2009 Engage With Grace Thanksgiving Weekend Blog Rally

Last year Paul Levy, Matthew Holt and Alexandra Drane asked me to participate in the Engage With Grace Thanksgiving Blog Rally. My post last year describes the Engage with Grace project and tells my personal story of why end of life care is important for all of us to discuss with our family and loved ones.

Along with my friends and health blogging colleagues, Paul, Matthew, Alexandra, Adam Bosworth, Christian Sinclair, Drew Rosielle, e-Patient Dave deBronkart, Jessica Lipnack, Ted Eytan and many others - we ask that you to take time to talk to your loved ones over this holiday weekend about these important end of life questions and carry out your wishes by executing a living will and medical power of attorney.

How else can you participate in the Engage With Grace Thanksgiving Blog Rally?

If you are a blogger, spread the word about the project by adding your own post about Engage With Grace. You can use the text below (download a ready-made html version here) or tell your own story of the importance of communicating your end of life wishes. We suggest you post it starting on Tuesday, November 24 and leave it up over the entire holiday weekend.

Second, you can donate your Facebook and/or Twitter status to the rally. Post a link to your post and post a status update. You can create your own status update or use the following universal update (use the following hashtag #EWG so that we can track the rally:

Pssssst - Engage with Grace at www.engagewithgrace. Join the Blog Rally. Pass it on. #EWG

Following is the 2009 Engage With Grace Thanksgiving Weekend Blog Rally blog post:

Some Conversations Are Easier Than Others

Last Thanksgiving weekend, many of us bloggers participated in the first documented “blog rally” to promote Engage With Grace – a movement aimed at having all of us understand and communicate our end-of-life wishes.

It was a great success, with over 100 bloggers in the healthcare space and beyond participating and spreading the word. Plus, it was timed to coincide with a weekend when most of us are with the very people with whom we should be having these tough conversations – our closest friends and family.

Our original mission – to get more and more people talking about their end of life wishes – hasn’t changed. But it’s been quite a year – so we thought this holiday, we’d try something different.

A bit of levity.

At the heart of Engage With Grace are five questions designed to get the conversation started. We’ve included them at the end of this post. They’re not easy questions, but they are important.

To help ease us into these tough questions, and in the spirit of the season, we thought we’d start with five parallel questions that ARE pretty easy to answer:



Silly? Maybe. But it underscores how having a template like this – just five questions in plain, simple language – can deflate some of the complexity, formality and even misnomers that have sometimes surrounded the end-of-life discussion.

So with that, we’ve included the five questions from Engage With Grace below. Think about them, document them, share them.

Over the past year there’s been a lot of discussion around end of life. And we’ve been fortunate to hear a lot of the more uplifting stories, as folks have used these five questions to initiate the conversation.

One man shared how surprised he was to learn that his wife’s preferences were not what he expected. Befitting this holiday, The One Slide now stands sentry on their fridge.

Wishing you and yours a holiday that’s fulfilling in all the right ways.



(To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team. )

WVHIN Releases RFP for West Virginia Health Information Exchange

Today the West Virginia Health Information Network released a Request for Proposal (RFP) for a statewide Health Information Exchange. More information, including the deadlines, bidder worksheets and a full copy of the RFP are available on the WVHIN website.

Following are sections from the RFP that provide a general overview of the proposed West Virginia Health Information Exchange and a general scope of the RFP:

The West Virginia Health Information Network (WVHIN) is soliciting proposals to provide a statewide Health Information Exchange (HIE) infrastructure platform for physicians, hospitals, other health care organizations, and consumers. The purpose of this Request for Proposal (RFP) is to obtain vendor services and expertise in support of the WVHIN. Details on the scope of work, requirements and deliverables are contained in this RFP. WVHIN reserves the right to use the results of this RFP to obtain services for additional and related work should the need arise throughout the course of this project . . .

. . . According to the eHealth Initiative’s Sixth Annual Survey of Health Information Exchange 2009, there are almost 200 self‐reported HIE initiatives across the country with a substantially increased number of organizations that reported being operational. The impetus for HIEs has increased as a result of the passage of the American Recovery and Reinvestment Act (ARRA) of 2009 and specifically key provisions from the Health Information Technology for Economic and Clinical Health (HITECH) Act. These provisions called for the Office of the National Coordinator (ONC) to create a program to engage in collaborative agreements with states or “qualified” state‐designated non‐profit, multistakeholder partnerships to “conduct activities to facilitate and expand the electronic movement and use of health information among organizations according to nationally recognized standards.” . . .

