Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Saturday, January 31, 2015

Weekly Overseas Health IT Links - 31st January, 2015.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.
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Patients increasingly open to video doctor visits

January 23, 2015 | By Susan D. Hall
Patient acceptance of telehealth services is growing, with 64 percent of patients recently surveyed by Harris Poll on behalf of telehealth company American Well saying they are willing to consider a video chat with their doctor instead of an in-person visit.
Based on responses from 2,019 consumers, a majority are open to the convenience and reduced wait times involved in an e-visit. The survey characterizes telehealth as a way for health systems to offer a lower-cost, more convenient alternative to in-person case.
Another recent study found that a telehealth visit saves about $100 or more compared to the estimated cost for in-person care. It put the cost of the average telehealth visit at $40 to $50, while in-person care can cost as much as $176.
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Strategy and innovation advisors wants predictive analytics included in HIT strategic plan

January 23, 2015 | By Katie Dvorak
The Health IT Policy Committee's strategy and innovation work group, on Thursday, outlined draft recommendations for the Office of the National Coordinator for Health IT's updated Federal Health IT Strategic Plan.
The workgroup's changes and suggestions for the plan include clarification of language to, among other things:
  • Emphasize a focus on improving health and well-being
  • Explain how a health-oriented infrastructure would function
  • Reflect a greater focus on health equity
Workgroup members also said predictive analytics should be included in the plan, and that ONC should articulate a vision for collection, ownership, protection and uses of personal health information.
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Two Generations of Geneticists, Two “Precision Medicine” Wish Lists

Alex Lash1/21/15
In late 2012, President Obama awarded Leroy “Lee” Hood the National Medal of Science for a lifetime of achievements, including the invention of machines that made the historic Human Genome Project possible.
So when Obama announced yesterday a “precision medicine initiative”—something that would surely require ever-deeper knowledge about the personal genetic differences that influence health and disease—I asked Hood for his thoughts.
He didn’t mince words. “It’s so vague and fuzzy, I don’t know what it means,” Hood said this morning from Southern California.
More details should follow, but not at this early date. (The National Institutes of Health referred all questions to the White House, which didn’t return inquiries.)
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Top mHealth apps as rated by doctors

January 20, 2015 | Eric Wicklund - Editor, mHealthNews
Aiming to get "the professional side of things," HealthTap has released dozens of lists ranking the top apps recommended by physicians.
The Palo Alto, Calif.-based company surveyed more than 65,000 physicians in its network and another 500,000 in its referral network on their recommendations on a wide variety of health and wellness apps. The company then listed the top 100 iOS and Android apps, then broke the recommendations down into roughly 30 lists on more specific categories, like running and diabetes care.
HealthTap founder and CEO Ron Gutman said the company's goal is to give clinicians and consumers a guide to choosing apps that have been approved by doctors, rather than resorting to the user ratings found in app stores (HealthTap's AppRx app, by the way, has a healthy 4.72 star rating in the Apple App Store, he said). The apps are judged on three standards – ease of use, effectiveness and medical accuracy, validity and soundness. They're not given a number rating, but are ranked solely based on how many doctors would recommend them.
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For clinicians, Google Glass isn't dead

Posted on Jan 22, 2015
By Mike Miliard, Editor
Google drew its Glass Explorer program to a close this past week, perhaps tacitly conceding that some of the criticisms of their much-hyped wearable computer – off-putting, invasive, "far too dorky-looking for normal people to want to wear" – had some merit.
But while a cursory look at certain media reports might lead some to think Google Glass is being killed off, that's hardly the case.
There's a decent chance a consumer-focused Glass will be resurrected at some point in the future, completely revamped and in a different form factor – redressing some of the clunkier hardware and software drawbacks that had some all too happy to have fun at its expense.
In the meantime, commercial applications of Glass are marching onward, with scores of outside developers and Silicon Valley startups continuing to work on apps for the platform. Healthcare is one industry that stands to reap the most benefit in the months and years ahead.
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Hospital CIOs share experiences, issues with interoperability

January 22, 2015 | By Susan D. Hall
Although most healthcare chief information officers have implemented certified electronic health record systems and the required standards, many remain frustrated in their quest for interoperability, according to Beth Israel Deaconess Medical Center CIO John Halamka.
In a recent blog post, Halamka, from his conversations with healthcare CIOs around the country, shared several issues, including:
  • HL7 2.x messaging is fine for lab and public health reporting, but there remains a need to specify a single transport mechanism for all public health agencies
  • Consolidated Clinical Document Architecture works well for generating transitions of care documents, but merging that with EHRs remains difficult. Those documents can be more than 50 pages, so there needs to be a way to include only the most relevant data
  • Implementing Direct still provides plenty of challenges, including certificate and trust issues. Medical devices use myriad transmission protocols, so getting that data over Direct isn't easy. And sending datasets larger than 10 megabytes can be a struggle
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Survey: 64 percent of patients willing to have video visits with docs

