Continue reading »]]> by Wayne W. Oliver,  Executive Director, Patients for Fair Compensation
Originally published in Atlanta Journal Constitution, May 10, 2013

For years now, we have held on to the hope that health information technology (health IT) solutions would translate into better health outcomes. We have indeed seen signs that physicians and hospitals which deploy health IT solutions like electronic health records (EHRs) provide better care.

We have also hoped that the day of an interoperable platform would allow healthcare professionals and facilities to access individual patient’s health information. Some progress has been made in a couple of states in terms of creating a legitimate health information exchange (HIE). However, the process of building, implementing and sustaining an HIE needs accelerating in most states including Georgia.

But as data is gathered, stored and analyzed, we have new, emerging opportunities which have promise. The term “big data” has surfaced as a new buzzword in healthcare.

Data is growing and moving faster than healthcare organizations can consume it. Most medical data is unstructured but is very clinically relevant. This data resides in multiple places like individual EMRs, lab, pharmacy and imaging systems, physician notes, claims data, and finance. However, gaining access to big data in order drive clinical outcomes and utilize advanced healthcare analytics are critical to improving care, aligning incentives for patients and providers, and driving system-wide efficiencies.

Additionally, progressive healthcare organizations are leveraging big data technology to capture as much patient-specific information to get a more complete view for insight into care coordination and outcomes-based reimbursement models, population health management, and patient engagement strategies.

IBM has been on the forefront of creating big data technology solutions. Many of you may remember that IBM created a voice recognition, supercomputer named “Watson” (after IBM founder Thomas Watson).  Watson gained widespread notoriety two years ago by easily defeating two celebrated human champions on the TV quiz show Jeopardy!  Working with companies like WellPoint, Memorial Sloan-Kettering Cancer Center, GlaxoSmithKline, and Emory’s Winship Cancer Institute, IBM is using a series of Watson-based technologies to help transform the quality and speed of care delivered to patients.

For example, researchers at Emory’s Winship Cancer Institute are teaming with IBM to build a data-mining and analytics center. Emory is using the system to compare data from clinical trials of cancer patients with genetic data housed in public and private databases, in hope of devising innovative treatment plans for certain cancers that can be tailored to individual patient’s genetic profiles.

Bringing big data down to the individual patient level is exciting. And making personalized treatment plans for individual patients is the essence of personalized medicine.

Watson’s artificial intelligence was also well suited to help drug giant GlaxoSmithKline develop new medications. For example, Watson was able to sort through all of the available literature on malaria, research all known anti-malarial drugs and other known chemical compounds and suggest 15 new compounds as potential anti-malarial drugs. Big data technology solutions are really transforming healthcare.

IBM, WellPoint and Memorial Sloan-Kettering Cancer Center in New York have partnered to create an advanced clinical decision support system for oncologists.  WellPoint and Memorial Sloan-Kettering researchers, clinicians and technology experts spent thousands of hours “teaching” Watson how to process, analyze and interpret the complex clinical information. So far, Watson has digested more than 600,000 unique pieces of medical information, two million pages of text from medical journals, and results from various clinical trials in oncology research. Starting with 1,500 lung cancer cases, Memorial Sloan-Kettering clinicians and analysts are training Watson to extract and interpret physician notes, lab results and clinical research.

The opportunity for clinicians, researchers, and healthcare professionals to design treatment plans based off of big data analytics is a significant breakthrough. Offering patient’s hope through personalized, evidence-based medicine is becoming a reality.

The Health Section of the Technology Association of Georgia (TAG Health) is hosting an event on May 23 which will focus on big data and its applications. For more information on this event, click here.

By looking into the health data of millions of Americans and designing personalized treatment plans for individual patients which are specifically tailored for a unique patient is the future of medicine.

Continue reading »]]> End “defensive medicine” by going to a system like workers’ compensation.

By Wayne W. Oliver
A version of this article appeared March 20, 2013, on page A13 in the U.S. edition of The Wall Street Journal, with the headline: Kicking the Malpractice Tort Out of Court.

http://online.wsj.com/article/SB10001424127887323869604578366770324716616.html

March 23 marks the third anniversary of the passage of the most controversial legislation in a generation, the Affordable Care Act, better known as ObamaCare. As the federal law moves toward a more thorough implementation next year, states are grappling with the costs and obligations imposed on them, such as the need to establish health-insurance “exchanges” where low-income workers can obtain coverage.

Some states are also searching for ways, outside the scope of ObamaCare, to improve health care and lower costs. A promising idea that is gaining traction is to completely overhaul medical malpractice by kicking it out of courtrooms. Two states leading the way are Georgia and Florida, where lawmakers are considering repealing their medical tort system and replacing it with a medical-compensation board similar to those used for workers’ compensation. Bills for the Patients’ Compensation System have been introduced in both states.

Getting rid of the entrenched malpractice system could have a major impact on health-care spending because one of the biggest cost drivers is “defensive medicine.” Doctors tend to prescribe more tests and medicines and specialist referrals than necessary, all in an effort to protect themselves against malpractice accusations in the event that something goes wrong.
Defensive medicine occurs every day in doctors’ offices and hospitals. We all pay for it with higher insurance premiums and larger out-of-pocket expenses.

Gallup surveyed doctors in 2010 just as President Obama was pushing the Affordable Care Act. The survey found that one in four health-care dollars spent in the U.S. can be attributed to the routine practice of defensive medicine. According to the independent health-care-economics firm BioScience Valuation, the annual cost of defensive medicine in America today exceeds $480 billion.

The Patients’ Compensation System, or PCS, being studied in Georgia and Florida is a no-fault, administrative model for addressing medical injuries. Patients unhappy with their care would file a claim to a panel of health-care experts. If the panel found that a medical injury had occurred, the injured person would be compensated. Without the involvement of the current adversarial legal system—in which cases often drag on for years, only to be settled out of court—payments to the injured would come much faster, mostly likely in a matter of months.

The benefits of this system to taxpayers and patients would be enormous. According to BioScience Valuation, if the compensation system were adopted in Georgia, over the course of a decade with physicians stopping the practice of defensive medicine, the savings in Medicaid to state taxpayers would be $3.1 billion. In Florida, the estimated Medicaid savings would be $16.8 over the same period. The savings in private health plans would be considerable as well.

Patients who may have been harmed by a doctor would also have greater access to justice. Joanna Shepherd Bailey, an associate law professor at Emory University, has found that about half of trial attorneys in the United States refuse to take malpractice cases unless the potential damage awards are $500,000 or greater. Under the PCS, any patient who was found to have been harmed would be fairly compensated at a rate determined by the board.

Where would the money come from? Not from taxpayers. Instead, a fund would be created from malpractice premiums paid by medical providers. With no more litigation—and no more legal costs driving up the quest for big awards—large savings would inevitably result. The premiums paid by doctors would be substantially lower than the ones they currently pay.

No one can be surprised to learn that trial lawyers and malpractice-insurance carriers, who both profit handsomely from the current system, oppose the compensation concept.

As governors and state lawmakers have been demonstrating since President Obama signed the Affordable Care Act, innovative solutions to the nation’s health-care crisis are going to be found in the states. According to BioScience, the proposed Patients’ Compensation System, if adopted in 50 states, could save the American health-care system $2.6 trillion over 10 years.

Patients would know that they have access to quick redress if they are harmed. Doctors no doubt would be relieved to be able to stop practicing defensive medicine and focus all of their attention on taking the offensive against disease and illness.

Mr. Oliver is executive director of the nonprofit organization Patients for Fair Compensation.

Continue reading »]]> by Wayne Oliver – Healthcare Consultant
Originally published by the Atlanta Journal Constitution on January 4, 2013

As we ring in the New Year, many features of the Accountable Care Act (ObamaCare) will begin to take shape. State Benefit (Insurance) Exchanges will begin to unfold. The Medicare and Medicaid Innovation Center within HHS will continue to examine and support promising models of care delivery. Cost containment programs like Accountable Care Organizations (ACOs) will begin to reshape the way Medicare pays for healthcare services.

So what are Accountable Care Organizations (ACOs)?

ACOs are organizations created by either groups of doctors or hospitals that improve quality measures in five key areas that impact affect patient care:
• Patient (caregiver) experience and satisfaction;
• Care coordination;
• Patient safety;
• Preventive health; and
• At-risk population health management.

HHS wants to improve the quality of care Medicare patients receive. ACOs are seen as a way to drive improved care through better coordination of healthcare services for Medicare patients. ACOs were also created to provide a framework for a patient-centered model of care.
As part of the ACO strategy, Medicare will continue to pay providers under the traditional fee-for-service basis but have added a shared savings programs to encourage providers to improve care delivery. While doctors and hospitals are the driving forces behind the development of ACOs, other providers such as pharmacists are in a unique position to help ACOs achieve the goals of improving patient care.

As America’s most accessible healthcare professional, pharmacists are experts in prescription drug therapy, which is the most utilized of all Medicare healthcare services. Working closely with physicians in an integrated, ACO environment, pharmacists can help better manage chronic conditions like diabetes, asthma, and hypertension.

Proper management of these and other chronic conditions helps to reduce hospitalizations and readmissions to hospitals. Pharmacists’ participation in ACOs help to ensure the achievement of clinical and financial performance targets that demonstrate improved patient outcomes and lower health care costs.

Studies have consistently demonstrated that pharmacists who participate in team-based care models make positive contributions to the safe and appropriate medication use. Pharmacists are distinctively positioned in the health care system to help optimize appropriate medication therapy, improve patient adherence to prescription drug therapy, reduce medication related problems and improve health outcomes.

As the ACO model is adapted for non-Medicare patients, pharmacists will be pivotal in terms of improving care while reducing costs. Whether serving as a clinical pharmacist embedded in a primary care medical practice or community pharmacists working with hospitalized patients at discharge, pharmacists continue to make significant contributions to improved care at lower costs.

So are ACOs going to single handedly solve Medicare’s budgetary woes. Probably not, but they offer the hope of creating a patient centered system that can help patients better navigate a complex system of healthcare providers and professional healthcare services. It is this promise of better coordinated care with an emphasis on prevention, wellness, and patient safety that can help in the transformation of the US health delivery system … one Medicare patient at a time.

ACOs that create a patient centered model where physicians, hospitals, nurses, and pharmacists work collaboratively will be successful. And Medicare patients are the beneficiaries of improved care while taxpayers benefit from lower costs.

Continue reading »]]> The American healthcare system … isn’t.   It isn’t a “system.”

Patients have multiple providers. These providers rarely interact. The payment system operates in silos. And patient care isn’t coordinated.

This disjointed system is not a new challenge. In 1965, the federal government created Medicare, a program which provides coverage for certain services. Medicare Part A covers inpatient hospital services. Medicare Part B covers outpatient care like physicians’ services.

Forty years later, in 2006, the government launched Medicare Part D, which covers prescription medications. But the original Medicare program created payment and data silos for Parts A and B.  Today, Medicare Part D is administered by private pharmacy benefit managers (PBMs). And the three parts (Medicare A, B and D) rarely talk to each other or share information.

So, that’s the public sector.

The payment and health information silos, unfortunately, also exist in the private sector. Most of us are covered by some kind of health insurance which pays for physicians, hospitals, and diagnostic tests like x-rays or CT scans. But our dental plan is usually completely separate.  And our pharmacy program is typically administered by a pharmacy benefit manager (PBM).

