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Bloomberg's Got Big Ideas on Health Care Too

By John Reichard, CQ HealthBeat Editor

February 12 -- New York City Mayor Michael R. Bloomberg Monday joined the ranks of prominent politicians prescribing a major overhaul of the U.S. health system, but he turned coy when asked if he would join them by running for the presidency in 2008. "You only get one question!" Bloomberg interjected when a reporter tried again to ask him about his presidential ambitions after he ducked a question on his plans to run in 2008.

Bloomberg made his fortune in business news by putting computers on the desktops of investors that delivered key financial analysis at a critical point in their decision-making. In a speech to health policy makers Monday in Washington, Bloomberg outlined a similar vision for the medical field, one that would harness health information technology to improve preventive care.

Bloomberg called for a $20 billion investment in health information technology in the United States and an overhaul of the health care reimbursement system that would reward preventive care.

Differentiating "pay-for-prevention" from "pay-for-performance," Bloomberg said that paying bonuses for delivering particular types of treatment, as is the case in pay-for-performance, fails to correct a fundamental misallocation of health care dollars in the United States.

"All too often, pay for performance focuses on what's easy to measure rather than what's truly important," he said. It fails to properly emphasize preventive primary care and focuses on the processes rather than improving the medical outcomes of treatment, he said.

"Over time, paying for prevention should cut health care costs," he said. "But there are going to be start-up expenses in equipment, training, and transition costs involved in retooling primary care in America." Bloomberg said $20 billion "is a lot of money, but in the context of a $2 trillion-a-year health care industry, it's a worthwhile investment. And let's not forget that what we're doing now costs money, too. The big difference is that paying for prevention will produce better results."

Electronic health records (EHRs) are a powerful tool that should be the centerpiece of a pay-for-prevention system, he said. "In this day and age, there is no excuse for any more delay. So let's set this national goal: Five years from today, every doctor's office, clinic, and hospital in America that accepts Medicaid and Medicare must be using prevention-oriented electronic health records."

Bloomberg said "we need to make EHRs as standard as stethoscopes in doctors' offices across the country. That's because the essence of preventive care is information—information that patients, doctors, and other health care workers need so they can make the right decision, at the right times."

As an example, Bloomberg said that his city's health department has brought prevention-oriented EHRs to more than 1,000 doctors serving a million patients in community health centers and other settings. The effects can be dramatic, he said. For example, a provider that operates 11 health centers in Manhattan and the Bronx was able to use EHRs to increase the number of elderly patients receiving pneumonia vaccinations by 400 in a single month.

The EHRs delivered those results by giving doctors electronic reminders to administer the vaccination. Vaccination rates at the clinics "have improved steadily ever since," Bloomberg said.

Bloomberg distinguished himself from other major politicians with major overhaul proposals by not specifically focusing on coverage of the uninsured.

Coverage of the uninsured is important, but "we have to face that, by itself, insuring the uninsured won't automatically produce the health improvements we have a right to expect from an additional investment in health care."

"Amazingly," Bloomberg said, nearly nine out of 10 Americans who have hypertension, diabetes, and high cholesterol have some form of insurance coverage. That's why paying for prevention is key, he emphasized.

However, Bloomberg was not so different from the political pack when it came to questions of what choices he would make to come up with the $20 billion to pay for prevention-oriented health IT. Bloomberg offered only a vague response, saying that the costs of technology would come down over time.

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