By: Aditi Pai | Jan 21, 2015
Sixty four percent of patients are willing to participate in a video visit with a doctor, according to an online Harris Poll survey of 2,019 adults aged 18 and up conducted in December 2014. Telehealth company American Well commissioned Harris Poll to conduct the survey.
Of those that were willing to visit with their doctor over video, 61 percent said convenience was a factor in this decision.
Seven percent of respondents who had been with their doctor for less than a year said they would switch doctors to get online video visits. And 10 percent of respondents who had been with their doctor for two to four years said they would switch. Younger people were more likely to switch to a physician that offered video visits. Eleven percent of patients between the ages of 18 and 34 said they would switch, while 8 percent of patients aged 35 to 44 said they would switch. 
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Docs urge big changes to health records program

By Elise Viebeck - 01/21/15 05:23 PM EST
A coalition of 35 medical societies is urging federal regulators to make major changes to the Meaningful Use electronic health records (EHR) program.
Led by the American Medical Association, the coalition wrote Wednesday to the National Coordinator for Health Information Technology arguing that Meaningful Use could harm patients if allowed to continue in its current state.
"We believe the Meaningful Use certification requirements are contributing to EHR system problems, and we are worried about the downstream effects on patient safety," the groups wrote.
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Mayo Clinic moves to Epic

Posted on Jan 20, 2015
By Mike Miliard, Editor
In the latest example of a world-class health system yanking its established electronic health record in favor of a blue chip vendor, Mayo Clinic is migrating to Epic.
 “We’re confident in choosing Epic as our strategic partner as we continue to enhance Mayo Clinic’s excellence in health care and medical innovation,” said John Noseworthy, MD, Mayo Clinic's president and CEO, in a statement announcing the partnership.
Epic will deploy a single, integrated EHR and revenue cycle management system at the renowned campus. This will replace Mayo’s three EHRs currently in use today, and will be the foundation for the next "several decades" of care delivery there, officials say.
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Erroneous med errors 'sail through' CPOE systems

January 21, 2015 | By Susan D. Hall
Nearly 80 percent of erroneous medication orders could be entered in computerized physician order entry (CPOE) systems, and more than half "sailed right through," with little or no difficulty or warnings, according to research published at BMJ Quality & Safety.
The researchers found 10,060 CPOE-related errors reported to the U.S. Pharmacopeia MEDMARX reporting system. They developed a taxonomy of those errors, then tried to replicate them on 13 CPOE systems at 16 sites.
Only 26.6 percent of erroneous orders generated specific warnings; of those, 69 percent were passive alerts, such as information displayed or easily overridden or ignored. Another 29 percent required workarounds, such as adjusting the dosage, but nonetheless, still could be entered, according to the research.
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Obama touts cybersecurity, personalized medicine efforts in State of the Union address

January 21, 2015 | By Dan Bowman
While health IT wasn't directly mentioned in President Barack Obama's State of the Union Address on Tuesday night, two proposals touted--on cybersecurity and personalized medicine--have the potential to alter the landscape of the industry to varying degrees.
Cybersecurity
Obama's cybersecurity plan, which already has won an endorsement from the Health Information Trust Alliance (HITRUST), calls for increased sharing of information on cyberthreats from the private sector with protection from liability. Specifically, the White House wants the private sector to share its cyberthreat information with the Department of Homeland Security's National Cybersecurity and Communications Integration Center, which would pass that information along to other federal agencies and private-sector operated Information Sharing and Analysis Organizations (ISAOs).
The plan also calls for a single notification requirement that would standardize the "existing patchwork" of state laws currently in place.
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Difficult birth

Maternity units have been slow to take up IT, and while that’s changing, it’s only changing slowly. Meanwhile, community midwifes and patients are even further behind. Kim Thomas reports and talks to two trusts that have implemented new systems with real benefits; Royal United Hospital Bath NHS Foundation Trust and Bradford Teaching Hospitals NHS Foundation Trust.
When EHI published its first report on maternity IT in 2013, it noted that the adoption of digital technology had been particularly slow at maternity units, despite the complexity of the maternity pathway.
Two years on, that is beginning to change, but there is plenty of room for improvement – and some of the particular challenges of maternity IT, such as the need for community midwives to be able to record data in the field, are only slowly being met.
While for many NHS practitioners, IT is integrated into everyday working practice, the same is not true of midwives. As Louise Caney, maternity and nursing product manager at System C, which supplies Medway Maternity, says: “They are a group of health professionals that are forgotten.”
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New privacy concerns over health care website

Ricardo Alonso-Zaldivar, Associated Press 10:39 p.m. EST January 20, 2015
Washington — The government’s health insurance website is quietly sending consumers’ personal data to private companies that specialize in advertising and analyzing Internet data for performance and marketing, the Associated Press has learned.
The scope of what is disclosed or how it might be used was not immediately clear, but it can include age, income, ZIP code, whether a person smokes, and if a person is pregnant. It can include a computer’s Internet address, which can identify a person’s name or address when combined with other information collected by sophisticated online marketing or advertising firms.
The Obama administration says HealthCare.gov’s connections to data firms were intended to help improve the consumer experience. Officials said outside firms are barred from using the data to further their own business interests.
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ECRI's top 10 technologies to watch