. . . There are 1.8 million people in the very rural state of West Virginia with a high level of elderly and low‐income people in many of the rural areas. With a geographically dispersed population, access to and coordination of care is a critical issue. To serve this rural population, there is a relatively high number of hospitals with less than 100 beds and a high level of clinics serving the underserved making access and care coordination both difficult and essential. Based on the population profile and the number of small providers, a strong case was made for the need for a statewide HIE, which will help providers overcome communication and geographic barriers to access and coordination of care.

The WVHIN was established in July 2006 by the West Virginia Legislature at the request of the Governor. The WVHIN is a sub‐agency under the West Virginia Health Care Authority. The intent of the legislation was for the WVHIN “to promote the design, implementation, operation and maintenance of a fully interoperable statewide network to facilitate public and private use of health care information in the state”. With this authority, the WVHIN established a multi‐stakeholder board and has been working with stakeholders to develop and implement a state‐level HIE. . .

. . . With this mandate, the WVHIN established a vision to enable “high quality, patient centered care facilitated by health information technology”. The WVHIN mission is as follows: “The West Virginia Health Information Network provides the health care community a trusted, integrated and seamless electronic structure enabling medical data exchange necessary for high quality, patient‐centered care.” Guiding principles have been established around collaboration, facilitation of patient‐centric care, enabled participation by all providers, quality improvement, patient participation, privacy and security, and sustainability.

The WVHIN, along with health systems, physicians, other providers, payers, and consumers, has a unique opportunity to establish a state‐level HIE infrastructure that helps communities and regions share data across organizations. The WVHIN is well positioned to provide a cost‐effective HIE infrastructure that benefits from economies of scale while enabling communities to develop their own unique solutions. As a convener and collaborator, the WVHIN will build bridges between health care stakeholders to launch and fund HIEs. It will help communities address complex issues such as setting standards for interoperable data exchange, addressing liability, setting policies for privacy and security, and exchanging data across state lines. It will collaborate with other health information technology (HIT) and HIE initiatives such as the Regional Extension Center (REC) to be initiated, public health, Medicaid, and others, to leverage collective resources. WVHIN activities are being pursued within the parameters of the West Virginia Statewide Health Information Technology Strategic Plan. WVHIN is one of several participating entities that jointly developed the strategic plan.

ONC: Health IT Buzz

The Office of the National Coordinator for Health Information Technology (ONC) has launched a second blog called the Health IT Buzz Blog.

Just a few weeks ago ONC announced the new Federal Advisory Committee Blog (FACA Blog).

The initial post by Dr. David Blumenthal, MD, MPP, National Coordinator for Health Information Technology, talks about the importance of using technology to continue the conversation on Health IT and create a forum for engagement.

Dr. Blumenthal's post goes on to state:

We intend to address a wide and diverse range of timely topics relevant to the “why’s and how’s” of efforts to support the secure and seamless exchange of electronic health information. We will discuss our ongoing work to protect patient privacy, secure information, and implement standards. We’ll also be using the blog to provide additional information regarding our new grant programs. And the conversation wouldn’t be complete without discussing the meaningful use rulemaking and incentive programs, clarifying our vision and addressing key challenges.

We want to hear from citizens, patients, health professionals, managers, policymakers, technology enthusiasts and technology skeptics. We can’t succeed unless we understand the wishes and concerns of the many constituencies we serve. So join us.

Tip to @ahier who pointed out the new ONC Blog.

AHLA: EHR, HIE and PHR Legal Liability Task Force

Today I participated in the first call of the American Health Lawyers Association's Task Force on Electronic Health Records and Legal Liability.

The task force will focus its efforts on the legal liabilities associated with Electronic Health Records (EHR), Health Information Exchanges (HIE) and Personal Health Records (PHR).

The group is being led by Jud DeLoss and Kathy Kenyon, both members of AHLA. There was a wealth of health lawyer experience and expertise on the initial conference call. I'm looking forward to helping out on the effort and learning lots from the the task force members on this project.

To follow up on Jud's blog post, we would welcome any input that others have on the legal liability issues.

A 1930 Medical Record

I was recently in my hometown of New Martinsville visiting my dad, a retired family physician. When I arrived he had waiting for me a copy of one of my grandfather's medical records from the 1930s. My grandfather, Dr. Albert Coffield, practiced rural medicine in Wetzel County, West Virginia from 1911 until his death in 1936.

