Transformation Requires Money

We were pleased with "Vision of Newt" [July 13], your substantive article on former Speaker Newt Gingrich, his work at the Center for Health Transformation and his visionary and sage leadership on health transformation and health information technology (HIT).

Your story noted the HIT implementation of the Mayo Clinic Foundation in the discussion of the barriers confronted by medical practitioners in their efforts to apply advanced information technology. As the Mayo spokesperson emphasized, the exorbitant cost of HIT purchase and implementation is the most significant hindrance. However, studies document that HIT for electronic prescribing, computerized physician order entry, electronic patient health records, etc., prevents medical errors and improves communication, thus saving lives as well as scarce financial resources.

The American Medical Group Association (AMGA) is proposing a joint public-private sector solution that will promote affordable implementation of HIT for health care providers (physicians and others). Based on the proven and successful Federal Direct Loan Program (FDLP), our proposed program would provide loans from the Treasury as HIT capital to providers. As with student loans, the government would own the loans, but subcontracted private entities would originate and service the loans.

Without a guarantee of availability of funds, health care providers will be resistant to start capital investing. Such funding through loans could be provided on an indefinite basis and not subject to the annual appropriations process.

Importantly, our proposal also calls for the federal government to explore ways to create incentives for HIT implementation through appropriate reimbursement mechanisms such as payment differentials, cost-sharing differentials and/or direct payment for services provided through HIT (e.g., a new CPT code for on-line visits). Lastly, AMGA's proposal calls for regulatory exceptions to other HIT barriers, such as irrelevant fraud and abuse rules, and for studies to determine savings from increased HIT usage resulting from this program.

Donald W. Fisher

President and chief executive officer

American Medical Group Association

Alexandria

Colorado on Their Minds

"Move This Way" [July 20] presented an exciting vision: What if other states could give residents such a rich variety of opportunities to bicycle, run and be active? The article did have one error, however, in defining the principle of "Complete Streets" as a policy of installing bike and jogging paths next to every street or highway.

In fact, states and local governments that follow a Complete Street policy simply make sure that every road or street that is built or reconstructed has safe, comfortable facilities for bicycling and walking. Only occasionally does this mean building a separate path; often it means installing bicycle lanes or building sidewalks, but the solution varies with each road. This is much easier to achieve than separate paths, and ensures that the public right of way truly serves the public.

Oregon, South Carolina and Virginia are among the states that have adopted this policy. While every state cannot offer ski slopes, they can all provide safe places for people to get physical activity by bicycling and walking.

Martha Roskowski

Campaign manager

America Bikes

Washington

More Neurofeedback

I am a counselor, a mediator and a neurofeedback practitioner and I am a deeply disappointed Post reader.

Your assertion that Neurofeedback is akin to snake-oil treatment is neither truth nor the result of a balanced discussion. This would be bad enough if it weren't for the fact that so many people who read the Post consider it gospel. To fail to present a balanced treatment of this topic is to do irreparable damage to the very readers you set out to inform.

Research studies and clinical findings continue to document the effectiveness of this form of training. I and other practitioners continue to use this tool because during and after training we regularly hear our clients report that they feel less depressed, more "together," better able to get things done and less anxious. Many of them report having fewer seizures and sleeping better. Parents regularly report that their children need less or no further medication for attentional problems.

We're not doing magic, and we're not doing voodoo. Neurofeedback simply enables clients to learn to change their own brainwaves through operant conditioning. While the technique is new and somewhat unusual, it is clearly within the tradition of psychology because it relies upon a clients' own ability to learn.

What a wonderful thing if we actually had the patience to learn the ways to teach our own brains and bodies to do what we all too often seek to accomplish with medications.

Carol C. Hughes EdD, LPC

Professor of psychology-emeritus

Randolph-Macon College

Richmond