This fragmentation – both healthcare services and payment – leads to many patient care challenges and conflicts.  Medicare Part D plan administrators (and PBMs) are laser-focused on keeping drug costs down.  As a result, they may not cover certain medications. Part D plans (and PBMs) are not impacted by – nor really care about – increased hospitalizations or more diagnostic tests. That’s not their problem. They care about keeping drug costs low. They don’t care if their decision to limit coverage of some medications results in increased physician or ER visits.

But just when we take two steps forward, we take two steps back.

Medicare Advantage plans are privately managed and provide comprehensive services from hospital care to medical care to pharmacy and diagnostic tests. These plans are integrated to ensure proper care coordination. Medicare Advantage plans have incentives to provide the best care to the patient. These plans are the two steps forward I referred to earlier.

To help pay for ObamaCare, the president and Congress cut Medicare Advantage funding by more than $700 billion.   Those are the backward steps.

The future of American healthcare is the promise of integrated systems where clinicians have access to patient data and payment models to reinforce coordinated care. Integrated systems do not create or reinforce silos of care.  Integrated systems destroy silos.  Patient care improves as a result.

Healthcare is just like everything else. More information is typically better than less.

You wouldn’t think about buying a car without the MPG or price or warranty information.

But in today’s non-integrated healthcare system, doctors don’t know what drugs other physicians have prescribed. Hospitals don’t know what tests and procedures have been performed on us as patients. And pharmacists don’t know if a patient has multiple prescriptions from multiple physicians for multiple controlled substances.

In integrated systems, more information is better. Physicians, pharmacists and other clinicians practice to the top of their licenses. Patients receive coordinated care that improves patient outcomes. And hopefully, because of health information technology, the American healthcare system can finally become a true “system” which drives and rewards performance, patient outcomes, and efficiency.

We need to break down more healthcare silos.

Continue reading »]]> Originally published in DC.CityBiz.
http://dc.citybizlist.com/article/rxally-appoints-wayne-oliver-vice-president-pharmacy-advocacy-and-government-relations

RxAlly, a first-of-its-kind alliance of more than 22,000 pharmacies nationwide, announced the addition of Wayne Oliver to the company’s leadership team.  Mr. Oliver will serve as Vice President for Pharmacy Advocacy and Government Relations.  In this role, Mr. Oliver will serve as liaison between RxAlly and its network pharmacies and federal, state and local governments. A recognized thought leader in the health care sector, Mr. Oliver has made hundreds of speeches and presentations on topics of health care and pharmacy, with a special focus on transformational solutions to a range of health care issues.  Mr. Oliver counts Governors, Members of Congress, State Legislators, and national leaders among those who have sought his consultation on health care policy.

Mr. Oliver’s background includes his role as Vice President at the Center for Health Transformation, founded by former Speaker of the House, Newt Gingrich, where he led the 21st Century Intelligent Pharmacy, Health Justice, FDA Modernization, and Health (Quality and Price) Transparency Projects.  Prior to his time at the Center for Health Transformation, Oliver was the lead lobbyist and chief spokesperson for the Georgia Pharmacy Association (GPhA) for 19 years and also served as the Managing Editor of the Georgia Pharmacy Journal. Additionally, Mr. Oliver was named an “Innovative Thinker” by the Center for Health and Learning, participated in the Great Ideas Summit sponsored jointly by Piedmont Hospital and Mercer University and was recently appointed to the Advisory Board for the Health Section of the Technology Association ofGeorgia (TAG).  Georgia Governor Sonny Perdue appointed Mr. Oliver to the Georgia Commission on Men’s Health, which serves as a catalyst to promote and improve the quality of the physical, social and mental health of men in the State of Georgia.

“RxAlly is confident that Wayne Oliver will help take us to the next level,” said Bruce Roberts, CEO of RxAlly. “His innovative approach and track record of creative health care solutions are right in line with what we hope to accomplish at RxAlly. We’re very excited to bring Wayne on board and continue developing the forward-thinking initiatives that will better serve patients and reduce overall health care costs.” “I am thrilled with the opportunity to work with a dynamic team like RxAlly that is so committed to bringing patients, payers and pharmacists together to deliver the highest quality health care solutions,” said Wayne Oliver, Vice President for Pharmacy Advocacy and Government Relations. RxAlly is a performance network of aligned pharmacies, united to help patients achieve better health through personalized pharmacist care while reducing costs.  The company was developed to provide a new solution to the critical issues of providing additional access to care and ensuring effective health care spending at a time when prescription medicine misuse is associated with $290 billion in annual costs. For more information, please visit: www.RxAlly.com, on Facebook, or Twitter.

About RxAlly With more than 22,000 member pharmacies nationwide, RxAlly has brought together the largest national network of pharmacies to improve health and lower costs. The RxAlly Performance Network of community pharmacies aims to improve health through personalized pharmacist care, clinical research and evidence-based clinical practices, and an interoperable technology platform. By advancing the role of pharmacists, RxAlly is facilitating new solutions as it leads an innovative approach to health care that aligns the interests of patients, pharmacists and payers. For more information, please visit us at: www.RxAlly.com , http://www.rxally.com/ on Facebook or Twitter .

Continue reading »]]> by Wayne Oliver – Vice President at RxAlly
Originally posted in the Atlanta Journal Constitution on November 8, 2012
http://blogs.ajc.com/health-flock/2012/11/08/we-need-more-mentors-in-america-today/

Giving back.  Paying it forward. We’ve all heard these expressions when talking about those who have experienced random acts of kindness like paying for the next driver’s toll or buying a stranger a cup of coffee. They are always appreciated and always bring an immediate smile to the face of the benefactor.

But, when someone has had such a profound influence over the way you critically think, over the way you process information and over the way you respond to life’s daily opportunities, that person is a mentor. We need more mentors in America today.

People walk into and out of our lives on a daily, weekly, monthly basis. But, mentors and their lessons last a lifetime. We should not discount the importance of mentors and of mentoring.

My first mentor, Larry Braden, was recently recognized by the National Community Pharmacists Association (NCPA) Foundation for his lifelong dedication to advancing pharmacists and, more specifically, to helping to reshape independent community pharmacists. I worked with Larry for ten years and he taught me the importance of active listening, effective communications, and deliberate reasoning. He also taught me you could do all of these things while be a gentleman. He is a consummate gentleman and has lived by the principles of being a gentleman – being respectful, honest, humble, civil, and staying strong – are all lifelong lessons. He is a much better gentleman than I will ever be. Thanks Larry.

Another mentor is former US House Speaker Newt Gingrich and founder of the Center for Health Transformation (CHT). Former Georgia Governor Sonny Purdue once described listening to Newt’s ideas as being as overwhelming as drinking from a fire hose. As the head of a hybrid think tank, consulting, and public policy shop, Newt taught me the importance of critical – virtually disruptive – thinking and of being articulate, especially in drawing a clear distinction between policy value propositions. Newt also taught me that communications take lots of forms … from blogging and social media like Twitter to traditional op-eds, print, TV and radio interviews. Equally as important, he taught me that people receive information from a broad array of traditional and non-traditional sources and that to be an effective communicator, you must deploy strategies aimed at all of those sources … not just those with which you’re comfortable. Thanks Newt.

Andy von Eschenbach, MD, is another of my mentors. Andy is a former Commissioner of the Food & Drug Administration (FDA) and former Director of the National Cancer Institute, Andy taught me about the importance of life balance between work, family, faith, fun and service. Andy lives it daily. As a dedicated husband, father, grandfather, and an accomplished surgeon at MD Anderson, Andy still found the time and energy to serve his country at the highest level while still balancing his family, his faith, his causes, and his passions. And, he reinforced the importance of service with grace and dignity. Thanks Andy.

As I approach the end of this post, please consider taking a young associate under your wing and serve as a mentor. Similarly, if you are a young person, find someone you genuinely respect and spend time with them. We need more mentors in America today to help shape the future of our country.

And, here’s the cool part. When you serve as mentor, you get so much out of it than you would ever expect. Over the years, I have been privileged to work with many talented young people. It is so very rewarding to watch the careers, the families, and contributions of those who I hope think of me as their mentor. Thanks Chris, Ashley, Rebecca, Kelly, Matt, Kimberly, Liz, Vince and Lee for allowing me to be a part of your life.

We need more mentors to pass along lifelong lessons … important lessons like being respectful, honest, humble, and civil … lessons like creative, critical thinking and being deliberately articulate when we communicate … lessons like of the importance of life balance between work, family, faith, fun and service.

We need more mentors in America today.

Continue reading »]]> by Wayne Oliver – Vice President at RxAlly
Originally published in the Atlanta Journal Constitution on October 5, 2012
http://blogs.ajc.com/health-flock/2012/10/05/did-you-brush-your-teeth/

As a child, I can’t tell you how many times I heard that question. As a parent, I can’t tell you how many times I’ve asked that question.

Over the years, dentists have done a fantastic job of raising awareness of the importance of preventative dental care. They give us tooth brushes and dental floss after each and every visit. They schedule appointments with us every six months to check our teeth and reinforce the importance of preventative dental care.

It wasn’t always that way. Dentists used make a living pulling teeth … not preserving them. But over the last half century, the dental community has changed the way we view preventative dental care. Plus, those of us fortunate enough to have dental insurance often paid little to nothing out-of-pocket for preventative dental services.

So how can the health care system — more specifically, how can health care professionals — learn from the dental profession?

First, we should learn to value preventative services.

At this time of year, every physician, pharmacist and nurse should be asking each individual, “Have you had your flu shot yet?” As patients, we should grow as tired of that question as kids have grown tired of parents asking them if they have brushed their teeth.

Influenza rapidly spreads around the world in seasonal epidemics and imposes a considerable economic burden in the form of hospitalizations and other health care costs and lost productivity. In the US alone, recent estimates put the cost of influenza epidemics to the economy at $71 to $167 billion per year.

And, the impact of influenza outbreaks can largely be controlled with a simple, affordable and readily accessible solution: the flu vaccine. It is one of the most preventable diseases and virtually everyone should get immunized against influenza.

Hospitalization and deaths mainly occur in at-risk groups (elderly, chronically ill and young children). Although difficult to assess, these annual epidemics are thought to result in between three and five million cases of severe illness and between 250,000 and 500,000 deaths every year around the world.

So, have you had your flu shot yet?

A study conducted by the Centers for Disease Control and Prevention (CDC) has put a dollar figure on visits to doctor’s offices and emergency rooms for the treatment of flu-stricken children. The study also looked at the amount of time parents have to miss work and care for little ones while they recover. The study found that parents had medical expenses ranging from under $300 to about $4,000 and missed between 11 and 73 hours of work, depending on whether their child was able to recover at home or was hospitalized. Most of these illnesses and costs are entirely and completely preventable.

Those of us who are parents know that kids are veritable germ factories. So, has your kid had his/her flu shot yet?

Several years ago, public health workers noticed that pharmacists had a significant impact on improving influenza immunization rates in states which allowed pharmacists to provide immunizations. Now, pharmacists in all 50 states can administer the influenza vaccine. According to the American Pharmacists Association, more than 20 million individuals are immunized by pharmacists against the influenza virus.

As we have discussed in this blog, pharmacists are America’s most accessible health care professional. Almost every community has access to a community pharmacy. There is usually not a wait in pharmacies to receive the vaccine and patients usually don’t have a schedule an appointment. The flu shot is relatively inexpensive ($20-$25) and is often covered by health plans.

There are few legitimate reasons not to get immunized against influenza this year. Talk to your family physician, pediatrician or pharmacist about getting the flu shot soon.