My dad told me the following story about the medical record.

My dad was a doctor who practiced out of his house on Coffield Ridge in Wetzel County. After my dad died in 1936 our mother sold the household furnishing and his office equipment. I was 12 years old when he died and my older brother was a first year student at West Virginia University. Since my mother wasn't employed she decided to move us to Morgantown where the University was so that my older brother could continue his college education. As a way to continue the family income she rented rooms to college students - many who came to the University from Wetzel County.

Included in the sale of the household and office furnishing was a wooden credenza with metal alphabetized slides. Behind some of the slides were some old medical records that were left in the credenza.

Thirty years later a lady who was a patient of mine brought the wooden credenza to me and told me that she had bought the credenza at the auction of my family's household items in 1936. She told me that she thought I would appreciate having it.

Here are photos of the medical record of a patient from 1934. The medical record format is simple yet complete. It contains all the important demographic and clinical information - including the patient statement, habits, family history, past history, physician examination and diagnosis. On the back is additional space for notes and a drawing of the internal organs that I suspect was meant to be used with the patient for education and instruction. It even has a built in billing record section that even the change:healthcare crowd would love.

What can these photos tell us about the current health care reform debate. Compare these photos of a medical record from 1934 to those that cost .73 cents today. Could today's physician and his or her patient get "meaningful use" out of this record?

A close up of the billing section for the change:healthcare gang.

Visualizing HR 3962: Affordable Health Care for America Act

Below is a visual of the top 500 words used in HR 3962: Affordable Health Care for America Act. Since most people (including many of our representatives in Washington) haven't read all 1,990 pages of the Health Care Reform Bill, I thought a visual aid might be helpful.

I had been thinking of creating the word cloud of the Bill since it was introduced on October 29, 2009, however, yesterday a couple of tweets by Vince Kuraitis caught my eye and I finally got around to creating the HR 3962 Wordle Cloud this morning. Vince's tweets looked into the word count of a couple of key words in the Bill. His tweets:

• @VinceKuraitis "medical home" referenced 67 times in latest House #healthreform leg
• @VinceKuraitis "pilot program" referenced 106 times in latest #healthreform leg -- lots of experimentation

In creating the cloud I was able to look at the use of some other words in the Bill. Here is what I found:

• Privacy referenced 28 times
• Insurance referenced 552 times
• Physician referenced 182 times
• Hospital referenced 330 times
• Consumer referenced 36 times
• Consumer-directed referenced 1 time
• Consumer-oriented referenced 1 time

Click graphic for larger/clearer version. Thanks to Wordle (www.wordle.net) for the cloud.

Federal Advisory Committee Blog (FACA Blog)

The Office of the National Coordinator for Health Information Technology (ONCHIT) has launched a new blog called the Federal Advisory Committee Blog (FACA Blog).

The initial post by Judy Sparrow discusses that the FACA Blog will be uses in a spirit of transparency and collaboration to help open a broader dialogue on the issues before the Health IT Standards Committee and the Health IT Policy Committee. The post also provides some background on the role that Federal Advisory Groups play under the Federal Advisory Committee Act.

The second post by Aneesh Chopra, Federal Chief Technology Officer, spells out the planned process for an open conversation that will take place over the next couple of weeks with various committee members blogging about a variety of topics (Proposed Standards, Interoperability, Vocabularies, Privacy, Security, Quality, Implementation Cases Studies).

The FACA Blog allows individuals to share public comments on each post and has an RSS feed. Great to see ONCHIT using a blog platform to quickly and efficiently distribute information about the ongoing work being done by the committees to further the health information technology efforts under HITECH.

West Virginia H1N1 (Swine) Flu Resource Center

The West Virginia Department of Health and Human Resources (DHHR) unveiled a website for sharing information and updates specific to West Virginia about the H1N1 Flu also known as Swine Flu. The website has information for prevention, schools, businesses, parents and providers.

The new West Virginia H1N1 (Swine) Flu Resource Center can be found at www.wvflu.org. The website also has includes a link to the federal Flu.Gov website with national information.

Please spread the word about the new website (but don't spread the flu).

HIPAA Enforcement Meets HITECH: HIPAA Administrative Simplification: Enforcement Rule

On October 30, 2009, the Secretary of the Department of Health and Human Services (HHS) issued the HIPAA Administrative Simplification: Enforcement Interim Final Rule, 45 CFR Part 160 (74 Federal Register 56123, October 30, 2009).

