Consulo Indicium 1/30/18

Information for your Consideration...
The Irony Of It All - I don't usually quote directly from news clippings. But, I wanted to share the one from page 5 of THE WEEK, January 12, 2018 edition in the "Only in America" section:
"Citizens can now carry guns into the chamber of Tennessee's state legislature, but can't bring home-made signs. Critics of the new policy say it's designed to curb the free speech rights of Tennesseans, in the wake of angry protests last year over immigration, Medicaid expansion, and other issues. Legislators said they banned "hand-carried signs and signs on hand-sticks because they represent a serious safety hazard." (emphasis added).
If you didn't read it there first, you read it here...
VA Cerner Deployment Paused - The U.S. Department of Veterans Affairs confirmed a "strategic pause" on further negotiations with Cerner Corporation related to the deployment of the Cerner electronic health record (EHR) system pending an independent assessment of the "interoperability requirements" needed by the VA from the new EHR system. In what some have described as a "spat", the VA contracted with neutral third-party - MITRE Corporation - to conduct the assessment.   In making the announcement to the US Senate Finance Committee, VA Secretary David Shulkin noted that, "My objective when it comes to healthcare for our veterans is to have a fully integrated, interoperable, operationally efficient healthcare system that's easy for veterans, employees and community partners to navigate." Well said!! Shulkin should hold firm on the question of interoperability. It's not only important for the VA but it's important for the nation to begin hold the EHR systems accountable for supporting interoperability. Go for it, David!! After all, for a project that will exceed an estimated $10B (which I think will actually end up being nearer to $20B at the end of the day), interoperability should be at the top of the list.
Health Spending Continues To Rise But, Slows - In 2015, the rate of health spending growth was 5.8%. In 2016, it grew at 4.3%. However, the rate of growth slowed and according to the CMS Office of the Actuary, the growth that did occur was broadly based across the entire industry base among the major payers (i.e. private health insurance, Medicare, and Medicaid) and providers of services (i.e. hospitals, physician and clinical services, and retail prescription drugs). The total percent of GDP allocated to health care continued to creep upwards from 17.2% in 2013 to 17.7% in 2015; and 17.9% in 2016. Also, health care spending actually grew a bit faster than the overall economy by about 1.5% due in large measure to demographics and the expansion of the number of insured among the USA populace. Although there was generalized growth among private health insurance, Medicare and Medicaid; the most notable finding from the report was the fact that out-of-pocket spending such as copayments, deductibles, and spending not covered by insurance continued to grow at a far faster rate. In fact, out-of-pocket spending grew 3.9% which was largely attributable to the continuing shift by consumers to enroll in high-deductible health plans. The other notable change was in the retail prescription drug spending which slowed in 2016 to an increase of 1.3% compared to a 12.4% (2014) and 8.9% (2015) increase from prior years. Why? According to CMS, the reasons were "fewer new drug approvals, slower growth in brand-name drug spending as spending for hepatitis C drugs declined, and a decline in spending for generic drugs." For a full read of the report download a copy of the report at
NET NEUTRALITY DAY APPROACHES - Let me say at the outset that I am an unabashedly PRO net neutrality advocate. So, as you can imagine, I was disappointed when the FFC prevailed in vote of 3 - 2 to undo the rules established back in 2015. Under those regulations, broadband was considered a utility under Title II of the Communications act and the rules established to create a level playing field included:
  • No blocking of websites or apps by Internet service providers,
  • No throttling of transmission data based on the nature of the content,
  • No Internet "fast lanes" where companies and/or consumers could pay a premium for the service and where large discriminations could be made against slow service. 
So, essentially all of this was undone by the FCC decision. The telecoms were out front and positive after the announcement with their advocacy that a "light touch" was a more appropriate model for managing the Internet. However, there is a widespread fear that splintering of the Internet will occur. In fact, it's already happening overseas where different "services" with different "levels" of capability are already being offered in the market place for social, messaging, video and other services where no net neutrality rules apply.
As it relates to "pay-to-play" schemes, we already have a problem in the USA. If you haven't been to rural America recently, you may not realize that the service levels and speeds of Internet capability vary considerably across the nation and between urban and rural areas especially. This is unwarranted. This is particularly apropos to health care because of the increasing reliance upon Internet connectivity to provide telecare, remote management and other similar tele-technology dependent services. The disparity makes an existing problem even worse. It's an issue that deserves our special consideration. I'm going to keep my eye on it.
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