Still, more has to be done to raise the awareness level of the general public of the importance of preventative health care services like the influenza vaccine. Maybe, beginning every fall, we need every health care professional to start asking the question, “So, have you had your flu shot yet?”

Continue reading »]]> by Wayne Oliver – Vice President at RxAlly. Orginally posted in Atlanta Journal Constitution at 12:20 pm September 5, 2012,

Regardless of what has happened in the past or what will happen in the future to the Affordable Care Act, also known as “ObamaCare,” there has been a general recognition that we need to create a new culture of health by and among the American people. From embracing a patient-centered model of care to management of chronic diseases, the health care system is changing to embrace a culture of health at the very center of our health care transformation.

Over the years, the health care system realized that a comprehensive team approach to patient care produced improved patient outcomes.  As that integrated team model gained notoriety, a more diverse panel of health care professionals began to interact directly with patients and their caregivers. While physicians have and will continue to be an integral part of the health care team, doctors have been joined by pharmacists, advanced practice nurses, physicians assistants, dentists, optometrists, dieticians and other health care professionals in provide direct patient care services. These skilled professionals are also helping patients better understand their role in their own health care. And, they are also helping to create a culture of health when they interact with their patients.

Pharmacists, for example, were once relegated to exclusively preparing and dispensing medications. However, today’s pharmacists are providing a host of direct patient care activities.  Pharmacists are now providing immunizations in all 50 states. In fact, the Centers for Disease Control and Prevention (CDC) has recognized that pharmacists play a vital public health role in preventing the spread of disease like influenza and pneumonia. Even though August was the National Immunization Awareness Month, I want to encourage everyone to get vaccinated … especially those at risk populations like seniors.

Pharmacists are also providing direct patients care services like medication therapy management (MTM). A recent Wall Street Journal article highlighted how community pharmacists are offering personalized patient services to improve care and reduce costs. Patients who do not take their medications as prescribed by their physicians cost the U.S. health care system an estimated $290 billion a year in avoidable medical spending.

As the health care system continues to look for innovative ways to control spending while improving health outcomes, addressing the problem of medication adherence seems to be a logical and important first step. Non-compliance to prescription drug therapy is a serious problem and pharmacists are rising up to develop innovative solutions to combat this issue.

Local community pharmacies all over the nation are participating in a public awareness campaign launched by the Centers for Medicare and Medicaid Services (CMS) called the Million Hearts initiative. This innovative blood pressure education campaign is focused on the prevention and control of high blood pressure. The new campaign aims to prevent a million heart attacks and strokes over the next 5 years.

Today’s pharmacists are making great strides in creating a culture of health in America. From prevention programs like immunizations for influenza, shingles and pneumonia to innovative, medication therapy management (MTM) services for diabetes and hypertension, pharmacists are raising awareness and expectations of patients across the U.S.  As the pharmacy profession continues to embrace health and wellness programs, new opportunities for patient engagement will occur. And, pharmacists will play a much larger role in creating a culture of health in America

Continue reading »]]> by Wayne Oliver, Vice President of Pharmacy Advocacy & Governmental Relations at RxAlly
Originally published in the Atlanta Journal Constitution on August 1, 2012

Over the past several years, the health care system has been attempting to define and create a “patient-centered model of care.”  Most health policy experts, much less health care professionals, can’t seem to agree on what constitutes a patient-centered model of care. I think that a patient-centered model is less about discussing the comprehensive services offered to patients and is more about putting the patient in the middle of the relationship. A true patient-centered model surrounds the patient and provides a true coordinated personalized system of care.

In examining U.S. health care delivery, rarely are the words “coordinated,” “personalized” and “system” used in the same sentence ― much less actually delivered to patients.

Primary care medical homes (PCMH) were first developed several years ago in an attempt to develop a patient-centered experience. Even those physicians currently practicing in the PCMH model indicate that there are issues associated with the PCMH concept, like the challenges of coordination of care, integration of the team approach to health care services, disparate electronic platforms and the lack of a sustainable reimbursement model.  All of these challenges make the broad adoption of this model difficult.

Concierge medicine, where physicians offer services to a limited the number of patients, closely aligns itself to a patient-centered model. Based on a monthly premium paid to a concierge physician, patients have direct access to that physician for same-day office visits, the ability to engage the physician during non-office hours and personalized treatment programs tailored specifically for each patient. However, concierge medicine is often limited to physician services and the exclusion of other parts of health care. Concierge medicine is too costly for patients and too limiting in terms of the number of eligible patients to become the norm in the health care delivery system.

The Affordable Care Act ― better known as ObamaCare ― makes an attempt to create a patient-centered model of care.  Six of the 2,700+ pages are dedicated to the development of accountable care organizations or ACOs, which provide the framework for the better coordination of care between hospitals and physicians. ACOs provide “bonus” payments to physicians and hospitals when patients have lower than expected medical bills. But what about other areas of health care like pharmacy, long term care, physical & rehab therapy and other outpatient services? These health care providers are not even mentioned in the ACO section of health reform law and are not referenced in the rules and regulations. Let’s face it, giving a patient a high blood pressure medication is a lot less expensive than treating the patient for a stroke.

Health information technology (health IT) will go a long way toward creating the technical infrastructure to help facilitate a patient-centered model of care. The primary care medical home concept is predicated on the physician using an electronic health record as part of their practices. States are moving at various speeds in creating health information exchanges where health care professionals share clinical information about patients.

However, there is a demonstrative need for practice re-engineering and the realignment among the medical professions to begin rethinking what a true patient-centered model of care looks like.

To legitimately embrace a patient-centered model of care, physicians, pharmacists, nurses, medical technologists and other health care providers and professionals need to work around the patient… rather than working in silos on the patient. Health care services are in fact coordinated and in a manner which is least disruptive for the patient. It is an entirely different view of health care from which we know today.

How long will it take for the health care system to move to a patient-centered model of care? That depends.

First, we need to develop a payment system which rewards and incentivizes  a patient-centered model of care. We currently base our health care payment system on the number of transactions which occur: the number of office visits, the number of lab values, the number of prescriptions dispensed, the number of x-rays or CT scans. We need a payment system where health care providers are paid based on patient outcomes and which encourages wellness and prevention.

Secondly, we need to align the new payment model with patient incentives. Patients must be engaged and viewed as partners in their own care. For example, health plans should create reduced or eliminated co-payments for patients who are compliant with physician orders, or who properly execute treatment plans. Examples of this would include patients with hypertension who take their prescription drugs as prescribed by their physicians, which results in lower blood pressure readings or overweight patients who follow a diet and exercise program and subsequently drops those extra pounds.

Last, we need to encourage health care providers to work together as an integrated health care team. A patient-centered model means that all providers are equally responsible for the care, treatment and management of the patient. Currently, in our disjointed system, there is no single provider who is ultimately responsible for the patient and therefore, there is no provider who is accountable. In a team approach, the hospital, the treating physician(s) and the patient’s pharmacists are all communicating, reviewing, providing and exchanging clinical information – all with the patient at the center of the equation.

Patients deserve a patient-centered model of care where health care professionals and health care facilities are all committed to same goal: Optimizing patient health outcomes.

Continue reading »]]> by Wayne W. Oliver – Healthcare Consultant
Originally published in the Atlanta Journal Constitution on July 4, 2012

The fate of ObamaCare now moves from the legal and constitutional stage back to the political arena.  As most Americans know by now, Chief Justice John Roberts joined with the more liberal members of the Supreme Court of the United States to create a 5-4 decision upholding ObamaCare as constitutional based on the ability of Congress to levy taxes. The high court has finally ruled on ObamaCare. So, what does this all mean?

Well, it might not be the decision most conservatives would have liked, but at least it is settled … for right now. Many health policy experts and political pundits are saying that the Chief Justice had a mental lapse or that he was pressured by the liberal media into upholding ObamaCare.

So how can the Chief Justice justify his historic position on the president’s signature legislative achievement?

First, he doesn’t have to … as it is all laid out in the opinion. The Chief Justice wrote in the majority opinion that ObamaCare was unconstitutional based on the Commerce Clause but was constitutional since Congress has the authority to create taxes … or impose penalties as they are described in ObamaCare. Secondly, Chief Justice Roberts may have ultimately decided that the American people … not nine black-robed presidential appointees … should decide the fate of ObamaCare.

And the Court’s decision could not have set up a more perfect storm for the November elections. One candidate likes all 2,700 pages and the other wants to repeal it. So the choice is pretty clear.

But before we all rush out to expand Medicaid programs … and before we set up elaborate health benefit exchanges with state or federal bureaucrats deciding what American families get in their health insurance policies, let’s remember that American healthcare system is still fundamentally broken. And, ObamaCare does little to fix it.

And, to me, we should focus on fixing the system before we expand coverage to 30 million new individuals.

Our current system rewards transactions instead of results. And, ObamaCare doesn’t change that. Doctors, hospitals, and pharmacists get paid when patients access the system. Every time a healthcare provider interacts with a patient, a transaction occurs and a charge is generated.  Payment is based on the number of transactions a healthcare professional provides rather than being based on a specific health outcome.

Instead, we should move to a system where the doctor, hospital and pharmacist are motivated to help the patient stay well. We should provide incentives for physicians to keep patients healthy. We should reward pharmacists when patients take their medications properly and adhere to their medication regimen. We should provide incentives for patients to become active and actively engaged in their own healthcare. In my opinion, rewards and incentives work better than penalties … or taxes … in this case, as determined by the Chief Justice.

Our current system is healthcare provider centric.  In other words, the doctor, the pharmacist, the hospital or the rehab therapist are central to the transaction of healthcare services.

Instead, we should migrate to a healthcare system where the patient is at the center of care and healthcare providers work in concert with each other to maximize patient-centered health outcomes and deliver the best patient care experience.

Our current healthcare system is way too expensive and ObamaCare does nothing to lower the cost of healthcare in America. Healthcare professionals … specifically physicians … spend too much time and too many resources on reducing their exposure to potential lawsuits instead of focusing on helping the patient get or stay well.  Hospitals and doctors order way too many tests … way too many procedures … and way too many powerful medications … not to help treat a disease or to help develop the proper diagnosis but rather to avoid a frivolous lawsuit brought by a personal injury attorney who advertises on late night TV.

Instead we should insulate providers from unnecessary litigation when they follow the legitimate standard of care and most current clinical best practices. I have written in this space about creating a new system of health justice (“Let’s Get Serious About Healthcare Costs,” February 3, 2012) … one that creates a new model for compensating legitimate medical errors. By creating a new system, we would not only improve the quality of care provided to patients by reinforcing best medical and clinical practices, it would also eliminate a ton of excessive and inappropriate testing and procedure and reduce overall healthcare costs.

So ObamaCare is left up to the American people in an election year. But before anything happens, we should fix the current system now … before we expand coverage to millions of Americans. Otherwise, we will be simply be wasting time and resources on a bigger but not better healthcare system.

Continue reading »]]> by Wayne Oliver – Healthcare Consultant
Originally published in the Atlanta Journal Constitution on June 6, 2012

Legal experts and political pundits are filling the airwaves and newsprint with their thoughts on what will happen to federal health reform (ObamaCare) when the US Supreme Court rules later this month (NFIB v Sebelius). What will happen to the individual mandate? Will they strike down the entire law? What about insurance coverage for my 24-year old college student?

All that speculation aside, there are common sense reforms that are being implemented today — in the private sector — without 2,700+ pages of Congressional mandates.

Let’s pick three areas where we can make a difference NOW: 1) Accelerate a Patient-Centered Model of Care; 2) Support the migration to Health Information Technology (Health IT) by Physicians and Hospitals; and 3) Demand Disclosure and Transparency of Healthcare Quality and Price Measures.