By Government Health IT Staff
Telehealth, Google Glass, and post discharge clinics are among the top 10 technology trends hospital executives should watch in 2015, according to a nonprofit organization that researches the best approaches to improving patient care.
ECRI Institute’s "2015 Top 10 Hospital C-Suite Watch List" covers what it says are "a blend of novel, new, and emerging technologies that will demand attention and planning over the next 12 to 18 months, plus important issues and programs affecting care processes and delivery in 2015 and beyond."
The institute's list:
1. Disinfection robots
2. Three-dimensional (3-D) printing
3. Alarm management middleware
5. Google Glass
6. New anti-obesity devices
7. Caring for millennials with cancer
8. Fecal microbiota therapy
9. Artificial pancreas device systems
10. Telehealth
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Physicians have urgent message for ONC

Posted on Jan 20, 2015
By Bernie Monegain, Editor-at-Large
Responding to the Office of the National Coordinator for Health IT's call for comments on its draft plan, the American Association of Family Physicians  did not mince words.
"Ease the administrative burden physicians face and build on goals set a decade ago," the AAFP wrote in a letter to ONC.
The ONC's 28-page "Federal Health IT Strategic Plan 2015-2020," released this past December, outlines the federal health IT working plan for the next five years.
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EHR Use Does Not Result in Coordinated Care

JAN 19, 2015 7:58am ET
Although more than 70 percent of U.S. doctors use electronic health records, up to half don't routinely receive the data necessary to coordinate patient care effectively.
That is the conclusion of a study published in Medical Care. “The study findings highlight the continuing challenges to using health information technology to coordinate care among providers," said lead author Chun-Ju Hsiao, of the U.S. Agency for Healthcare Research and Quality.
The researchers analyzed data from about 4,500 office-based physicians responding to a nationally representative 2012 survey on the use of EHRs and electronic sharing of information. The doctors were also asked how regularly they received specific types of patient health data for effective coordination of care.
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Recap of Q4 2014 Federal Health IT Activity

by Helen R. Pfister and Dori Glanz, Manatt Health Solutions Tuesday, January 20, 2015
The federal government continues to implement the HITECH Act, enacted as part of the American Recovery and Reinvestment Act. Below is a summary of key developments and milestones achieved between Oct. 1, 2014, and Dec. 31, 2014.

Key Q4 2014 Developments

  • ONC Releases Federal Health IT Strategic Plan. The Office of the National Coordinator for Health IT's new five-year Strategic Plan for Health IT, released on Dec. 10, 2014, frames the federal health IT strategy and focuses on increasing health IT adoption, expanding interoperability of electronic health records, improving the safety of health IT and expanding access to broadband Internet for rural providers.
  • ONC Releases Draft Details on Nationwide Interoperability Roadmap. The draft roadmap -- unveiled at a joint meeting of the Health IT Policy and Standards committees on Oct. 15, 2014 -- focuses on implementing improved interoperability of EHRs, and aims to create a learning health system focused on patients and improved outcomes through improved clinical, cultural, business and regulatory environments. The full roadmap will be released in March.
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Allina Health and Health Catalyst's Unusual Deal

Scott Mace, for HealthLeaders Media , January 20, 2015

Teams building analytics technology for healthcare organizations find themselves jointly holding intellectual property and equity in new arrangements not seen before in healthcare.

Follow the money, they say. It's not always easy. "Terms of the transaction were not disclosed" is the common coin of many a deal. But despite this, some deals are harbingers of bigger things.
To make my point, I will appropriate a word: extrapreneur. It's a word that you won't find in most dictionaries. In 1992, the American Heritage Dictionary defined intrapreneur as "a person within a large corporation who takes direct responsibility for turning an idea into a profitable finished product through assertive risk-taking and innovation."
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What a National Breach Notification Law May Look Like

JAN 19, 2015 7:53am ET
President Obama’s proposed legislative language to improve the nation’s cybersecurity does not require companies to harden their information networks.
But the legislation sent to Congress lays out the President’s plans to establish a national breach notification rule, lift legal barriers to enable industries and government to share threat data, and change federal racketeering laws “relating to fraud and related activity in connection with computers” which would include deterring development and sale of computer and cell phone spying devices. The legislative language and plain-English summaries are available here.
The breach notification standard--requiring notification to affected individuals within 30 days of discovery and regardless of the size of a breach--would apply to a “business entity,” which would include “any organization, corporation, trust, partnership, sole proprietorship, unincorporated association or venture whether or not established to make a profit.” The legislation does not exempt any industry by name. Under HIPAA, the healthcare industry presently has a 60-day notification requirement.
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Execs Upbeat on Population Health ROI

John Commins, for HealthLeaders Media , January 20, 2015

More than half of healthcare executives surveyed believe they'll see a return on investment for healthcare information technology and data/analytic tools in four years or less.

