Home » Dr. Jayne » Currently Reading:

Curbside Consult with Dr. Jayne 6/1/15

June 1, 2015 Dr. Jayne 2 Comments


I had lunch this week with some former colleagues. One of the topics of discussion was the 21st Century Cures initiative that was approved by the House Energy and Commerce Committee in May. Supporters such as Representative Frank Pallone state that it “will ensure that innovative treatments are getting to those who need them most, giving real hope to patients and their families.”

For those of you who may not have seen the non-IT details, the bill has significant goals:

  • Reauthorize National Institutes of Health (NIH) funding through FY2018
  • Establish an innovation fund at NIH
  • Require strategic planning and greater accountability at NIH
  • Increase funding for pediatric research
  • Require sharing of data generated through NIH-funded research
  • Standardize patient information across trials housed in ClinicalTrials.gov
  • Establish a public-private Council for 21st Century Cures to “accelerate the discovery, development, and delivery of innovative cures, treatments, and preventive measures”
  • Increase patient-focused drug development
  • Require the FDA to issue guidance on precision medicine
  • Streamline policy to facilitate development of new antibacterial and antifungal agents
  • Formalize vaccine recommendation processes
  • Modify FDA review requirements for certain categories of drugs and devices

Most of us have heard about the language on ensuring interoperability and “holding individuals responsible for blocking or otherwise inhibiting the flow of patient information throughout our healthcare system.” There is also a section on expanding telehealth under Medicare.

As a primary care physician, I also liked the section addressing issues where Medicare beneficiaries can’t get certain services covered because care is delivered in the home setting. My favorite part, though, is Medicare site-of-service price transparency. I hope all the health systems doing so-called “provider-based billing” take note of this. It’s going to be harder to trick patients into paying exorbitant facility fees if this makes it through. Rebranding free-standing physician offices as hospital departments as a thinly-veiled cash grab is one of the more despicable practices I see among hospitals and health systems.

The Senate is working on its own version of the bill, so it remains to be seen whether all of this passes, and if it does, how much the individual sections are modified. Funding research and cutting edge therapies is important, as is dealing with various Medicare oddities that complicate care delivery. In talking with my colleagues, however, we all balk a little at the call-out for precision medicine. Although it’s an interesting concept, is it really going to be pivotal for the majority of patients?

I’m a huge fan of public health. Basic sanitation and preventive measures have made a tremendous difference in quality of life for people around the world. However, I’d like to see more discussion (and also funding) of the basic health services that many people either cannot access or lack understanding of their value. It is still difficult to get insurance companies to pay for nutrition counseling or sessions with a registered dietician except for certain disease states. We can try to get patients to self-pay for these services, but it’s a difficult proposition when some are already paying large premiums for minimal coverage.

I’d like to have the time and resources to try to convince patients of the return on investment for these interventions (both in quality of life and lower health costs), but it’s hard to make headway during a 10-minute office visit. Watching Congress debate legislation that impacts rare diseases and drug development is difficult when one realizes how much work is still yet to be done on diseases that have 19th and 20th century cures already. A good number of the diseases on which we spend the most can be markedly improved (if not cured) through behavioral and lifestyle interventions, but these are the most difficult to implement. It’s much easier to take a pill for many Americans.

I’m not sure what primary care will look like in the next century. I can’t wait for the next generation to be able to scan patients with a Tricorder and synthesize antidotes and treatments Star Trek style. That seems such a long way away, though, when we’ve yet to figure out how to implement some of the basics such as universal vaccination, healthy eating habits, and regular exercise.

Looking back through the Bill’s history, I did see a small step that actually will make an immediate difference. At the same time the House of Representatives Energy and Commerce Health Subcommittee was hearing about 21st Century Cures, they were also considering HR 1321, the Microbead-Free Waters Act of 2015. It caught my eye because I’ve been aware of the microbead problem for a while, especially the fact that the US lags other countries in banning them. I must say, this Act is probably the shortest piece of legislation I’ve seen in a long time – a grand total of two pages and 14 numbered lines. If only Meaningful Use was that simple.

What’s your favorite Act of Congress? Email me.

Email Dr. Jayne.

View/Print Text Only View/Print Text Only

HIStalk Featured Sponsors


Currently there are "2 comments" on this Article:

Subscribe to Updates



Text Ads

Report News and Rumors

No title

Anonymous online form
Rumor line: 801.HIT.NEWS



Founding Sponsors


Platinum Sponsors































































Gold Sponsors















Reader Comments

  • Another Dave: Orwellian Aeron chair: If sitting is the new smoking, I sure this exercise motivator will have some real health benefit...
  • SoCal grunt: I for one did select Meditech. The people were welcoming and seemed to be the only ones insterested in having a discussi...
  • Annon: 100% agree, this is vaporware, they are not doing anything remotely close to interoperability. Not the only ones though,...
  • Brian Too: Wait... I thought that any voids in the brain automatically filled up with cerebro-spinal fluid? Wouldn't an air void c...
  • Ophelia: Where are you seeing the 97% MIPS claim? I'm aware of their claimed 97% attestation rate for MU, but I haven't seen anyt...
  • Sue Powell: Re: "airhead". Maybe Q04.9 Congenital malformation of brain, unspecified or G93.9 Disorder of brain, unspecified? #notac...
  • Not Mr. Bush: It is very interesting that they claim to be able to guarantee something that is so dependent on physician behavior....
  • Debtor: Athena has a long history of supporting MU and PQRS attestation. It wouldn’t surprise me if they have insight into the...
  • Frank Discussion: Cerner--the best Visual Basic 5 application our tax dollars can buy! Then there's CCL (*vomits into nearest trashcan)...
  • Stormy MU: Hi, Does anyone have any feedback on athena's claim of 97% MIPs success rate? How can they publish that when 2017 at...

RSS Industry Events

  • An error has occurred, which probably means the feed is down. Try again later.

Sponsor Quick Links