We should accelerate the development of a patient-centered model of care. When providers put the patient at the center of the relationship and do what is in the patient’s best interest, incredible things happen. Just ask patients about their experience at Intermountain Healthcare in Salt Lake City or Geisinger Health System in Central Pennsylvania or the one of the Mayo Clinics nationwide.

And, there is a hospital coming to Georgia later this summer which embraces a patient-centered model of care. Cancer Treatment Centers of America (CTCA) has not only adopted this model, they have made it part of the cancer hospitals’ corporate culture. CTCA is opening a new state-of-the-art facility in Newnan, where they have spent countless hours training doctors, nurses, staff members and technicians about how to put the patient first. From providing locally grown, organic foods for their patients to help the body fight cancer to dynamic scheduling programs which minimize patient hassle and discomfort, CTCA has fully embraced a patient-centered model of care that focuses on the individual needs of the individual patient.

While adoption of health IT by healthcare professionals and hospital systems is growing, there is significant progress yet to be made. According to Surescripts, half of the prescriptions issued this year will be electronically transmitted. In other words, half of the prescriptions will still be written in a such a manner that only chicken scratch interpreters and some pharmacists can decipher.

Health IT makes too much such sense. Physicians who are using electronic health records (EHR) have access to clinical best practices which can improve medical outcomes. Additionally, EHR systems can reduce redundant tests like CT scans and x-rays and some can suggest alternative treatment plans for unique patients. Health IT not only saves lives and saves money, it can help prevent avoidable medical errors.

Back in March, in this space, we commended WellStar Health System in Cobb and Douglas Counties for creating teams of healthcare professionals who are dedicated to using data and performance measures to further advance patient safety efforts. (Read column.) This dedication to driving quality through health IT has resulted in zero errors in the each of neonatal intensive care units … systemwide.

Lastly, we should demand transparency in healthcare services … both in terms of price and quality. As patients, caregivers, and concerned taxpayers, we should know which healthcare providers are performing well and which facilities are excelling at certain procedures. Similarly, we should which doctors and which hospitals to avoid.

It is a little known but sad, dirty secret that medical device manufacturers prohibit hospitals from disclosing the price of artificial knees and hips … even to Medicare or Medicaid. Transparency in price and quality is important to competition … which something the medical device manufacturing industry does not want.

Regardless of what the Court decides to do, we should begin implementing common sense health reform. We should accelerate the development of a patient-centered model of medical care.  We should support the migration to Health IT by physicians and hospitals. And, finally, we should require disclosure and transparency of healthcare prices by providers including medical devices as well as the quality of care being provided by physicians and hospitals.

Continue reading »]]> by Newt Gingrich and Wayne Oliver
Originally published in the Philadelphia Inquirer on April 07, 2009

Civil-justice reform, also known as tort reform, has often been viewed as a battle between the health-care community (physicians and hospitals) and personal-injury lawyers. However, there is another side to tort reform that personal-injury lawyers don’t want to talk about: It can jump-start the economy and create new jobs.

States that have enacted tort-reform measures have significantly improved access to health care, reduced costs, and strengthened economies.

Texas is a prime example. In 2003, Texas enacted comprehensive legal reform, including appropriate limits on noneconomic damages (compensation for such intangibles as emotional distress). As a result, Texas has seen an incredible influx of physicians. According to the Texas Medical Board, more than 10,000 doctors have either returned to the state or decided to move there as a direct result of the legal reforms.

Texas Turnaround

Communities in Texas that were once underserved medically now have access to primary and specialty care that they didn’t have before. Many parts of the state suffered chronic shortages of key specialists, such as obstetrician/gynecologists and neurosurgeons, but now have a full complement of these physicians.

According to a 2008 study by the Perryman Group, A Texas Turnaround: The Impact of Lawsuit Reform on Business Activity in the Lone Star State, tort reform has resulted in “nearly a half-million jobs in the state of Texas” and an increase in annual personal income of almost $32 billion. Additionally, the study found that “annual output in Texas is $51.2 billion higher, while total spending is up $112.5 billion each year as a result of [civil-justice] reforms.” And almost 430,000 previously uninsured Texans now have health insurance.

So, there are significant economic benefits for states that enact litigation reform. Maybe states that have not yet adopted comprehensive civil-justice reforms, such as Pennsylvania, should strongly consider them. Such states should approach civil-justice reform as a way to make the economy grow, create jobs, and reduce the rolls of the uninsured – all while improving access to health care.

Budgetary benefits

These are lean times for state lawmakers. State tax revenues are down significantly. State budgets are being slashed all over the nation. But tort reform offers budgetary help, too.

A study published in the American Journal of Public Health indicates that states could save 3 percent to 4 percent of their total health spending by imposing reasonable limits on noneconomic lawsuit damages.

Let’s translate that into real dollars and cents. If the Pennsylvania legislature were to adopt progressive legal reform, the commonwealth’s taxpayers would save more than $2 billion annually.

We’re sure the Pennsylvania legislature could use an additional $2 billion to spend on education, health care, transportation, or other priorities. However, because of the efforts of personal-injury lawyers and the deteriorating civil-justice system, Pennsylvania continues to see physicians steadily migrate away from the state.

Furthermore, health-care facilities are closing their doors or limiting certain services. In November, for example, Philadelphia saw its 18th closure of a maternity ward.

If Pennsylvania is serious about economic recovery, the General Assembly should enact meaningful civil-justice reforms. Such measures would add new jobs, increase personal wealth, stimulate the economy, decrease the number of citizens without health coverage, reduce health-care costs, stem the exodus of physicians, and improve access to needed medical services. Tort reform would give Pennsylvania a real economic stimulus without using a single taxpayer dollar.

Continue reading »]]> by Wayne W. Oliver, Vice President, Center for Health Transformation
Originally published by the Atlanta Journal Constitution on November 4, 2011

At the Center for Health Transformation, we are working hard to create a 21^st Century Intelligent Health System that can save lives and saves money for all Americans. However, it seems like every time we make a little progress, we must overcome a new challenge.

Take electronic prescribing and electronic medical records (EHRs). Both rely on cutting-edge technology to provide better healthcare for patients.

We know that e-prescribing and EHR systems are safer and more cost effective than paper prescriptions and paper health records. The state and federal governments are even creating incentives for doctors and hospitals to move away from traditional paper.

And, it is working. We are seeing more and more physicians making significant investments of time and resources as they embrace electronic systems. According to Surescripts which provides the infrastructure for e-prescribing, by the end of this year, more than half of the prescriptions issued in our nation will be issued electronically.

But just like the old saying, “One step forward, two steps back,” we are seeing challenges surface that seriously threaten the on-going movement toward electronic medicine.

One example of a barrier to e-prescribing is referred to as “prior authorization” or “prior approval” for prescription medications. Sometimes health plans require prior authorization of a drug for a clinical reason. But usually, health plans require prior authorization because of the high cost of the drug (and to steer patients toward generics) and the desire to ensure that the medication is medically necessary.
Virtually every prior authorization program is paper based. So, before a patient can receive a medication which requires a prior authorization, a physician must fill out a paper form by hand, fax it off to some health plan bureaucrat who either approves or rejects the request. Then, the physician and possibly the pharmacy are notified 2 to 4 days later. It is a laborious process that causes needless delay in prescription medication therapy.

Prior authorization programs are not new. They have been around for more than two decades. But prior authorization programs were conceived before e-prescribing and EHR solutions were created to help cut down on medical errors.

There are electronic solutions available. The National Council of Prescription Drug Programs (NCPDP) has created an industry-wide standard for an electronic prior authorization process. However, with new ObamaCare requirements bearing down on health plans and more and more regulations coming down every day from Washington, most health plans are focusing on other priorities. But they should abandon 20^th Century prior authorization programs and adopt 21^st Century electronic solutions.

As a nation, we have encouraged physicians, pharmacists and hospitals to migrate to electronic platforms, obviously something that moves us into the 21^st Century. It’s now time to remove some of the barriers, hassles and challenges to a fully-integrated, electronic health system. It’s time for health plans nationwide to embrace 21^st Century solutions such as electronic prior authorization programs so we can all get on with the business of saving lives and saving money.

Continue reading »]]>
by Wayne W. Oliver, Vice President, Center for Health Transformation
Originally published by the Atlanta Journal Constitution on April 23, 2009

All Americans want health care coverage. All Americans like choice. Americans who like their current health insurance coverage should be able to keep it.

Those without coverage should have the freedom to choose the most appropriate plan that fits their specific needs and that of their family. But, everyone should have access to affordable health coverage.

President Obama wants to create a public plan option for health consumers under the age of 65. The public plan option will establish a government-run health insurance company — a move that is poised to undermine health care providers, employers and the very sustainability of the entire health care system, not to mention the health and well-being of patients.

Big government should not stick its nose into private markets — much less compete in them.

We have tried something similar to a public plan option. It was called TennCare in Tennessee, and it failed miserably. After the better part of two decades of out-of-control expenditures, TennCare is now being dismantled because it was too bureaucratic, too inefficient, did not improve health outcomes and was costly for taxpayers.

Rather than compete with the private sector, the appropriate role of the government should be to create incentives for innovation through the private health insurance market. Plans must focus on prevention, wellness and effective disease management.

The creation of a government-run health insurance company could jeopardize coverage for 130 million Americans who are currently receiving it through the private sector.

What happens when health insurers begin to withdraw from the private sector? A lack of competition results in higher costs.

Then, we are left with fewer choices of health insurance coverage and even fewer options of medical treatments. Having fewer choices at higher costs of lower quality is not how we believe we should approach reform.

Everyone should be required to have health insurance coverage; or, if they are opposed to insurance, they should post a bond. Insurance can be issued by employers or purchased by an individual from a private health insurance company. If purchased by an individual, they should be able to deduct health insurance premiums from their taxes just like employers can.

The working poor could receive subsidies to help with the cost of coverage. Everyone would have coverage – all 300 million of us.

Our goal should be to have a 300 million-payer system that is individually focused, wellness- and prevention-driven and based in the private sector.

At a time when new scientific breakthroughs are occurring almost daily, we must have a system that accelerates the discovery, development, dissemination and delivery of those solutions that can save lives and create better health.

Yet by their very nature, government bureaucracies are slow, inefficient and stifle innovation. It is exactly the opposite of what we need today.

Actuaries have said that the Medicare system is going to start running deficits as soon as 2017.

If federal bureaucrats can’t manage Medicare, why then do we want these same bureaucrats to run a new government-managed health insurance company?

America has really good sick care, but we need a system that creates incentives for physicians, clinics and hospitals to keep individuals healthy.

We need to let the private sector lead the way by implementing innovations to develop an individually centered, wellness- and prevention-focused, coordinated system of care.

Continue reading »]]> by Newt Gingrich and Wayne Oliver
Originally published in Politico.com on October 21, 2009     Also published in The Detroit News

As congressional leaders meet behind closed doors to merge a compromise by the Senate, House and White House on a health care reform plan before the holidays, some might believe the task seems monumental.

Add the concept of civil justice reform to the mix, and the job may appear impossible because of political forces on each side.

But if the president and Congress are honest about what they have been saying all year — that health care reform is about health care expenses, costs that affect each of us — then it is still not too late to insert civil justice reform into the health care proposal.

Perhaps no other piece of health care reform is known to provide as much savings and fix the problem of defensive medicine, skyrocketing medical malpractice insurance premiums and how those costs are passed along to the consumer. It can be corrected through civil justice reform.