More than half of healthcare executives believe they will recoup their investment in population health management programs within three to four years, an online survey from KPMG LLP shows.
"It can be realistic within three or four years, but let's not sugarcoat it. It takes a lot of time, effort, commitment, and understanding to make that happen," says Joe Kuehn, a partner with KPMG's Healthcare Advisory Practice.
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Execs Expect Population Health Management ROI in 3-4 Years

JAN 19, 2015 7:49am ET
More than half of healthcare managers surveyed expected to recoup their investments in population health management programs within three to four years, according to KPMG, the U.S. audit, tax, and advisory firm.
“Our clients see benefits from population health management programs as a part of the solution to reduce avoidable medical costs and variability in care,” said West Johnson, a KPMG advisory partner who heads provider transformation. “Preventive care is given a big priority in these programs, since they deliver improvements in efficient and effective care with a high degree of patient engagement.”
According to KPMG’s online survey, 20 percent believe that investments in healthcare information technology and data and analytic tools will pay off in one to two years. Another 36 percent indicated that the payback period for these investments could take up to three or four years, showing a majority expect to recoup their costs within this time frame. The survey showed that 29 percent see the investment in population health paying off in five or more years. Only 14 percent see them not recouping their costs at all.
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Can population health IT investments pay off?

Posted on Jan 19, 2015
By Mike Miliard, Editor
More and more healthcare organizations are recognizing the value of population health management – and a majority say they expect to recoup their investments in the technology to power those programs in just a few years, according to KMPG.
An online poll from KPMG shows that 20 percent of respondents say investments in healthcare information technology and analytics will pay off in one to two years. A slightly bigger group (36 percent) think ROI could take up to three or four years.
The survey showed that 29 percent see the investment in population health paying off in five or more years. Only 14 percent see them not recouping their costs at all.
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Philips, MIT collaborate on ICU data sharing

January 15, 2015 10:20 pm by Dan Verel | 
Royal Philips and MIT announced an initiative that will allow healthcare researchers to access data on more than 100,000 patients, which has been collected by Phillips through its Hospital to Home eICU telehealth program.
For researches, data sets are often limited to insurance claims data, which offers a summary of patient’s stay at a hospitals. The Philips effort, officials said, will add a more comprehensive look at ICU patients and will include clinical information like vital signs, pharmacy medication orders, lab results, diagnoses and severity of illness scores.
The data from Philips accounts for 10 percent of all adult ICU patients in the U.S., according to the Dutch company.
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MIT, Royal Philips Provide Researchers with Critical Care Data

JAN 20, 2015 9:09am ET
The Massachusetts Institute of Technology and Royal Philips have teamed to provide healthcare researchers with access to one of the largest critical care data resources.
Under the initiative, Philips will be granting access to data from more than 100,000 patients that have been collected and anonymized through the Philips Hospital to Home eICU telehealth program. The Laboratory of Computational Physiology at MIT’s Institute for Medical Engineering and Science will serve as the academic research hub for the initiative, and will provide and maintain access, as well as help educate researchers on the database and offer a platform for collaboration. 
“Most inpatient multi-center data sets available to researchers today are limited to insurance claims data, which offers just a summary of a patient's stay,” according to an announcement “Through this new initiative, Philips will release a more comprehensive look at the ICU patient's journey by opening up data sets from patient stays in eICU centers representing approximately 10 percent of all adult ICU beds in the United States.
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Enjoy!
David.

Friday, January 30, 2015

It Would Be Good To Know That The PCEHR Does Not Leak Information The Way A Major US Government Health Site Does.

These two articles appeared last week.
First we have:

New privacy concerns over health care website

Ricardo Alonso-Zaldivar, Associated Press 10:39 p.m. EST January 20, 2015
Washington — The government’s health insurance website is quietly sending consumers’ personal data to private companies that specialize in advertising and analyzing Internet data for performance and marketing, the Associated Press has learned.
The scope of what is disclosed or how it might be used was not immediately clear, but it can include age, income, ZIP code, whether a person smokes, and if a person is pregnant. It can include a computer’s Internet address, which can identify a person’s name or address when combined with other information collected by sophisticated online marketing or advertising firms.
The Obama administration says HealthCare.gov’s connections to data firms were intended to help improve the consumer experience. Officials said outside firms are barred from using the data to further their own business interests.
More here:
Second we have:

Group Confirms Healthcare.gov Shares Personal Health Info with Third Parties

JAN 22, 2015 7:47am ET
The Electronic Frontier Foundation, a technology policy advocacy group, says it has confirmed that the federal government's healthcare.gov insurance exchange site is sharing personal data, including ZIP code, income level, smoking status, pregnancy status, and more, with at least 14 third parties.
"EFF researchers have independently confirmed that healthcare.gov is sending personal health information to at least 14 third party domains, even if the user has enabled Do Not Track," EFF staff technologist Cooper Quintin writes in an EFF blog post after recent Associated Press reports.
According to Quintin, the information is sent via the referrer header, which contains the URL of the page requesting a third party resource. The referrer header, he wrote, lets the requested resource know what URL the request came from. In this case, the referrer URL contains personal health information.
Among the companies EFF technologists say the site is sharing information with are network optimization developer Akamai, Yahoo, Twitter, and Google and numerous Google subsidiaries such as Doubleclick and YouTube.
Lots more here:
While it would seem unlikely I wonder does the PCEHR site use similar approaches to share information with other entities?
Anyone able to say yes or no for certain?
David.

