows the head of the Department of Health and Human Services or any other agency with authority under the law, not to enforce regulations that impose a financial burden on a state, company or individual.

It's so broad it could allow many of the law's provisions, including many of taxes it imposes on insurers and the requirement that individuals buy insurance, to die from lack of enforcement.

The order is an important political act for Trump, who pledged throughout his campaign that he would act quickly to roll back the health care law. Its reach, however, depends upon exactly which provisions he decides to target.

The order comes as Trump's pick to lead the Department of Health and Human Services, Rep. Tom Price, R-Ga., is awaiting his confirmation hearing and vote, which could come within days or weeks.

It's unclear how much of this order could be carried out before Price, if he's confirmed, is installed at HHS.

Trump's order also pushes one of his favorite health care ideas — to allow insurance companies to sell policies across state lines — by encouraging "the development of a free and open market in interstate commerce for the offering of healthcare services and health insurance, with the goal of achieving and preserving maximum options for patients and consumers."

It lands just as members of Congress are working to repeal and replace the Affordable Care Act.

Trump and Republican lawmakers have promised that any repeal would be followed immediately by a replacement for the law and they've said that anyone who has insurance through the ACA will not lose it in the transition.

"While President Trump may have promised a smooth transition, the Executive Order does the opposite, threatening disruption for health providers and patients," said Leslie Dach, director of the Protect our Care Coalition, a group of organizations trying to save the Affordable Care Act.

Health policy analysts have warned that repealing the unpopular parts of the law such as the taxes or individual mandate could lead to the collapse of the individual health insurance market. This executive order could allow those provisions to be rolled back before a replacement bill is ready.

Republicans in Congress have laid out a number of broad road maps for a new health care law but have yet to reveal a specific bill that would show how many people will get insurance coverage or how much it might cost.

Here are my thoughts on this:-

"This is good news. Local hospitals have been closing in droves. If things continued on their current course 20% of hospitals are expected to close by 2020. The reason is that administrative costs made the operating at a profit prohibited. For most hospitals one in every three dollars they receive in revenue is spent on administrative costs. It used to be one in every four. The elimination of these administrative costs could mean the difference between your local hospital closing or keeping its doors open."