On October 9, the Congressional Budget Office pronounced that a tort reform, or civil justice reform, package would reduce the federal budget deficit by an estimated $54 billion over the next 10 years. At the Center for Health Transformation, we believe that is a low estimate and just a drop in the bucket in terms of savings if civil justice reforms were enacted.

The projected savings were based primarily on physicians paying lower premiums for medical liability insurance; therefore, patients, employers and health plans would also pay less for physician services.

But for the first time ever, CBO has recognized that civil justice reforms also have an impact on the practice of “defensive medicine.” Defensive medicine is when doctors order more tests or procedures than are truly necessary just to protect themselves from frivolous lawsuits. Studies show that defensive medicine does not advance patient care or enhance a physician’s diagnostic capabilities.

Doctors and hospitals regularly practice defensive medicine, which adds significant costs to every single American who seeks health care services — whether he or she has private insurance or a government-sponsored plan such as Medicare.

The CBO projection of $54 billion in savings with civil justice reform was an important acknowledgement. Yet we believe this is just the tip of the iceberg.

According to several studies, the real cost of defensive medicine is between $151 billion and $210 billion annually. Civil justice reforms such as health courts, caps on noneconomic damages, and creating safe harbors or protections from lawsuits for physicians who incorporate best medical practices could go a long way toward significantly reducing or eliminating defensive medicine. That $151 billion to $210 billion in savings could be used to provide health insurance for the uninsured without raising taxes on those who already have insurance policies.

Civil justice reform is simple. It neither increases our taxes nor expands the federal bureaucracy.

So as the debate rages on in Washington over what to do about health reform, civil justice reform continues to be pushed to the back burner. The president called for a closer examination of successful state-based civil justice reform solutions. But we already know what works.

• California passed civil justice reforms more than 30 years ago, and malpractice premiums in several specialties are now as much as 50 percent lower than those in states such as New York, Pennsylvania and Florida.
• Texas recently adopted comprehensive legal reform, and more than 10,000 doctors have returned to the state or decided to move to Texas as a result of civil justice reforms. Communities in Texas that once did not have primary or specialty care doctors now have a full complement of physicians.

In these final weeks, it will come down to this: Congress and the president have the option of saving between $54 billion and more than $200 billion by embracing civil justice reform.

But it will take bold leaders willing to stand up to personal injury lawyers instead of taxing Americans and cutting Medicare benefits. Surely this Congress and this president won’t leave tens of billions of dollars on the table.

If health care reform is really about the American people, Congress won’t charge us another dime, nor will it run up the deficit during the worst economic period in 70 years. Instead, Congress should surprise us with savings that can cover the uninsured while bringing an end to defensive medicine and costly nuisance litigation.

Former House Speaker Newt Gingrich (R-Ga.) is founder of the Center for Health Transformation. Wayne Oliver is a vice president of the center and directs its Health Justice Project.

Continue reading »]]> by Newt Gingrich, Andrew C. von Eschenbach, MD and Wayne Oliver
Originally published by The Hill on February 11, 2011

President Obama in his State of the Union speech said he wants to stimulate the economy by spending billions of dollars for research and development and create a new federal agency called the National Center for Advancing Translational Sciences at the National Institutes of Health.

At the Center for Health Transformation, we are passionate supporters of biomedical research and join others in applauding that well-intentioned idea. Unfortunately, it is probably doomed to fail.

If we are to invest taxpayer funds, the American people expect us to invest their money wisely. In this case that means assuring that investments in research will result in products that improve the lives of the people making that investment. The administration’s proposal is worse than building a bridge to nowhere; it is investing in a road that cannot reach its destination because there is no bridge. The “bridge” from investments to discovery and development to delivery to the American people is the Food and Drug Administration (FDA).

Historically, the National Institutes of Health (NIH) has focused on basic scientific research while the pharmaceutical and biotechnology companies have then taken that basic scientific research to create and develop new drug products. Every single drug, vaccine, biologic and medical device must be approved by the FDA before it can ever be offered patients.

Over the past 20 years, despite hundreds of billions of dollars invested in biomedical research by the NIH and industry, the FDA has approved fewer and fewer new medications. In 2010, only 21 new medications were approved by the FDA which was the fewest number of new drugs approved by the FDA since 2007, when there were 17.

If science and technology are advancing, then why are there fewer new drug products being approved? The problem is not that we are underfunding research and development but rather we are ignoring the critical role of regulation and not addressing the fact that the current FDA is woefully inadequate for the challenges and opportunities of the 21st Century.

So, creating a new federal agency to accelerate new drug discovery only to see those new drug products languish under antiquated and inane FDA regulations makes no sense whatsoever. We need to upgrade and modernize the current FDA instead.

The FDA’s current regulatory path way is broken and costs American lives, and deprives millions of people of life-saving and health-enhancing new and emerging therapies.

Not surprisingly, the pharmaceutical and biotechnology industries have responded to a non-responsive FDA by taking their research and development investments to a better regulatory climate. More specifically: those jobs, those funds, those R&D investments are now flowing into Europe and Asia.

Congress is currently engaged in discussions of reauthorizing the role and responsibilities of the FDA. At the Center for Health Transformation, we are working to help identify solutions to modernize the FDA and define strategic opportunities to make the FDA regulatory process more efficient, transparent, predictable and rigorous.

The President and the administration want the right outcome but have the wrong diagnosis and treatment. While we are certainly not opposed to accelerating the development of new, life-saving remedies, the problem is more complicated than simply creating a new federal agency or yet another federal bureaucracy.

We need a more flexible, intuitive, predictable, responsive and transparent FDA that is in tune with the 21st Century. We need an FDA that understands the importance of encouraging the investment in the development of new medications and devices which can save lives, improve the quality of life and diminish the impact of disease.

The current regulatory environment impedes progress, discourages innovation, destroys jobs and undermines our economy. Increasing investment in research and development for the discovery of new drugs is laudable but only after the FDA goes through a comprehensive structural and functional overhaul. Congress and the Obama administration would be well advised to focus first on modernizing, improving and transforming the current regulatory process within the FDA.

Gingrich, former Speaker of the House, is founder of the Center for Health Transformation. Von Eschenbach is the former Commissioner of the Food and Drug Administration. Oliver is a Vice President at the Center for Health Transformation. The Center for Health Transformation is an organization dedicated to transforming health and healthcare in America to save lives and save money.

Continue reading »]]> by Wayne Oliver, Vice President, Center for Health Transformation
Originally published in the Atlanta Journal Constitution on May 2, 2012

Improved access to healthcare was one of the main selling points of federal health reform. ObamaCare places a great deal of importance on expanding coverage with a special focus on advancing health wellness, preventative services and primary care.

However, there is an underutilized healthcare resource which is available to everyone … now.

Continue reading »]]> by Wayne Oliver – vice president, Center for Health Transformation
Originally published by the Atlanta Journal Constitution on July 6, 2011

Investors are always looking to earn an easy profit, particularly from well-managed companies. But when the profit is from a hedge fund that finances medical malpractice lawsuits aimed at driving doctors out of the profession, Wall Street may have gone too far.

Continue reading »]]> by Newt Gingrich and Wayne Oliver
Originally published in the Kansas City Star on September 23, 2009

President Barack Obama has offered a fig leaf to doctors by pledging to consider civil justice reform. He directed Health and Human Services Secretary Kathleen Sebelius to look at creating “demonstration projects in individual states to test” civil justice reform ideas.

To those who have followed this issue, the proposal must have sounded like a plan to reinvent the wheel. Several states already have acted as demonstration projects for civil justice reform for years, and the results are in: Civil justice reform measures have improved access to care, reduced costs and strengthened those states’ economies. For example, California passed the landmark Medical Injury Compensation Reform Act more than 30 years ago. Under it, the state ensures that injured patients receive fair compensation while preserving their access to health care by keeping doctors, nurses and health care providers in practice and hospitals and clinics open.

According to Californians Allied for Patient Protection, the law “has saved health care consumers tens of billions of dollars.” Before the reform, California was facing a health care crisis. Hospitals, clinics and doctors, particularly those in high-risk specialties such as obstetrics and neurosurgery, were leaving the profession or going out of business because of skyrocketing malpractice premiums.

Another example is Texas. The state in 2003 enacted comprehensive legal reform, including appropriate limits on non-economic damages, something known as compensation for “pain and suffering.” According to the Texas Medical Board, more than 10,000 doctors have either returned to the state or decided to move to Texas as a result of the reforms.

Communities in Texas that were once medically underserved now have access to primary and specialty care doctors.

There are also substantial economic benefits. As a direct result of reform efforts, almost 500,000 jobs moved to Texas. Additionally, almost 430,000 previously uninsured Texans now have health insurance.

In other states, Missouri and Georgia adopted reforms in 2005, and Mississippi enacted civil justice reform measures in 2002 and 2004. Oklahoma’s medical malpractice reform statutes become effective in November. Each state was threatened by a physician shortage because of skyrocketing malpractice premiums. Civil justice reform was the key to addressing the problem.

In contrast, states without liability reform continue to suffer shortages of providers, leading to the closing of hospitals, clinics and trauma centers, leaving patients with no doctors in their immediate vicinity.

For example, 19 maternity centers have closed in Philadelphia alone since 1997. The average waiting period for gynecological care for a new patient in the five-county southeastern Pennsylvania area is six to nine months. The reason is that Pennsylvania refuses to adopt civil justice reforms.

In New York, another state without reforms, eight counties are without obstetricians, according to the Center for Health Workforce Studies. The center also found that 18 of New York’s counties have shortages of practicing obstetrician-gynecologists.

We must embrace health reform nationally, but it must address changing our civil justice system. The threat of frivolous lawsuits has led to the practice of defensive medicine, which wastes the patient’s and physician’s time and costs an estimated $100 billion to $200 billion a year. Defensive medicine is when doctors order unnecessary tests and screenings to keep from being sued.

According to a recent poll conducted for the Common Good, a nonpartisan legal reform coalition, and the Committee for Economic Development, 83 percent of Americans want Congress to reform the medical malpractice system as part of any health care reform plan.

We don’t need to “study” what works. Those studies have already been written. We don’t need demonstration projects. We can already see the results of civil justice reform. Instead, we need real solutions and those solutions exist. Serious health care reform must include civil justice reform.

Former House Speaker Newt Gingrich is founder of the Center for Health Transformation. Wayne Oliver is director of the center’s Health Justice Project.

Continue reading »]]> by Newt Gingrich and Wayne Oliver
Originally published in Forbes.com on April 19, 2011

From coffee shops to bingo halls and wherever seniors gather throughout America, the talk these days is about modern science and how those who have been in pain for years now have routine knee or hip replacements.

Medical devices too such as pacemakers or stents are extending the lives and improving the quality of life for older Americans. As the first of 78 million baby boomers begin to retire this year, they will enroll in Medicare and many will have these procedures.

The problem is the federal government is paying top dollar for anything from a titanium shoulder to a spinal implant. Medical device manufacturers require hospitals to sign confidentiality agreements that make it impossible for hospitals to disclose or document the cost of devices. This makes true price competition in the $153 billion medical device marketplace impossible.

Hospitals bill health insurance companies, including Medicare and Medicaid, for the surgical procedures and medical devices. Hospitals, consumers and the government have no idea whether the devices have been marked up hundreds of percentage points, because there is no ability to compare it with what other hospitals pay for the same products.

This practice is contributing to the insolvency of Medicare and Medicaid and must stop. The American people should be able to see where the majority of their taxpayer dollars are going and which companies are benefiting.