Thursday, January 29, 2015

Review Of The Ongoing Post - Budget Controversy 29th January 2015. Utter Disarray!

Budget Night was on Tuesday 13th May, 2014 and the fuss has still not settled by a long shot. Indeed more than a few commentators are now wondering out loud if the Abbot Government will last for a second term.
The modified Medicare co-payment plan - announced late last year  - seems to have annoyed most other than the Government and we now wait till mid February 2015 to see what the Senate thinks of Plan B. We know the AMA and RACGP are talking to the Government and the new minister about it.
Now part of Plan B is gone but some extreme nasties still remain, i.e. the rebate cut for short consults has been abandoned the freezing of rebate levels until 2018 and a plan for a co-payment are still live.
As for the rest of the Budget - who knows and Mr Hockey is threatening tax rises to repair the Budget!
See here:

Hockey: income tax burden to increase if Labor keeps blocking savings measures

Date January 24, 2015 - 7:53PM

Gareth Hutchens

Treasurer Joe Hockey has warned that if Labor continues to block savings measures in the Senate he will not be able to stop Australians' income tax burden increasing through so-called "bracket creep".
"We have been warning about bracket creep and we want to deliver tax cuts, but the Labor controlled Senate continues to block savings measures that would help pay for those tax cuts," Mr Hockey told Fairfax Media.
"If Labor continues to block our savings measures the cost burden will inevitably fall on middle Australia. We do not want this to happen."
Australia's top economists, including former Treasury Secretary Martin Parkinson, have warned that middle and low-income households will face an increasing tax burden in coming years if the government does not move to prevent bracket creep.
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Seems there are lots of broader problems also. See here:

Glenn Stevens must act fast to rescue Australia's economy

Date January 25, 2015 - 10:34AM

William Pesek

Comment
Few central bankers in modern history have had a better run than Australia's Glenn Stevens. He steered his country around the global financial crisis, drove its currency to record highs and extended its recession-free run past the two-decade mark.
That's all in jeopardy now, however, as Stevens, governor of the Reserve Bank of Australia, stands still while China's slowdown and deflationary forces close in. Markets are registering their disappointment by driving the Aussie dollar below 80 US cents for the first time since 2009. The message from traders: It's time for a rate cut. The question is, will Stevens act ahead of, or at, the central bank's February 3 policy meeting?
The odds he will are rising, but remain too low for comfort. The European Central Bank's quantitative-easing program and the Bank of Canada's surprise rate cut add to the pressure on Stevens to trim a benchmark rate he's held at 2.5 per cent for 17 months.
The most immediate danger is China, to which commodity-rich Australia has increasingly hitched its fortunes. The collapse in global commodity prices challenges Beijing's claim that its economy is growing by 7.3 per cent. Even more than the plunge in crude oil, iron ore at its lowest price in more than five years suggests China is growing slower. Such metals fuel the Chinese urbanisation trend that's been lifting world growth. As Premier Li Keqiang explained at Davos this week, China's move to a consumer-led economy from an investment-led one is real, and the fallout will be felt everywhere. China's "new normal" is particularly bad news for Australia's mining industry.
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Other articles this week.

General Budget Issues.

The black plague of finance: easy money not seen since the 14th century

Date January 22, 2015 - 2:28AM

Paul Sheehan

It is not a good sign when an internationally respected economist, one of the few who predicted the 2008 global financial crisis, invokes the black plague when discussing today's global financial markets.
"We are in a world that is dangerously unanchored … We're seeing true currency wars and everybody is doing it," said William White, a senior economist for the Organisation for Economic Co-Operation and Development.
"Sovereign bond yields haven't been so low since the black plague," he told Ambrose Evans-Pritchard, the European economics editor of The Telegraph in London. Evans-Pritchard has been a prescient (and pessimistic) observer of the eurozone.
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Health Budget Issues.

Tony Abbott should work with states to cut the cost of healthcare

AS one health minister to another, I advise new federal Health Minister Sussan Ley to pin up in her office the words “Poor quality healthcare is always more expensive than high quality care”, and remember that the US has the lowest life expectancy in the developed world, despite spending twice the percentage of its GDP on healthcare that Australia does.
The cost of providing healthcare, particularly the acute healthcare citizens have come to expect, threatens to overwhelm budgets around the world. It is understandable that the Abbott government is trying to tackle this, albeit in an ill-thought fashion. But measures which adversely affect the quality of healthcare, especially anything that discourages people from seeing their GP, will do nothing to curb the cost of healthcare.
Federal government expenditure on Medicare this year will be about $19 billion. But this is dwarfed by the $140bn state and federal governments spend on public hospitals. To change Medicare without considering the impact on public hospitals is shortsighted.