This new rule was developed and adopted by HHS to conform the enforcement regulations under HIPAA to the revisions made to HIPAA under the Health Information Technology for Economic and Clinical Health Act (HITECH), which was part of the American Recovery and Reinvestment Act of 2009 (ARRA).

The rule amends the HIPAA enforcement regulations to include the imposition of tiered ranges for civil money penalty amounts based upon an increasing culpability associated with the violation. A full chart of the violation categories and related amounts can be found in the rule.

The interim final rule is effective on November 30, 2009. Comments on the rule can be made prior to December 29, 2009.

Congressional Members Concerned About HHS Inclusion of "Harm Standard" In Breach Notification Rule

Members of the U.S. House of Representative submitted an October 1, 2009 letter of concern to Secretary Sebelius and the Department of Health and Human Services (HHS) concerning inclusion of a "harm standard" in the recently released(August 24, 2009) Interim Final Rule - Breach Notification for Unsecured Protected Health Information (45 CFR Part 160 and 164) 74 Fed. Reg. 42740.

HHS in developing the Interim Final Rule interpreted the term "compromises" as meaning that a threshold substantial harm standard should be included when determining whether a breach of data has occurred. However, the Members indicate in their letter that they considered whether a "harm standard" should be a part of the legislation and decided not to include such a standard. The letter urges HHS to revise and repeal the harm standard provisions included in the Interim Final Rule.

The letter was submitted by Rep. Henry Waxman, Rep. Charles Rangel, Rep. John Dingell, Rep. Frank Pallone, Jr., Rep. Pete Stark and Rep. Joe Barton.

Tip to Alan Goldberg, health care attorney and American Health Lawyer Association HIT Listserve Moderator, who posted a copy of the letter.

ARRA - HITECH: Health Care Information Breach Notification Regulations Now In Effect

Have you had a health data security breach? Do you know what a health data breach is? Are you required to notify individuals impacted by the breach? Do you have to notify federal agencies of such breach?

Read on for more information regarding the Office for Civil Right (OCR) and Federal Trade Commission (FTC) regulations requiring health care providers and other health data business vendors to assess and in some cases notify and report health information data breaches under the new federal law created by ARRA-HITECH.

The new regulations went into effect on September 23, 2009 and September 24, 2009, respectively, with a full compliance date of February 22, 2010. Health care providers covered under HIPAA and third party users of health information, including personal health record (PHR) companies and vendors, PHR related entities, health 2.0 companies and other third party health data service providers, should examine the regulations and understand the impact on their business.

The regulations require entities to develop internal compliance processes to act upon and advise individuals of data breaches that pose a significant risk of financial, reputational or other harm to the affected individual. The OCR regulations apply mainly to covered entities and business associates under HIPAA and the FTC regulations apply mainly to PHR vendors and PHR related entities. The regulations define a "breach" and set forth the time frames and scope of notification required. The regulations require the tracking and reporting of such data breaches to OCR and FTC. Also, OCR has published separate guidance specifying the technology and methods that will render health information unusable, unreadable and undecipherable as defined under ARRA-HITECH.

OCR has provided a summary of the breach notification rule on its website. OCR has also published instructions for reporting breaches to the HHS Secretary. The instructions include details for reporting "Breaches Affecting 500 or More Individuals" and "Breaches Affecting Fewer than 500 Individuals." OCR will also maintain a list of reported breaches that impact 500 or more individuals. The FTC also has a section on its website providing information on its health breach notification rule.

Below are links to the full regulation text:

• OCR Interim Final Rule - Breach Notification for Unsecured Protected Health Information (45 CFR Part 160 and 164) 74 Fed. Reg. 42740 (Aug 24, 2009).
  

• OCR Guidance Specifying the Technologies and Methodologies That Render Protected Health Information Unusable, Unreadable, or Indecipherable to Unauthorized Individuals for Purposes of the Breach Notification Requirements Under Section 13402 of Title XIII (Health Information Technology for Economic and Clinical Health Act) of the American Recovery and Reinvestment Act of 2009; Request for Information 74 Fed. Reg. 19006 (April 27, 2009).
  

• Federal Trade Commission: Health Breach Notification Rule: Final Rule -- Issued Pursuant to the American Recovery and Reinvestment Act of 2009 -- Requiring Vendors of Personal Health Records and Related Entities To Notify Consumers When the Security of Their Individually Identifiable Health Information Has Been Breached (16 CFR Part 318) 74 Fed. Reg. 42962 (Aug 25, 2009). The FTC has also issued a Breach Notification Form.