There is price and transparency in everything from medications to bed pans. But the cost of an implant or other medical device is one of the few items in health care that is hidden from the consumer and taxpayer.

A 2009 report by McKinsey Global Institute found that hip implants cost 60% more in the U.S. than in the U.K., Germany, France and Italy; knee implants cost 32% more than in those countries. It is all because of confidentiality agreements and lack of transparent pricing of these devices. And with tens of millions of potential patients utilizing such devices annually, it is an enormous bill adding to our national debt.

Currently the average hip replacement procedure costs about $50,000, which is a bundled price tag for the hospital stay and the device. Medicare and Medicaid traditionally wind up paying 70% of those costs.

Like pharmaceuticals, device manufacturers market their products directly to surgeons and other physicians. But unlike drugs, the prices of medical devices are not published, and neither patients nor hospitals are offered a choice between medical devices when a doctor selects a specific product–nor can they find out the quality or price difference among the various implants on the market.

The only way to bring down costs is to bring transparency to what providers–and taxpayers–are charged. That’s why Congress should pass legislation banning again such exclusivity agreements at hospitals that accept Medicare, Medicaid or other government programs.

In 2007 two U.S. senators, Chuck Grassely of Iowa and Arlen Specter of Pennsylvania, introduced legislation requiring price transparency in medical devices. Unfortunately it never came up for a vote.

States and the federal government are already taking steps to make the cost of health care more transparent. More than 30 states, including Florida, Georgia and Indiana, are publishing health care data online for consumers to access. Health insurers such as UnitedHealth, Aetna and WellPoint are also making health care pricing and quality information available on the Web.

Most of this health care transparency is focused on total price and care quality related to hospitals, physicians and prescription drugs.

Today we can shop–often online–and compare the price of a new car or a month’s supply of blood pressure medication or a pair of blue jeans. We also, as health care consumers, can determine whether a generic drug or a brand name best serves our needs. But we are barred from comparing the quality, medical outcomes or price of an artificial hip or knee.

That isn’t right, especially when we the taxpayers are footing the bill, no matter what the charge.

Newt Gingrich, former speaker of the House, is the founder of the Center for Health Transformation. Wayne Oliver is a vice president at the center.

Continue reading »]]> by Wayne Oliver – vice president, Center for Health Transformation
Originally published by the Atlanta Journal Constitution on August 3, 2011

As former Surgeon General Dr. C. Everett Koop said, “Drugs don’t work in patients who don’t take them.” Prescription medications are only effective when they are taken.

Continue reading »]]> by Wayne Oliver, Vice President, Center for Health Transformation
Originally published in the Atlanta Journal Constitution on September 8, 2011

They say, “Perception is reality.”  If that is the case, the American Medical Association (AMA) is in serious trouble.

In a recent survey of physicians conducted by the Atlanta-based physician recruitment firm Jackson & Coker, doctors believe that the AMA no longer represents their views. A whopping 77 percent of physicians reject that premise that the AMA currently reflects their profession. Only 11 percent said the nation’s oldest doctors’ organization today stands for what they do. (To view the survey, go to: http://www.jacksoncoker.com/news/News.aspx?sc_cid=AMA)

When asked if they agreed with the AMA’s support of federal health reform, physicians said the organization sold out the nation’s medical profession.  The AMA’s high profile endorsement of ObamaCare has been questioned by AMA and non-AMA member physicians from every corner of the country.

So why did the AMA turn its back on the medical professional?

Many believe that the AMA is deeply conflicted. You see, the AMA was torn between generating revenue versus reflecting the position of America’s practicing physicians.  The AMA owns the mechanism by which the entire healthcare delivery system is reimbursed – a coding system used for Medicaid and Medicare reimbursements and then utilized in the private health insurance market. The contract for CPT codes or Current Procedural Technology belongs exclusively to the AMA.

In 2008, the AMA collected an estimated $70 million from books, workshops, and licensed data files related to CPT codes, according to the National Center for Policy Analysis.  Membership dues accounted for less than 16 percent of 2008 revenues, according to the NCPA.

Clearly, the AMA is conflicted between the revenue which is generated by the CPT coding system and doing what’s right for the medical profession.

And, the Jackson & Coker poll speaks volumes about this conflict.

When asked why former AMA member physicians dropped their AMA membership, over half pointed to the “CPT business is a conflict of interest.”

And the current CPT coding system is also a major barrier to fundamental, comprehensive and legitimate healthcare reform.

Most experts agree that ObamaCare was little more than a band-aid on a system which needs real change.  There are no CPT codes for creating a system which rewards improved health outcomes. There are no CPT codes which pay physicians and hospitals for providing outstanding patient care. The CPT coding system reinforces the status quo. So, when the AMA endorsed national health reform, it did so to preserve the current system which is clearly broken.

But what does this mean going forward?

First, the Jackson & Coker survey reaffirms that the AMA is out of touch with the thoughts and beliefs of most physicians.  More than 70 percent of the responding doctors said that the AMA no longer represents physicians.  Secondly, as more and more medical doctors leave the AMA, there will be opportunities for organizations like Docs for Patient Care (Docs4PatientCare) and state medical associations to step in to more accurately reflect the needs of physicians. Seventy-five percent of the physicians surveyed by Jackson & Coker indicate that “physicians need a more representative voice.”  And lastly, issues like tort reform, government over-regulation of the medical profession and legitimate healthcare reform will be addressed by some organization other than the AMA.

There is a fundamental difference between leadership and representation. Unfortunately for America’s physicians, the AMA is doing neither.

Continue reading »]]> by Newt Gingrich and Wayne Oliver
Originally published by Human Events on February 23, 2010

CT scans. Blood tests. Ultrasounds. Cesarean sections. In many instances, these examples of diagnostic tools and procedures are vital to treat a patient.

However, physicians say that too often these tests and procedures are ordered unnecessarily and drive up the cost of medicine for patients, taxpayers and insurance carriers. The result, according to a new poll of the nation’s physicians released by Gallup and Jackson Healthcare this week, is that an astounding one in four dollars now spent on health care in this country is on unnecessary medical care.

The reason is simple. Doctors order these tests, treatments and procedures to protect from being sued. It is a safety valve that helps protect them from frivolous lawsuits as trial lawyers seek an easy payout, particularly after a doctor makes a simple mistake.

Doctors simply don’t want to lose everything they’ve worked for their entire lives on a minor error. As a result, American patients across the country not only endure extra hours of tests, treatments and medication but are paying much more in healthcare costs.

If President Obama and Congress are serious about reducing healthcare costs, then the $625 billion price tag of unnecessary medical care will be at the top of the list when it comes to Thursday’s bipartisan healthcare summit.

We at The Center for Health Transformation believe that Congress has to address civil justice reform so that physicians won’t be so nervous in the practice of medicine.

Seventy-three percent of doctors surveyed in the Gallup-Jackson Healthcare poll said they had practiced defensive medicine in the past year.

Congress must create incentives for states to enact civil justice reform so lawyers will think twice about suing doctors for frivolous cases.

We believe there is a place for health courts that only address malpractice cases; and a need for caps on non-economic damages known as “pain and suffering” that have nothing to do with lost wages or actual damages. We also believe in “safe harbors” or protections from lawsuits for doctors who incorporate best medical practices.

These reforms, if encouraged by Congress, will allow doctors to stop playing defense and, in turn, patients and taxpayers won’t have to empty so much from their wallets to afford healthcare in America.

Gingrich, the former Speaker of the U.S. House of Representatives, is the founder of the Center for Health Transformation. Oliver is a vice president of the Center and directs the Center’s Health Justice Project.

Continue reading »]]> By Newt Gingrich and Wayne Oliver
Originally published in the Chicago Tribune on December 7, 2008  

Efforts to bring sanity to the civil justice system in Illinois are under serious attack. In 2005, the Illinois legislature enacted a progressive law aimed at creating a balance in medical malpractice claims. The law created a cap ($500,000 against a physician and $1 million against a hospital) on pain and suffering or non-economic damages.

But recently a Cook County judge ruled that the cap was unconstitutional (LeBron vs. Gottlieb Memorial Hospital). This is not a new phenomenon. Personal injury lawyers nationwide have begun to ask the courts to systematically impose their own narrow interpretation of tort-reform efforts and to overturn caps on awards.

Personal injury lawyers have taken an aggressive position to attack civil justice reforms on a state-by-state basis. In Texas, New Mexico, Georgia and now Illinois, personal injury lawyers are asking the courts to overturn state laws that protect access to essential medical services. Soon after lawmakers adopted reform measures in those states, medical professionals, including physicians and surgeons, began to return to these states and serve areas that had previously been neglected, especially rural locations.

In Texas, physicians returned in record numbers after the passage of tort reform in 2003.

In Illinois, tort reform stemmed the migration of talented health-care professionals to surrounding states. Stability has been restored to the liability insurance market, and physicians in specialties such as neurosurgery and obstetrics have begun to resume their practices. Before the adoption of tort-reform measures in Texas and Illinois, OB-GYNs were moving out of the states or making the decision to no longer deliver babies. Since the passage of tort-reform laws there has been noticeable increase in the numbers of these much-needed practitioners.

However, activist judges are beginning to dismantle tort reform by judicial fiat. There are serious consequences when the legal system overrules sound legislative policy. For example, in early November, Chestnut Hill Hospital in the Philadelphia metropolitan area closed its maternity unit, leaving more than 5 million people nearly without OB-GYN services.

In those states that refuse to adopt reform measures or overturn reasonable caps, physicians are retiring early or migrating to states where the malpractice insurance rates are more stable.

There is one fundamental question we should ask: Would you rather have access to your doctor or a personal injury lawyer? A recent report indicates that more than 60 percent of jury awards go directly to personal injury lawyers and not the victims. There is something inherently wrong about a system that allows lawyers to financially benefit more from the settlement or award than the victims.

If the personal injury lawyers are successful in persuading the courts to overturn tort-reform efforts, the cost of health care will continue to escalate and physicians will keep leaving states where the malpractice climate favors lawyers rather than medical providers.

As we continue to develop solutions aimed at increasing health insurance coverage for all Americans, we must create an intelligent system of health justice. But, in order to sustain such a system, we must also insist on a judiciary that upholds the law and refrains from legislating from the bench.

Newt Gingrich is a former speaker of the U.S. House of Representatives and the founder of the Center for Health Transformation. Wayne Oliver is the center’s health justice project director.

Continue reading »]]> by Newt Gingrich and Wayne Oliver
Originally published in The Wichita Eagle on September 19, 2009

In President Obama’s health care speech to Congress last week, he offered a fig leaf to doctors by pledging to consider civil justice reform. He directed Health and Human Services Secretary Kathleen Sebelius to look at creating “demonstration projects in individual states to test” civil justice reform ideas.

To those who have followed efforts for civil justice reform, this proposal must have sounded like a plan to reinvent the wheel. The fact is that several states have acted as “demonstration projections” or “incubators” for civil justice reform for years, and the results are in: Civil justice reform measures have significantly improved access to care, reduced costs and strengthened their economies. For example:

* California. Since passage of the landmark Medical Injury Compensation Reform Act more than 30 years ago, California ensures that injured patients receive fair compensation while preserving their access to health care by keeping doctors, nurses and health care providers in practice and hospitals and clinics open.

According to Californians Allied for Patient Protection, “MICRA has saved health care consumers tens of billions of dollars.” Prior to MICRA, California was facing a health care crisis. Hospitals, clinics and doctors, particularly those in high- risk specialties such as obstetrics and neurosurgeons, were leaving the profession or going out of business because of skyrocketing malpractice premiums.