Take it from a baby doctor: cuts to GP services are a false economy

Date January 19, 2015 - 12:00AM

Benjamin Veness

At 8am on Monday, in hospitals from Wagga Wagga to Sydney to Lismore, 969 new doctors will be born. We baby doctors comprise this fertile state's newest crop of interns – the largest in the country and the most in NSW's history. We are grateful for the public's trust, and also for Tony Abbott's decision while he was health minister to increase the number of medical school places, allowing many more of us to realise a dream of caring for our fellow citizens' health.
After already spending up to six years at medical school, plus this coming year of internship, deciding on a speciality will be our next big decision.
"Are you going to specialise, or just be a GP?" is a question I am often asked, but it hasn't been possible to "just be a GP" for two decades. Once, the internship was the only impediment to a new doctor hanging his or her shingle as a GP and bulk-billing Medicare for services to patients. In 1996, new federal legislation made aspiring GPs spend several more years after internship in further supervised training and exams. General practice effectively became a specialty, just like cardiology or neurosurgery.
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Lesley Russell & Stephen Leeder: Rough road

Lesley Russell and Stephen Leeder
Monday, 19 January, 2015
THIS year will be a critical time for federally funded health care in Australia and many of us are wondering which direction we will take.
Will we see the dismantling of Medicare and health care services as we know them, or the rebuilding and restructuring of both the system of care and the way we finance it, to better meet the needs of all Australians?
In its first year, the Abbott government has torn down and cast aside policies and programs of the previous government and commitments it made in election mode. Central to these is the undermining of the financial base for acute care services, by the clawback of an estimated $50 billion over the next decade from the National Health Reform payments to the states and territories and the abandonment of activity-based hospital funding.
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Superficial debate on health policy is starting to sound like a joke

Judith Sloan

EVERYONE knows the joke about the bloke asking for directions to Dublin — I wouldn’t start from here is the punchline. When it comes to public policy, that wise Irishman has a real point.
Economists have a fancy name for it — path dependence. When considering policy options, there is no point getting a clean sheet of paper. You have to deal with what you have and tweak or modify policies, depending on your degree of political courage.
Where policy settings have been in place for long periods of time, as with Medicare, career and business decisions have been made and the electorate has built certain expectations based on their experience with the system.
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Joe Hockey raises prospect of Australians living until 150 to justify budget cuts

Date January 19, 2015 - 11:34AM

Matthew Knott

Treasurer Joe Hockey has raised the prospect of people living until 150 to explain why Australians should accept cuts to government benefits and pay a greater share of their health costs.
It's kind of remarkable that somewhere in the world today, it's highly probable that a child is being born that is going to live to 150 
Mr Hockey also refused to deny reports that he and former health minister Peter Dutton opposed a $20 cut to Medicare rebates for short consultations in a meeting of cabinet's powerful Expenditure Review Committee. The government abandoned the planned cut, which was due to take effect on Monday, after a revolt by doctors and Senate crossbenchers.
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21 January 2015, 6.25am AEDT

The AMA and Medicare: a love-hate relationship

Lesley Russell

Adjunct Associate Professor, Menzies Centre for Health Policy at University of Sydney
The Australian Medical Association (AMA) has emerged from the recent brouhaha over the Abbott government’s proposed Medicare reforms as both a winner in the protection of doctors’ incomes and an apparent champion of the affordability of health care for patients.
Medicare changes that were due to come into effect this week would have imposed a ten-minute minimum for regular (Level B) GP consultations which currently attract a A$37.05 rebate. Consultations under ten minutes would have attracted a smaller rebate of A$16.95. GPs were faced with a choice: absorb the cuts or pass them on to patients.
The AMA framed the change as a A$20 cut to patient rebates for short visits and used data to dismiss government claims of “six minute medicine”.
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Serious message behind Treasurer's 150-year aside

Date January 21, 2015 - 12:15AM
EDITORIAL
No sooner had Treasurer Joe Hockey returned from his summer holiday and attempted to shape the debate about the financial challenges facing Australia, then he was subject to ridicule. The Herald thinks those attacks were unfair, and mainly confined to the more malign influences in social media. In mentioning that some people alive today may live to the age of 150, the Treasurer was not only drawing on a considerable body of medical and scientific opinion, he was discussing, in a welcome conversational style, Australia's demographic change, its dramatically aging population, and the serious national challenge this presents.
His remarks did not deserve the kneejerk opprobrium they attracted.
While Hockey has been a forceful figure in parliamentary debate, his stewardship of the Treasury portfolio has been beset by gaffes, accidents and a poorly prepared and delivered budget message. 
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Government accused of overstating health spending growth