UPDATE (July 29, 2010):

Today the OCR/HHS issued a statement that the OCR Interim Final Rule listed above and published on August 24, 2010, is being withdrawn from the Office of Management and Budget (OMB). The full notice published on the OCR website states:

Breach Notification Final Rule Update

The Interim Final Rule for Breach Notification for Unsecured Protected Health Information, issued pursuant to the Health Information Technology for Economic and Clinical Health (HITECH) Act, was published in the Federal Register on August 24, 2009, and became effective on September 23, 2009. During the 60-day public comment period on the Interim Final Rule, HHS received approximately 120 comments.

HHS reviewed the public comment on the interim rule and developed a final rule, which was submitted to the Office of Management and Budget (OMB) for Executive Order 12866 regulatory review on May 14, 2010. At this time, however, HHS is withdrawing the breach notification final rule from OMB review to allow for further consideration, given the Department’s experience to date in administering the regulations. This is a complex issue and the Administration is committed to ensuring that individuals’ health information is secured to the extent possible to avoid unauthorized uses and disclosures, and that individuals are appropriately notified when incidents do occur. We intend to publish a final rule in the Federal Register in the coming months.

Create WV Conference 2009: A personal invitation to attend . . .

Over the last few years I have been involved in Create West Virginia, an organization affiliated with Vision Shared whose mission to create and stimulate new economy growth and empower West Virginians to grow creative communities in West Virginia. Communities centered on innovation, technology, entrepreneurship, education, quality of life and arts/culture.

Each year Create WV holds an annual conference. The first annual conference was held in 2007 and attracted approximately 250 attendees. Last year’s event held at Snowshoe Resort and attracted 395 attendees. This year’s Create West Virginia 2009 Conference is set for October 18-20 in Huntington, WV at the Big Sandy Arena.

I want to personally invite you to attend the Create West Virginia Conference 2009. Check out the keynote speakers and sessions.

A special attraction this year will be a live Mountain Stage performance on Sunday evening at the Keith Albee Theater featuring West Virginia native, Kathy Mattea, and The Songcatchers, The Ahs, Shannon Whitworth and Or, The Whale.

Click here for more information about the conference including how to register.

Feel free to forward a link of this invitation to others who you think might be interested in attending the conference.

West Virginia's Statewide Health Information Technology Strategic Plan

Over the past several months I have been involved with a group in developing West Virginia's statewide strategic plan for health information technology.

The final draft of the West Virginia Health Information Technology Statewide Strategic Plan, September 2009 is now available for review and comment. Additional comments and feedback on the strategic plan are welcome.

The strategic plan is a part of West Virginia's efforts to position itself as a national leader in implementing and adopting health information technology to improve our health care system. The strategic plan will be a part of the the state's efforts to submit applications to the Office of the National Coordinator for Health Information Technology (ONC) for funding under the State Health Information Exchange Cooperative Agreement Program and the Health Information Technology Extension Program: Regional Centers Cooperative Agreement Program, both programs developed under the American Recovery and Reinvestment Act of 2009, Title XIII - Health Information Technology, Subtitle B.

The project has been lead by the Adoption of Health Information Technology Workgroup under the West Virginia Health Improvement Institute. Both private and public stakeholders from across West Virginia have collaborated and provided input into the development of the strategic plan.

Mandatory Reading Before President Obama's Speech Tonight On Health Care

This morning I finally got around to reading the article by David Goldhill, CEO of the Game Show Network, in the Atlantic. How American Health Care Killed My Father is a thought provoking look at the failure of our current health care system.

On the eve of President Obama's speech to Congress on health care I hope he and his advisors have taken time to read the article. The article eloquently highlights much of what I have come to believe over the last few years is missing from health care. It is a time to step back from the existing complex system and refocus on the health consumer and make fundamental changes to the existing system. Incremental change treating the symptoms and not the underlying disease will only solidify the current "insurance based, employment centered, administratively complex" system now in place.

There are too many great thoughts in this article to quote them all here -- so go read the full commentary.

Some of the quotes that caught my attention:

. . . Why, in other words, has this technologically advanced hospital missed out on the revolution in quality control and customer service that has swept all other consumer-facing industries in the past two generations? . . .

. . . All of the actors in health care—from doctors to insurers to pharmaceutical companies—work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create . . .

. . . Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing. And that—most important—remove consumers from our irreplaceable role as the ultimate ensurer of value . . .