* Texas. In 2003, Texas enacted comprehensive legal reform, including appropriate limits on noneconomic damages, something known as compensation for “pain and suffering.” According to the Texas Medical Board, more than 10,000 doctors have either returned to the state or decided to move to Texas as a direct result of the civil justice reforms.  Communities in Texas that were once medically underserved now have access to primary and specialty care doctors.

Many parts of the state suffered chronic shortages of key specialists, but as a result of progressive civil justice reforms, these areas of Texas now have a full complement of physicians.

There are also significant economic benefits of civil justice reforms. As a direct result of reform efforts, almost 500,000 new jobs relocated to Texas. Additionally, almost 430,000 previously uninsured Texans now have health insurance. Texas is another shining example of how civil justice reform can stimulate the economy, create jobs and reduce the rolls of the uninsured — all while improving access to health care.

* Other states. Georgia adopted comprehensive reforms in 2005. Mississippi enacted civil justice reform measures in 2002 and 2004. And Oklahoma’s medical-malpractice reform statutes become effective in November. Each state was threatened by a burgeoning physician shortage due to skyrocketing malpractice premiums, and civil justice reform was the key to addressing the problem.

In contrast, states without liability reform continue to suffer from shortages of providers — leading to the closing of hospitals, clinics and trauma centers and leaving patients with no doctors in their immediate vicinity.

For example, 19 maternity centers have closed in Philadelphia alone since 1997. The average waiting period for gynecologic care for a new patient in the five-county southeastern Pennsylvania area is six to nine months. The reason is that Pennsylvania refuses to adopt civil justice reforms.

In New York, another state without reforms, eight counties are without obstetricians according to the Center for Health Workforce Studies. The center also found that 18 of New York’s counties have significant shortages of practicing obstetricians/gynecologists.

We can and must embrace health reform on the national level, but it must address changing our civil justice system. The threat of frivolous lawsuits has led to the practice of defensive medicine, which not only wastes the patient’s and physician’s time but also costs an estimated $100 billion to $200 billion a year. Defensive medicine is when doctors order unnecessary tests and screenings to prevent themselves from being sued.

Americans want to change the way we settle medical injury disputes. According to a recent poll conducted for the Common Good, a nonpartisan legal reform coalition, and the Committee for Economic Development, 83 percent of Americans want Congress to reform the medical-malpractice system as part of any health care reform plan.

We don’t need to “study” what works. Those studies have already been written. We don’t need demonstration projects. We can already see the results of civil justice reform. Instead, we need real solutions, and those solutions exist in states such as California, Texas, Georgia, Mississippi and Oklahoma. Mr. President: The time for serious health reform is now. It must include civil justice reform.

Newt Gingrich is founder of the Center for Health Transformation. Wayne Oliver is director of the center’s Health Justice Project.

Continue reading »]]> by Wayne W. Oliver, Vice President, Center for Health Transformation
Originally published in the Atlanta Journal Constitution on March 7, 2012

Whether it is a patient centered medical home (PCMH) or an accountable care organization (ACO), we have all seen or read accounts on how we should change health and healthcare in the United States. And, quite frankly, we must change the dynamics in the healthcare sector to improve patient outcomes, decrease medical errors and lower healthcare costs.

But how do we go about improving the quality of care provided and patient satisfaction? First, it takes measureable data.  Once the information is secured, it requires data analytics to set performance goals or metrics. After all, we have to have a way to measure the metrics that drive how and where we can improve medical care and patient satisfaction.

Many of us read the book or saw the critically acclaimed movie “Moneyball” starring Brad Pitt as the Oakland A’s General Manager Billy Beane.  What was the basis of “Moneyball?” Metrics: using data to put the best possible team on the field at the lowest possible salary. And it worked. The A’s were able to compete with the likes of the New York Yankees and the Boston Red Sox but with a much leaner payroll.

In Rudy Giuliani’s book entitled “Leadership,” the former mayor discussed the creation of Comstat, which centered on mapping where and when crimes were committed in NYC. Comstat was a computer program created by former New York City police commissioner William Bratton.  And it worked. By focusing police resources on where and when crimes were being committed, New York City became the safest large city in America.

So, we are using data, data analytics and metrics to improve results and performance in sports and public safety. But, what data and metrics are being used to improve the healthcare system?

Until recently, there was no meaningful way for healthcare providers including physicians and hospitals to use data to improve medical care because there was no readily available data. The migration of physicians and hospitals to electronic platforms including electronic health records (EHRs) and other data analytic programs has created new opportunities to improve the care provided to patients.

For example, hospitals are using data to set new performance standards for patient safety. Right here in metro Atlanta, Wellstar, a group of five hospitals serving Cobb, Paulding and Douglas Counties, has been on the forefront of using data to create a culture of safety. And, it’s working.

An example of how data and data-driven metrics have resulted in improved care at Wellstar is the neonatal intensive care units (NICU) at Cobb and Kennestone Hospitals.  Increasing staff awareness and using safety coaches in the NICU, so-called “in-line” infections have been reduced to zero and have been maintained at that level in both units for well over 18 months.  To the parents of an under-weight baby, that must be seriously reassuring.

Wellstar is using data and metrics to reduce medical errors in all five hospitals. Several examples are contained in a white paper entitled “Healing without Harm” which was published in 2010 by the Center for Health Transformation.  The white paper, which was released on the decade anniversary of the IOM report entitled “To Err Is Human”, focused on creating and sustaining so-called High Reliability Organizations within healthcare which drive out human errors.

Wellstar is also using employee and patient satisfaction surveys to improve everything from emergency room wait time to creating safety coaches to improve human performance. Dr. Marcia Delk, Senior Vice President and Chief Quality Officer for the Wellstar Health System says, “We are transforming healthcare by using data and applying Lean improvement methodologies and creating a robust safety culture in partnership with improved health information technology to help us address the needs of patients in the communities we serve.”

Wellstar has a team of professionals who are dedicated to using data and performance measures for patient safety efforts, leadership development, revenue cycle improvement, patient satisfaction, employee engagement, operational improvements and medical efficiencies.

So data and metrics can be used in healthcare to improve patient outcomes, reduce medical errors, create a culture of patient safety and develop operational efficiencies. And, Wellstar is proving it can be done.

Continue reading »]]> by Wayne W. Oliver, Vice President, Center for Health Transormation
Originally published in the Atlanta Journal Constitution on April 5, 2012

Last month, ObamaCare had its day (or days) in court. The case … NFIB, et.al. vs. Kathleen Sebelius, et.al. will be the most celebrated Supreme Court cases in modern history.

The Supreme Court heard six hours of oral arguments over three days. That is unprecedented.

There are 26 states that are suing the federal government. That is unprecedented.

The Supreme Court’s decision will impact over twenty percent of the US economy. That is unprecedented.

But what happens if the Supreme Court does strike down all or part of ObamaCare? We better have “Plan B” ready to go.

We all know that our healthcare system is broken. However, we can’t all seem to agree on how we reform or transform our healthcare system. Here is my short list of those things that the Congress should consider if the Supreme Court strikes all or part of ObamaCare:

• Make significant changes to the way we litigate medical professional liability cases. Physicians today order too many tests, prescribe unnecessary medications, and inappropriately admit too many patients into hospitals because of the fear of being sued. The practice of defensive medicine contributes nothing to a physicians’ ability to diagnose, treat or care for patients. But defensive medicine costs patients, employers, taxpayers and health insurers billions of dollars each year and exposes us to unnecessary drugs, radiation and hassle. Insulate healthcare providers who use electronic health record systems and follow best patient care practices.

• Move away from the traditional fee-for-service delivery model toward one based on positive patient outcomes. A 21st-century healthcare model encourages patients to be engaged in their own health care and creates incentives for doctors and hospitals when patients get well or stay healthy and less when patients keep returning to hospitals in a revolving-door fashion.
• Advance consumer-directed healthcare. To empower patients with their own health care, we should reform the tax code to encourage more Americans to set up health savings accounts (HSAs). HSAs would allow consumers to pay for routine medical care, like we do for regular oil changes or tires on a car, and then use high-deductible insurance plans for major medical expenses. That is directly opposite of Obamacare, which taxes and restricts health savings accounts, dealing a blow to consumer-driven health care.
• Allow individuals to deduct their costs associated with health insurance just like employers. Some individuals and families bear the entire cost of health coverage. But recently, we have seen health insurance premiums increase and become more expensive. Many employers have shifted the premium increase to employees. Individuals should be able to deduct their share of health insurance premiums from their federal taxes. Such a change in the tax code would encourage individual personal responsibility to maintain health insurance coverage.
• Stop paying crooks through a more aggressive crackdown on criminal activity within Medicare and Medicaid. Some crooks claim it is more profitable to cheat the government in these programs than to engage in other illegal activities. The inspector general believes nearly 10 percent of Medicare cases are outright fraudulent. Hundreds of billions of dollars could be saved through better enforcement, whether rooting out nursing homes billing the government for deceased patients or criminals running HIV clinics that simply do not exist.
• Create a culture which supports a patient-centered approach to healthcare. Whether it is expanding patient safety programs in hospitals or advancing wellness and prevention services, developing a patient-centered healthcare system places the focus on the individual and their specific, individual needs.
• Create a 21^st century Food & Drug Administration (FDA) which encourages innovative new medical therapies. The current FDA does not have the capacity or capability to more rapidly approve new drugs and devices which can cure or manage disease. As a result, the US is losing investment capital, intellectual property and good jobs to Europe and Asia because of the policies of today’s FDA.
• Maintain federal incentives to ensure nationwide implementation of electronic health records by hospitals, physicians and other health care providers. An electronic platform not only reduces the chance for medical errors in treating patients, but also makes it more efficient and safer to transfer a patient’s history from one provider to another.

While some of these suggestions are not new ideas, they can serve as a good starting point if and when the Supreme Court strikes down all or part of the 2,700 pages of federal health reform.  We should be poised to fix what is wrong with our healthcare system and begin to examine what an effective, 21^st century healthcare system looks like.

Continue reading »]]> by Wayne W. Oliver, Vice President, Center for Health Transformation
Originally published in the Atlanta Journal Constitution on February 3, 2012

We are all concerned about the ever escalating healthcare costs. Employers struggle whether to offer health insurance benefits because premiums continue to rise at an alarming rate.

Employees and patients who do have insurance must endure higher, premiums, higher co-pays and coinsurance.  With healthcare costs are out of control, we must consider something totally transformational.

One primary driver of rising healthcare costs is due to the way physicians practice medicine these days. Physicians order unnecessary tests, procedures and prescription drugs simply to protect themselves from being sued.  This practice is known as “defensive medicine.”

And, according to Oppenheim Research, defensive medicine costs Georgians more than $14 billion each year.  Eighty-two percent of the Georgia doctors polled by Oppenheimer said they practice defensive medicine.

Solutions vary.  Traditional tort reform measures like caps on “pain and suffering” damages help to stabilize the medical liability insurance market. But physicians still practice defensive medicine by ordering expensive ultrasounds, CT scans, x-rays, MRIs, and dangerous medications that aren’t medically necessary.

These tests not only waste a patient’s time but cost a lot of money – sometimes tens of thousands of dollars. And patients are often exposed to radiation and other treatment options they don’t need just to give the doctor peace of mind.

A recent Gallup poll found that one-in-four healthcare dollars nationwide is spent on unnecessary tests, procedures and prescriptions.