Date January 21, 2015 - 6:23PM

Dan Harrison

Health and Indigenous Affairs Correspondent

The Abbott government has been accused of exaggerating growth in healthcare spending to justify cuts to Medicare rebates.
Health Minister Sussan Ley has begun consulting doctors about reforms to rein in what she has called the "rapid and unsustainable" rate of growth in Medicare spending.
While her first public act as minister was to withdraw changes that would have cut rebates for short GP visits by $20, the government still plans to cut rebates for GP visits by $5 in July, and give bulk-billing doctors the option of charging patients a fee of up to $5.
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Why private health is so pricey – and what can be done

Jessica Gardner
For private health insurance customers who cannot understand why their premiums are set to rise at triple the rate of inflation, the experience of CUA Health may shed some light.
The fast-growing health fund just paid out its biggest claim ever. A patient receiving end of life care in an intensive care unit just cost the fund $270,000 over a few months. “That was unique,” chief executive Philip Fraser told The Australian Financial Review. “But utilisation across the board is rising.”
In line with other insurers, CUA Health, which has 50,000 members and premium revenue of about $118 million, is facing a rise in the cost it pays hospitals and healthcare providers of “about 6.5 to 7 per cent”, he said.
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Cost of cancer drugs rises sharply to $586 million

Date January 24, 2015 - 12:30AM

Kate Hagan

Government subsidies for high-cost cancer drugs are growing at a faster rate than for other medicines, an analysis shows.
A parliamentary research paper found spending on chemotherapy rose from $84 million in 2009-10 to $586 million last financial year.
The 63 per cent annual growth in the cost of cancer drugs far exceeded that of other medicines, including those dispensed in public hospitals to manage complex conditions such as HIV/AIDS and hepatitis.
Other high-cost drugs subsidised by the government include those used to treat infertility and rare and life-threatening diseases.
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Doctors' fees under the microscope amid accusations of over-diagnosis

Date January 24, 2015 - 12:15AM

Harriet Alexander, Julia Medew and Dan Harrison

It's not a lot of fun, picking a fight with the medical profession.
In 2009, Angela Pratt was chief of staff to the health minister Nicola Roxon when the entire ophthalmological fraternity started running at them with spinning arms.
Roxon had decided to halve the Medicare rebate for cataract surgery, which still reflected the days when the procedure was lengthy and costly, though it became simple and inexpensive. Ophthalmologists were  said to be earning up to $1 million a year.
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New funding models are a long-term alternative to Medicare co-payments

fronjacksonwebb | Jan 21, 2015 2:01PM | EMAIL | PRINT
Peter Sivey writes: The Abbott government is struggling with its Medicare co-payment reform, scrapping the latest version for a period of consultation, starting this week. The government claims it wants to make Medicare sustainable by controlling costs. However the proposed reforms are piecemeal and inequitable, antagonising Medicare’s stakeholders [...] without addressing underlying problems.
To recap, the revised Medicare co-payment policy as of December 9, 2014 was to reduce Medicare rebates by A$5 and encourage GPs to recoup this from patients; freeze the indexation of Medicare rebates for all doctors; and perhaps most controversially, impose a ten-minute minimum duration for level B appointments. This would have meant a A$20 rebate cut for short visits but the government scrapped this part of the plan.
Introducing demand restraints such as co-payments points to a lack of faith in the principles of universal health care and the preventive benefits of primary care. Hence they prompt outrage from the public and doctors alike who see the “slippery slope” to further increased co-payments, and reduction in government funding for public health care.
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Medicare Co-payment Issues.

As Sussan Ley tries to patch the cuts to Medicare, the question is: why?

If the health minister takes a good look at Medicare she’ll find it’s not bleeding profusely after all
Lenore Taylor, political editor
As the Abbott government casts around for a third version of its Medicare copayment policy, it’s surely time for it to ask the basic question: “Why are we doing this again?”
The reasons for abandoning the second copayment policy are clear: voters hated it; doctors were going to the barricades over it; it wasn’t going to pass the Senate; it was going to cause serious trouble for Campbell Newman’s Queensland election campaign.
In short, they were political. (And foreseeable, but that’s another story.)
But the policy reasons for cutting Medicare in the first place have been various and confusing – to return savings to the budget but also to provide money for a medical research fund, to reduce “unnecessary” visits to the doctor, to force payment from those who can afford it and to “save” the long-term future of a scheme with costs “ballooning out of control”.
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Repetitive Medicare backdown strain sends Sussan Ley to the doctors

The new minister needs to do things differently after previous efforts left the government looking hard-hearted and chaotic
So much much for all that nonsense last year about scraping off the barnacles for a fresh political start in 2015. The government has now backed down on last year’s co-payment backdown before it has even begun.
The new health minister, Sussan Ley – quite sensibly – says she wants to consult with doctors and the parliament to try to find a fair way to implement what she says are the government’s core aims: a price signal for patients who can afford to pay and continued bulk-billing for those who cannot.
It’s just a shame the government didn’t think of that in the first place, either when it announced the original across-the-board $7 co-payment, or when Tony Abbott and his then health minister, Peter Dutton, waited until after parliament had risen for 2014 to announce a complex series of changes to replace the original budget policy that had stalled in the Senate.
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GPs 'relieved' by backdown