. . . But health insurance is different from every other type of insurance. Health insurance is the primary payment mechanism not just for expenses that are unexpected and large, but for nearly all health-care expenses. We’ve become so used to health insurance that we don’t realize how absurd that is. We can’t imagine paying for gas with our auto-insurance policy, or for our electric bills with our homeowners insurance, but we all assume that our regular checkups and dental cleanings will be covered at least partially by insurance. Most pregnancies are planned, and deliveries are predictable many months in advance, yet they’re financed the same way we finance fixing a car after a wreck—through an insurance claim . . .

. . . My dry cleaner uses a more elaborate system to track shirts than this hospital used to track treatment . . .

. . . But my father was not the customer; Medicare was . . . Of course, one area of health-related IT has received substantial investment—billing. So much for the argument, often made, that privacy concerns or a lack of agreed-upon standards has prevented the development of clinical IT or electronic medical records; presumably, if lack of privacy or standards had hampered the digitization of health records, it also would have prevented the digitization of the accompanying bills . . . In case you wonder who a care provider’s real customer is, try reading one of these bills . . .

. . . Keeping prices opaque is one way medical institutions seek to avoid competition and thereby keep prices up. And they get away with it in part because so few consumers pay directly for their own care—insurers, Medicare, and Medicaid are basically the whole game. But without transparency on prices—and the related data on measurable outcomes—efforts to give the consumer more control over health care have failed, and always will . . .

OCR Designates HIPAA Regional Office Privacy Advisors

The Acting Director and Principal Deputy Director for the Office for Civil Rights, Robinsue Frohboese, has designated Office for Civil Rights Regional Managers in each of the HHS Regional Offices to serve as the Regional Office Privacy Advisors. On July 27, 2009, Secretary Sebelius authorized the Director of the Office for Civil Rights to carry out the designation required under the Health Information Technology for Economic and Clinical Health (HITECH) Act (Title XIII of Division A and Title IV of Division B of the American Recovery and Reinvestment Act of 2009 (ARRA).

The designation of these Regional Office Privacy Advisors was mandated by the ARRA-HITECH provisions under Section 13403(a). The Regional Office Privacy Advisors will offer guidance and education to covered entities, business associates, and individuals on their rights and responsibilities related to the HIPAA Privacy and Security Rules

The names, addresses, and contact information for each of the Regional Managers are listed together with a list of the States for which each Regional Manager has responsibility are listed below:

Region I - Boston (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont)
Peter Chan, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
Government Center
J.F. Kennedy Federal Building - Room 1875
Boston, MA 02203
Voice phone(617)565-1340
FAX (617)565-3809
TDD (617)565-1343

Region II - New York (New Jersey, New York, Puerto Rico, Virgin Islands)
Michael Carter, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
Jacob Javits Federal Building
26 Federal Plaza - Suite 3312
New York, NY 10278
Voice Phone (212)264-3313
FAX (212)264-3039
TDD (212)264-2355

Region III - Philadelphia (Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia)
Paul Cushing, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
150 S. Independence Mall West
Suite 372, Public Ledger Building
Philadelphia, PA 19106-9111
Main Line (215)861-4441
Hotline (800) 368-1019
FAX (215)861-4431
TDD (215)861-4440

Region IV - Atlanta (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee)
Roosevelt Freeman, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
Atlanta Federal Center, Suite 3B70
61 Forsyth Street, S.W.
Atlanta, GA 30303-8909
Voice Phone (404)562-7886
FAX (404)562-7881
TDD (404)331-2867

Region V - Chicago (Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin)
Valerie Morgan-Alston, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
233 N. Michigan Ave., Suite 240
Chicago, IL 60601
Voice Phone (312)886-2359
FAX (312)886-1807
TDD (312)353-5693

Region VI - Dallas (Arkansas, Louisiana, New Mexico, Oklahoma, Texas)
Ralph Rouse, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
1301 Young Street, Suite 1169
Dallas, TX 75202
Voice Phone (214)767-4056
FAX (214)767-0432
TDD (214)767-8940

Region VII - Kansas City (Iowa, Kansas, Missouri, Nebraska)
Frank Campbell, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
601 East 12th Street - Room 248
Kansas City, MO 64106
Voice Phone (816)426-7277
FAX (816)426-3686
TDD (816)426-7065

Region VIII - Denver (Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming)
Velveta Howell, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
1961 Stout Street -- Room 1426 FOB
Denver, CO 80294-3538
Voice Phone (303)844-2024
FAX (303)844-2025
TDD (303)844-3439

