health law

The New York Times' Julie Creswell reports on how doctors are finding barriers to sharing electronic health records because computer programs made by different companies don't share records with each other: "Doctors and hospital executives across the country say they are distressed that the expensive electronic health record systems they installed in the hopes of reducing costs and improving the coordination of patient care — a major goal of the Affordable Care Act — simply do not share information with competing systems." Doctors who are getting federal funds in support of their electronic health records must show that they can share patient data or face cuts in their Medicare reimbursements, Creswell further reports. 

One of those companies is Epic Systems, which charges a fee to send data to some non-Epic systems, Creswell notes. Epic's founder, in a rare interview, "offered muted criticism of regulators for, essentially, failing to create what she did — a contract to help providers connect to one another and a way to authenticate that only the correct person could view the patient information." Regulators are in the process of developing a standard to make health information technology interoperable.

The U.S. Supreme Court is facing a circuit split on whether the federal government can provide tax subsidies to low-income workers to obtain health insurance on the federally-run insurance exchanges, SCOTUSBlog's Lyle Denniston reports. The U.S. Court of Appeals for the D.C. Circuit has said no (but the en banc court is going to hear the case in December). The Fourth Circuit has said yes. U.S. District Judge Ronald A. White, who sits in Oklahoma, added to the list of 'no' rulings yesterday.

According to the New York Times, White's ruling appears to increase the likelihood that the Supreme Court will resolve the issue. SCOTUSBlog's Denniston reports that White "relied on what he found to be the clear language of the ACA on that point — that is, subsidies are only to be available on an exchange 'established by the state.'  It was not his option, the judge said, to read the entire health care law to find reasons to make sure that the subsidy system worked in all exchanges across the country, federal and state."

The Washington Post reports that the millions of of enrollees who have benefited from the expansion of Medicaid appear to be "generally happy to have coverage, though many are encountering roadblocks to receiving the care they want, according to new research that provides one of the earliest insights into people's experiences under the expanded health insurance program for low-income Americans." The biggest problem for enrollees has been finding a primary care doctor, the Post further reports, because many doctors won't take new Medicaid patients.

In a separate report, the Los Angeles Times reports that as many as 500,000 people, or 10 percent, who have signed up for coverage under the Affordable Care Act may lose coverage or need to pay more because they haven't verified their citizenship or immigration status, or sent in the forms proving their income. The downside? "The Obama administration may face a backlash from consumers who will be asked to repay hundreds or thousands of dollars in subsidies that they weren't entitled to receive," the Times further reports.

There's another glitch in Obamacare, according to a Washington Post report: "A flaw in the federal calculator for certifying that insurance meets the health-care law’s toughest standard is leading dozens of large employers to offer plans that lack basic benefits, such as hospitalization coverage, according to brokers and consultants." The calculator is mainly used by self-insured employers and will allow employers to avoid getting fined as much as $3,000 per worker next year.

Virginia Gov. Terry McAuliffe is cutting back on his efforts to expand Medicaid healthcare coverage for poor Virginians in the face of strong opposition from Republican legislators, the New York Times reports. The governor has called it '''unconscionable' that such a wealthy state could not provide health care for its needy." The state constitution forbids spending without legislative approval, leading the governor to issue modest orders Monday to cover 20,000 people with severe mental illness and 5,000 kids of low-income state workers.

Capital New York's Dan Goldberg reported last week on the problems with electronic health records. For example, a Columbia University physican inadvertently exposed thousands of patient records by accessing a server at New York Presbyterian Hospital with his personal laptop. The result was the hospital paid $3.3 million and Columbia paid $1.5 million.

Moving patient information into electronic form comes with a greater risk of data breaches, Goldberg writes: "'Because more and more information is becoming electronic, there is a greater risk of breach of loss of that information,' said Ken Rashbaum, an attorney with Barton L.L.P., who specializes in cases related to the federal Health Insurance Portability and Accountability Act (HIPAA), and advises hospitals and health systems on how to remain in compliance with state and federal privacy laws."

The healthcare sector is the new place for identity theft, Goldberg reports, because the billing systems are out-of-date.

Also of concern: hackers messing with healthcare technology: "According to a Wired report published in April, Scott Erven, founder and president of SecMedic, 'found drug infusion pumps–for delivering morphine drips, chemotherapy and antibiotics–that can be remotely manipulated to change the dosage doled out to patients; Bluetooth-enabled defibrillators that can be manipulated to deliver random shocks to a patient’s heart or prevent a medically needed shock from occurring; X-rays that can be accessed by outsiders lurking on a hospital’s network; temperature settings on refrigerators storing blood and drugs that can be reset, causing spoilage; and digital medical records that can be altered to cause physicians to misdiagnose, prescribe the wrong drugs or administer unwarranted care.'"

In huge healthcare news, Pennsylvania Governor Tom Corbett has relented on expanding Medicaid to cover more poor Pennsylvanians under Medicaid, the Huffington Post reports: "Federal regulators accepted a modified proposal from Gov. Tom Corbett (R) that will offer an estimated 500,000 low-income individuals subsidies to purchase private insurance. The plan allows some low-income individuals to be charged premiums for coverage, and permits the number of available benefit plans to be reduced from 14 to two -- a 'high-risk' option and 'low-risk' options -- according to the Pittsburgh Post-Gazette." This makes Pennsylvania the ninth state run by a Republican governor to accept the Medicaid expansion.

Oregon has sued Oracle America for allegedly shoddy work on the Cover Oregon health exchange, The Oregonian's Nick Budnick reports. The state is prosecuting various theories all alleging that the IT firm fraudulently enriched itself at Oregon's expense.

Both sides blame each other for the failure to hire a systems integrator, or a general contractor to oversee Oracle's work, Budick further reports. When the systems integrator was not hired, Oracle became the primary contractor and ultimately was paid more than $103 million.

Outside counsel Markowitz, Herbold, Glade & Mehlhaf has been deputized to handle the case for the Oregon Department of Justice in exchange for a $2 million contract, Budnick concludes.

As electronic health records reach a critical mass in the healthcare field, the litany of problems with them could be "hazardous to your mental health," the Pittsburgh Post-Gazette's Bill Toland reports. The symptoms of issues with electronc health records (EHRs) include "pharmacy errors, hard-to-find clinical alerts, 'farcical' training, and potentially life-threatening design flaws," Toland further reports. EHR critic Dean Kross, a cardiologist in private practice at the Allegheny Health Network, told Toland that EHR vendors have not been held accountable for the devices they are manufacturing.

The main safety issue with EHRs may be ensuring patient safety and privacy during their implementation. They are still thought to be a better practice than paper records. For example, faxes of patients are still commonly used in Canada, and an Alberta man reports that he has been receiving private health records on his office fax machine for the last six years, Canada's Global News reports. But EHRs are only as secure as technology can make them. Community Health Systems Inc., one of  the largest hospital groups in the United States, disclosed this week that Chinese hackers stole social security numbers and other personal data of 4.5 million patients, Reuters reports. The security breach did not include patient information.