To get to a system where physicians no longer feel the need to practice defensive medicine, there must be a serious commitment to a complete transformation of the current litigation system.  And, there is a group — Patients for Fair Compensation — which has been formed to advocate for such a transformation.

By moving to a different system of health justice – one which replaces the medical tort system with one that resembles a workers’ compensation system, we reduce healthcare costs, eliminate bogus lawsuits, reduce medical errors, reduce legal costs, and improve healthcare.

Dr. Jeff Segal, founder and CEO of Medical Justice Services, and a member of the Center for Health Transformation, recently published an article entitled “Doctors on defense as health costs soar” in the Atlanta Business Chronicle which discusses the need for transformation.

Dr. Segal said, “Instead of trying to tweak the medical tort system, we propose establishing a Patients’ Compensation System mirroring the state Workers’ Compensation Board. It would create a predictable model where patients know their cases would be heard. Doctors would know they wouldn’t be hauled into court. The system would accommodate more patients who are legitimately injured. They would receive quick, predictable settlements. Doctors would learn about medical errors. The cause of patient safety would be advanced.”

Sounds simple, right? Well, as Coach Lee Corso of ESPN ‘Game Day’ fame would say, “Not so fast.”

No one likes change and the impact will be dramatic. Since it is a no fault system, virtually every medical error will be disclosed so process and system improvements will be made just like in the airline industry. Physicians will no longer feel compelled to order senseless test which offer no diagnostic or therapeutic value. Furthermore, since doctors will be focusing on the patient as a patient and not a plaintiff, we can begin to restore the physician-patient relationship which might also lead to better patient outcomes.

As for personal injury lawyers, they will remain very well-paid individuals as they will have an even greater pool of clients to enter the Patients’ Compensation System. Today, very few patients who are harmed ever see an attorney nor get an attorney to take their case – let alone make it to court.

Since the Georgia Supreme Court threw out the centerpiece of the state’s 2005 tort reform effort, this is an effort worth exploring. It could be transformational for patients and doctors and for bringing down healthcare costs. It could also be transformational for Georgia as more tax dollars will be saved.

Continue reading »]]> by Wayne W. Oliver, Vice President, Center for Health Transformation
Originally published by the Atlanta Journal Constitution on October 5, 2011

Since its passage, President Obama’s federal health reform has resulted in a series of unintended consequences. Just last week, the Kaiser Family Foundation released a study which indicates that ObamaCare has caused annual family health insurance premiums to increase at a rate three times higher than in 2010.

ObamaCare has created way too many unintended consequences.

Remember the ObamaCare provision which guaranteed issue of health insurance for children? It was intended to ensure that kids who were sick or had pre-existing conditions could obtain health coverage. However, the unintended consequence? Many health insurers made the business decision to no longer offer so-called “children only” health insurance policies and thousands of children no longer have access to coverage in their state.

Remember how federal health reform was supposed to reduce overall costs? When ObamaCare was passed by Congress and signed by President Obama, the price tag was just over $800 billion. The latest Congressional Budget Office (CBO) figures put the price tag at well over $2 trillion. More unintended consequences.

Remember the 1099 provision of ObamaCare? Yes, it was the first provision to be repealed but its intended purpose was to tighten up the tax code. The unintended consequence would have created paperwork nightmares for small businesses and individuals.

Remember how ObamaCare was supposed to reduce the number of uninsured? Well, according to Commonwealth Fund, there are now more individuals and more families without health insurance than before ObamaCare was passed. More unintended consequences.

Remember how ObamaCare was supposed to increase the numbers of employers that provided health insurance for their employees? Just the opposite effect has occurred. More and more employers are deciding to no longer offer health coverage or shifting more of the cost to their employees.

Remember how ObamaCare was supposed to use Medicaid to expand coverage for those who didn’t have health insurance? Well, 26 states are suing the federal government over the impact that ObamaCare will have on their state’s budget and their citizens. The lawsuit is likely to be decided by the US Supreme Court. In the mean time, in anticipation of additional unfunded mandates as a result of ObamaCare, state Medicaid agencies all over the nation are rapidly reducing Medicaid rolls and reducing covered services. More unintended consequences.

So the Kaiser study released last week showing how ObamaCare has resulted in dramatic premium increases for families is just the latest in a series of unintended consequences. Hopefully, the Supreme Court will hear the case and direct Congress to re-think reform. Then, we can engage the American people in a real conversation and pass meaningful, marketplace-driven, private sector-based health reform that saves lives, saves money and eliminates the unintended consequences of ObamaCare.

Continue reading »]]> by Wayne W. Oliver, Vice President, Center for Health Transformation
Originally published in the Atlanta Journal Constitution on December 7, 2011

The U.S. Food & Drug Administration (FDA) regulates virtually everything that Americans consume or put on their bodies. Those FDA-regulated products account for about 25 cents of every dollar spent by American consumers each year — products that touch our lives every day.

But there is a problem. The FDA is trying to do its job with 20^th Century tools, technology, culture, and regulatory approach. Innovation is driving 21^st Century medical breakthroughs but the FDA does not have the capacity or the capability to help bring these breakthroughs to the American people.

But it gets worse. If we do not transform the FDA, there will be significant consequences. Currently, more than half of the population has at least one chronic disease.  Bringing new, innovative treatments to market for diseases such as cancer, diabetes and heart disease will have tremendous human and economic benefit.

The Partnership for Chronic Disease indicates that chronic diseases kill more than 1.7 million Americans per year and are responsible for seven in 10 deaths, by far the leading cause of death in America. And, chronic diseases also account for 75 percent of the nation’s health care spending.

A 21^st Century FDA should lead a revolution in science and medicine which offers medical breakthroughs to help every American prevent and/or manage chronic disease.

Because the FDA is trapped in the 20^th Century, the biomedical community is taking investments in innovation to other countries. The FDA’s lack of a transparent, predictable and efficient regulatory pathway has resulted in a dramatic decline in private sector investments in new pharmaceuticals or medical devices, for example, that could save lives.

As a result of the FDA’s regulatory climate, companies have moved offshore to develop important new medicines, taking with them jobs, financial capital and intellectual property. In February, Pfizer announced the planned closure of their US antibacterials unit. Some 1,100 jobs are to be eliminated over an 18-month period as the facility moves to China.

At the Center for Health Transformation (CHT), a two-year project was launched in 2009 to make recommendations on how to create a 21^st Century FDA. A couple of our recommendations include:

 Congress should provide the FDA with adequate resources to allow the Agency to be more efficient, more transparent, more predictable, more evidence-based, and more responsive in bringing medical breakthroughs to the American people.

 The FDA should create a new accelerated, patient-centric “conditional approval process.” This new flexible regulatory pathway would bring promising new and innovative medical therapies, treatments and devices to patients more rapidly.

With a more responsive, predictable, transparent and proactive FDA that allows American innovation to stay in our country, we will save lives, improve healthcare and save money.

Continue reading »]]> by Wayne Oliver, Vice President, Center for Health Transformation
Orginally published by the Atlanta Journal Constitution on January 7, 2012

Happy New Year! As we welcome in 2012, it is a year which will likely be full of change.

Later this year, we should have a historic decision about the two questions facing the Supreme Court of the United States regarding ObamaCare:  1) Can Congress require individuals to purchase of health insurance? And 2) Can the federal government force states to expand their Medicaid program?

If the Court upholds the Patient Protection and Affordable Care Act and its provisions, it will trigger a whole series of events and policies which must be implemented pursuant to the 2,700+ page legislation.  One of those state triggers which must be implemented are state health insurance exchanges which will allow individuals and small employers to purchase health insurance coverage.

The manner in which these exchanges are established and maintained is also of importance. Several states such as Massachusetts and California have adopted a “restricted” exchange model.  In other words, bureaucrats select which health insurance policies that individuals and small businesses can purchase. The dominate other model is a market-based approach which allows individuals and small business to select from all health insurance products in a particular state.   A third model which is cropping up in several states is one that creates a private sector health exchange with little or no state government assistance.

If a state decides not to set up some form of health insurance exchange, the federal government will step in and set one up for the state.  I am typically fearful when the feds step in so my bias would be for a health insurance exchange which offers more choices, not less; allows state flexibility, not rigid federal red tape; and encourages health and wellness over providing more of the same type policies which simply cover “sick care.”

As to the second question before the Court on expanding Medicaid eligibility, the economic downturn has put states in a budgetary tight spot. While ObamaCare will pick up some of the funds necessary to expand the Medicaid program, the states will be asked to pick up more and more of those costs over the years.

This fundamental funding shift from the feds to the states will cause state governments to make tough new cuts to education, public safety, transportation and other government services.  Expanding state based Medicaid programs will simply put states in the awkward position of having to raise taxes to cover the Medicaid expansion or cut other worthy programs.  You see, unlike the federal government, states’ actually have to balance their budgets.  And, state governments from Georgia to Oregon have already trimmed most of the fat in state based programs.  Therefore, if the Supreme Court rules that Congress can mandate that states expand their Medicaid rolls, then states will have to raise taxes in order to pay for and implement their “share” of ObamaCare.

But what happens if the Supreme Court rules that Congress and the President exceeded their constitutional boundaries in adopted federal health reform?

With or without ObamaCare, there is still a need to reform our healthcare system.  At the Center for Health Transformation, we believe we should move away from the current fee-for-service model which pays for individual medical transactions.  We should embrace a 21st-century model encourages patients to be engaged in their own health care and creates incentives for doctors and hospitals when individuals stay or get well.

We should also extend to individuals the same rights which companies, both large and small, have regarding the tax deductibility of health insurance premiums.  Creating a dynamic, robust individual insurance marketplace where health insurance products are widely available, which provide incentives for wellness and prevention and which focus on outcomes is vitally necessary.  We should advance consumer-directed healthcare plans. To empower patients with their own healthcare, we should reform the tax code to encourage more Americans to set up health savings accounts (HSAs). HSAs would allow consumers to pay for routine medical care, like regular maintenance on a car, and then, use lost cost, high-deductible insurance plans for major medical expenses. That’s directly opposite of Obamacare implemented which taxes and restricts health savings accounts, dealing a blow to consumer-driven health care.

Lastly, we should look at ways to create a totally new system of how we decide medical malpractice claims.  Under the current system, providers rarely disclose medical errors because of the fear of being sued.  Therefore, process engineering aimed at correcting medical errors are more difficult to implement.

And then there’s the issue of defensive medicine.  A Jackson Healthcare/Gallup poll of physicians last year found that $1 in $4 spent on healthcare is dedicated to unnecessary tests, procedures and drugs that doctors order to prevent being sued.  As long as doctors are forced to play defense, healthcare costs will continue to escalate and drive up costs for all of us. Creating a new innovative health justice model to properly compensate legitimate injuries while preventing bogus lawsuits is a very important priority.

Hold on tight because 2012 is likely to be a wild ride.

Continue reading »]]> by Wayne Oliver – Vice President, Center for Health Transformation
Originally published by AJC on May 18, 2011

We’ve all seen news reports of escalating healthcare costs and likely felt the implications of those spiraling expenses. Employers are shifting more costs to employees.  Many smaller companies are scaling back health coverage or dropping benefits entirely.

But there is a hidden cost of healthcare that no one wants to talk about and it’s one you’re going to start hearing more about: defensive medicine.

In healthcare, there can be “side effects” of medical procedures or prescription drugs. And, there is a rather significant “side effect” from the failure to do something about nuisance lawsuits filed against physicians. That side effect is called “defensive medicine.”