Region IX - San Francisco (American Samoa, Arizona, California, Guam, Hawaii, Nevada)
Michael Kruley, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
90 7^th Street, Suite 4-100
San Francisco, CA 94103
Voice Phone (415)437-8310
FAX (415)437-8329
TDD (415)437-8311

Region X - Seattle(Alaska, Idaho, Oregon, Washington)
Linda Yuu Connor, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
2201 Sixth Avenue - M/S: RX-11
Seattle, WA 98121-1831
Voice Phone (206)615-2290
FAX (206)615-2297
TDD (206)615-2296

Health Care Reform Explained from Back of the Napkin Blog

Dan Roam at the Back of the Napkin Blog sums up the current health care reform effort in this four part health care series, Healthcare Napkins All. Great back of the napkin summary of health reform (actually insurance reform).

Thanks to Jay Parkinson MD for the tip.

Healthcare Napkins All

View more documents from Dan Roam.

State Medicaid Fraud Control Units Annual Report FY 2008

The DHHS Office of Inspector General has issued the Fiscal Year 2008 State Medicaid Fraud Control Units Annual Report. The report covers FY 2008 (October 1, 2007 - September 30, 2008.

The summary of the report provides background on the Medicaid Fraud Control Unit (MFCU) grant program, the number of states participating, the amounts recovered and number of convictions obtained in FY 2008:

During this reporting period, 49 States and the District of Columbia participated in the Medicaid fraud control grant program through their established MFCUs. The mission of the MFCUs is to investigate and prosecute Medicaid provider fraud and patient abuse and neglect. MFCUs’ authority to investigate and prosecute cases varies from State to State.

Forty-three of the MFCUs are located within Offices of State Attorneys General. The remaining seven MFCUs are located in various other State agencies.

In FY 2008, MFCUs recovered more than $1.3 billion in court-ordered restitution, fines, civil settlements, and penalties. They also obtained 1,314 convictions. MFCUs reported a total of 971 instances in which civil settlements and/or judgments were achieved. Of the 3,129 OIG exclusions from participation in the Medicare, Medicaid, and other Federal health care programs in FY 2008, 755 exclusions were based on referrals made to OIG by the MFCUs.

The report also contains examples of Medicaid fraud and patient abuse and neglect case investigations and prosecutions undertaken during FY 2008.

Read the full report for more information on the role that state MFCUs play in the oversight of the Medicaid program.

Viral Health Effort Via Twitter: Fit West Virginia (#FitWV)

Dawn Miller of the Charleston Gazette highlights the ongoing Fit West Virginia (#FitWV) effort ongoing via Twitter in her op-ed piece, West Virginians try to tip scales on obesity.

The idea was born back on West Virginia Day as a result of Jason Keeling asking his blog readers to discuss solutions to West Virginia's problems in a post, West Virginia: Using Social Media for the Mountain State's Betterment. In response, Skip Lineberg of Maple Creative responded with his post, A Fitter West Virginia.

As a result of that "healthy idea seed" being planted a core group of West Virginia tweeters have been regularly posting on Twitter using the hashtag #FitWV. The effort has created a viral movement of West Virginians supporting other West Virginians in making health choices, exercising regularly, etc. Hopefully, this positive discussion is bringing about positive change and support to those participating.

As the country discussed health care reform efforts like #FitWV should be made a part of the equation. As Jordan Shlain, MD says in his recent op-ed over at The Health Care Blog:

. . . Nowhere in this debate is the patient, the consumer, and the citizen: the American! We lack accountability, responsibility and civic sensibility. It is Joe Diabetic that snacks on ice cream, misses appointments and doesn't take his insulin that increases the cost of health care. This diabetic will be admitted to your local ER with diabetic ketoacidosis and have many subsequent hospital admissions at our (read: your) expense, not his. This is a fundamental collective action problem.

Our town square is so big that we can get away with malfeasance to our village (and our country) with no shame. Yet, the forces of economics do not defy gravity and the cost of health care is now affecting all of us. Those of us that are untethered from the reality of cost are driving our health care 'car' into the ground. . .

If you use Twitter -- please join the effort.

Dawn Miller also provides a link to some great new information from the Centers for Disease Control. The CDC released last month "Recommended Community Strategies and Measurements to Prevent Obesity in the United States."