By Jessica Chambers
Jan. 19, 2015, midnight
Gippsland doctors have expressed relief at the Federal Government's back-down on "unfair" Medicare changes that were meant to come into effect today.
Health Minister Sussan Ley announced on Thursday the government would take a measure "off the table" that would have seen general practitioners receive about $20 less in rebates for consultations that last less than 10 minutes.
Ms Ley said she became aware of "significant concerns and unintended consequences" and halted the proposal, but said it remained critical changes were implemented "to ensure quality care for Australians and a secure future for Medicare".
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Liberal MPs fear rebate backdown

Sarah Martin

TONY Abbott is being urged to abandon plans to cut the Medicare rebate by $5, as government MPs warn against fighting an unwinnable political battle that plays into Labor’s hands.
Last week’s backdown on a $20 rebate cut for short GP consultations has failed to quell unrest among Liberal MPs who say the “debacle” of the government’s Medicare policy had made selling a modest co-payment politically fraught.
With the opposition and the Greens resolved to block the $5 cut to the rebate in the Senate, ­Coalition MPs say the issue will dog the government for much of the year, cruelling attempts to reset its agenda without delivering any budget savings.
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Six-minute hold-up in the clinic

THE capitulation by the government to the naked self-interest of the Australian Medical Association regarding changes to GP funding not only reaffirms the premier protection racket of the AMA but is also a profoundly disappointing missed opportunity to encourage desperately needed innovation in healthcare delivery.
Instead of the commentariat blindly accepting ludicrously ­unfounded and cataclysmic rants by GPs who seek to defend their six-minute-medicine business model, the media should foster long overdue debate about the use of highly trained and talented paramedical professionals for task substitution. If medicine can be done in six minutes, it can be done by someone else.
If a history, examination, assessment and treatment (including reasonable thinking time, discussion of options with the patient, and maybe looking things up to confirm the first opinion) can be performed in six minutes, it must be a highly standard, obvious and routine clinical encounter. This could be triaged and/or performed by trained non-doctor professionals at less cost, freeing up GPs for more complex tasks.
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Knives are still out over GP rebates

  • Miles Godfrey
  • The Daily Telegraph
  • January 21, 2015 12:00AM
A PLANNED $5 cut to GP Medicare rebates could be ­restructured as the federal government gears up for crunch talks with the Australian Medical Association this week.
Health Minister Sussan Ley is scheduled to meet AMA bosses for a fresh round of consultations on the government’s vexed Medicare reforms, which the Abbott government insists are necessary to rein in the $19 billion-a-year costs.
The government still plans to introduce a $5 cut to GP ­rebates on July 1, despite opposition from Labor and the Greens who have vowed to block the reforms in the Senate amid concerns the increased cost of care will hurt the poor and increase pressure on hospital emergency rooms.
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Doctors groups expect deal on $5 co-payment

Sarah Martin

Rosie Lewis

DOCTORS groups are hopeful a fresh approach by new Health Minister Sussan Ley will see the government strike a compromise on its proposed $5 cut to the Medicare rebate.
Ms Ley had her first meetings with key interest groups yesterday as she reaches out to the sector in a bid to win support for the health reforms.
As Tony Abbott urged MPs to rally behind him and to stick to the government’s “plan”, he reiterated the case for a price signal on GP visits.
“We are going to persist with injecting some more price signals into the health system. These are all sensible economic reforms as well as important long-term savings. We have our plan,” the Prime Minister told Melbourne radio.
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Pharmacy Issues:

Pharmacy the answer to health spend crisis: Guild

19 January, 2015 Christie Moffat
Pharmacy is pitching itself to new Health Minister Sussan Ley as the answer to Australia’s health care expenditure crisis.
In the wake of the Federal government’s backdown over the controversial Medicare cuts, the Pharmacy Guild of Australia says “full utilisation” of Australia’s community pharmacy network offers the opportunity for “better and more cost-effective health outcomes.”
The Guild says it will use the health minister’s commitment to consult stakeholders for a more sustainable Medicare, and advocate for an array of “enhanced’ pharmacy services.
Some examples of these service enhancements include:
  • Enhancing access to repeat prescriptions for stable, long term conditions
  • Extending the treatment of minor ailments to community pharmacies
  • Improving access to vaccinations
  • Post hospital and transitional care medicine reconciliation support
  • Basic health checks, screening and preventative health services
  • Mental health support
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Comment:
I also have to say reading all the articles I still have no idea what is actually going to happen with the Budget at the end of the day.
As pointed out on Insiders a few weeks ago the next chance to have progress  in February, 2015 when Parliament comes back! Right now there is a lot of planning going on behind the scenes.
One wonders for how much longer this will go on?
Enjoy.
David.