Ms. Miller writes:

The CDC did all the research and evaluation work, so individual communities don't have to. They assembled a group of people with experience in urban planning, nutrition, physical activity, obesity prevention and local government. The group reviewed a couple years' worth of research, evaluated various tactics and settled on 24 recommendations. For each one, the CDC summarizes the evidence behind it and suggests ways to measure progress. Communities should:

1. Make healthier food and drinks available in public places. Schools are key, but think also of after-school programs, child care centers, parks, playgrounds, swimming pools, city and county buildings, prisons and juvenile detention centers.

2. Make healthier food more affordable in those public venues. Lower prices, provide discount coupons or offer vouchers for healthy choices.

3. Improve the availability of full-service grocery stores in underserved areas. One study of 10,000 people showed that black residents in neighborhoods with at least one supermarket were more likely to consume the recommended amount of fruits and vegetables than those in neighborhoods without supermarkets. Residents consumed 32 percent more fruits and vegetables for each additional supermarket in their census tract.

More supermarkets also raised real estate values, economic activity and employment and lowered food prices.

4. Provide incentives to food retailers -- supermarkets, convenience stores, corner stores, street vendors -- to locate in underserved areas or to offer healthier food and drinks. Incentives can be tax benefits and discounts, loans, loan guarantees, start-up grants, investment grants for improved refrigeration, supportive zoning and technical assistance.

5. Make it easier to buy foods from farms.

6. Provide incentives for the production, distribution and procurement of foods from local farms.

Did you know that the United States does not produce enough fruits, vegetables and whole grains for every American to eat the recommended amount of these foods? Dispersing agricultural production throughout the country would increase the amount of available produce, improve economic development and contribute to environmental sustainability.

7. Restrict availability of less healthy foods and drinks in public places.

8. Offer smaller portion options in public places.

9. Limit advertisements of less healthy foods and drinks.

10. Discourage people from drinking sugar-sweetened beverages.

11. Support breastfeeding, which appears to provide some protection from obesity later in life.

12. Require physical education in schools.

13. Increase the amount of physical activity in school PE programs. Modify games so that more students are moving at all times, or switch to activities in which all students stay active. Improving phys ed improves aerobic fitness among students.

14. Increase opportunities for extracurricular physical activity.

15. Reduce screen time in public settings. TV and computer time displaces physical activity, lowers metabolism, increases snacking and exposes children to marketing of fattening foods.

16. Improve access to outdoor recreational facilities, such as parks, green spaces, outdoor sports fields, walking and biking trails, public pools and community playgrounds. Access also depends on how close such places are to homes and schools, cost and hours of operation.

17. Support bicycling. Create bike lanes, shared-use paths and routes on existing and new roads. Provide bike racks near commercial areas. Improving bicycling infrastructure can increase how often people bike for utilitarian purposes, such as going to work and school or running errands.

18. Support walking. Build sidewalks, footpaths, walking trails and pedestrian crossings. Improve street lighting, make crossings safer, use traffic calming approaches. Walking is a regular activity of moderate intensity that a large number of people can do.

19. Locate schools within easy walking distance of residential areas.

20. Improve access to public transportation to increase biking and walking to and from transit points.

21. Zone for mixed-use development, including residential, commercial, institutional and other uses. This cuts the distance between home and shopping, for example, and encourages people to make more trips by foot or bike.

22. Enhance personal safety in areas where people are or could be physically active.

23. Enhance traffic safety in areas where people are or could be physically active.

24. Participate in community coalitions or partnerships.

AHLA Public Interest Committee Publishes Stark Law White Paper

The American Health Lawyers Association's Public Interest Committee recently published a new white paper on on the federal self-referral law also known as the "Stark Law" which looks at and considers what, if any, changes to the Stark Law might be beneficial under the current health care system and the proposed reform efforts.

The white paper is entitled, A Public Policy Discussion: Taking the Measure of the Stark Law. The white paper was written as a result of the Committee's Convener on Stark Law, held in Washington, DC on April 24 and June 30, 2009.

HIPAA Security Rule Enforcement Delegated to OCR

Today HHS Secretary Kathleen Sebelius announced that enforcement of the Security Rule under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will be delegated to the Office for Civil Rights (OCR).

The official delegation occurred on July 27, 2009. More information about the transition of authority for the administration and enforcement of the Security Rule can be found in the OCR press release. The official Delegation of Authority by the Office of the Secretary has been issued and will appear in the August 4, 2009 Federal Register.

Prior to today, administration and enforcement of the HIPAA Security Rule has been the responsibility of the Centers for Medicare & Medicaid Services (CMS).