Cost of HITECH Act
July 29, 2010
What will the HITECH actually cost taxpayers?
Neil Versel reports in his column today that the behavioral health community is upset because many mental health care professionals are not eligible for the health IT incentive payments.
Charles Ingoglia, VP of public policy at the National Council for Community Behavioral Health Care said that as the Recovery Act was developed in Congress, the amount of money available for health information technology was reduced from $50 billion to $20 billion and mental health providers got left out.
Versel adds that CMS recently estimated that it would pay out about $27 billion in incentives over the life of the meaningful-use program, but didn’t say if that included savings.
You could look at this from the perspective of “infrastructure investment.” After all the U.S. interstate highway system, built by the Eisenhower Administration, cost (in today’s dollars) many billions. It is fair to say it was a good investment that has paid off for citizens many times over. Will we be able to say the same about our “national” EHR system?
Canada’s EMR Subsidies Fail
July 27, 2010
Joe Conn at Modern Healthcare reports on a new study that finds Canada’s program to subsidize EMRs for physicians has a poor track record.
Seven of 13 Canadian provinces and territories offer subsidies to primary-care physicians for the purchase of EHR systems, according to a new report published in the Journal of Healthcare Information Management.
Alberta, with 3.7 million people and about 4,000 primary care physicians, launched its first provincial government program to subsidize electronic health record systems in 2001. And yet its EHR penetration rate, highest of all Canadian provinces and territories, is 40%.
In Canada, EHR testing and certification is done by the individual provinces. As a result, several systems have been certified in one province but failed in another.
The study’s author notes the differences in the approaches of the two countries. He notes that they share one weakness: both certification systems are designed solely to measure functionality – not ease of use.
EHR Policy: Opt-In or Opt-Out
July 22, 2010
The HIT Policy Committee, a senior level group formed by HHS in response to ARRA, is charged with “developing a policy framework” for a nationwide health information infrastructure.
That’s a tough row to hoe, given the diverse interests of the various players.
At its most recent this week, the HIT Policy Committee wrestled with patients’ rights to opt in or opt out of health information exchange.
Paul Tang, MD, vice-chair of the committee, said it was unlikely there would be a consensus on the issue. Judy Faulkner from Epic Systems said it comes down to a moral and ethical decision. She recommended that policy on the issue be based on evidence, not on the “vocal minority” of privacy activists.
However, another committee member, a former Florida state legislator was adamant. “Giving people an ‘opt-out only’ is not a choice.”
It is a constitutional and legal right to have your health information private, she said.
I am concerned that if the government decides to creat an “opt-in” system, people will give in to their fears, only a small percentage will opt-in and 90% of health information will be walled off, creating problems for individual physicians and public health officials.
Two points: 1) currently patients have virtually no rights at all. The insurance companies maintain vast data files about all of us. When you pick-up a prescription, that information is recorded and sold. You have no choice to keep it private.
2) your personal financial records, potentially of as much concern as your health information, are totally public. For $25, you can obtain a detailed financial report about anybody. I do not see any widespread movement to have these records changed to an “opt-in” system.
CU Wants Fed Database for HAIs
July 18, 2010
Consumers Union has called for the HHS and CMS to maintain a national database listing hospitals and their rates of healthcare associated infections (HAIs).
As reported in a recent issue of Healthleaders, on July 12, the CMS expanded its Hospital Compare website to include outpatient data related to areas such as 30-day mortality rates and readmission rates for certain patients. But the site does not now report the rate of HAIs.
Under this year’s healthcare reform bill, the federal Hospital Compare site will report HAI rates begining in 2014. Currently, only one state, Pennsylvania, is publicly releasing hospital-specific HAI data.
According to Consumers Union, over the next five years, “10 million hospital patients will get an infection over the next five years and a half a million of them will die.”
Progress is being made on several fronts. The Association for Professionals in Infection Control reports that a number of its member facilities have seen their central-line associated bloodstream infections reduced, in some cases to zero.
Error Reports: Does the Public Care?
July 14, 2010
A small news item in the July 11 Las Vegas Sun noted that three St. Rose Dominican Hospitals will post on their website cases of preventable harm known as adverse events.
Noting that no Nevada hospital has done this before, the CEO suggested other hospitals make the same reports.
The National Council of State Legislatures reports that 26 states require hospitals to report adverse events, although only a few currently have the information posted on websites.
This information is undoubtedly important for state public health officials, but can the general public understand the meaning of the statistics? Will it impact their choice of hospital?
My guess is no, it won’t. In California, most consumers are in HMO network plans which limit the choice of hospital. Even if they have a limited choice, they are probably going to select a hospital their physician recommends.
How many people look at the Consumer Reports rankings of new or used cars before buying one? Some, but not many.
Healthcare M&A Activity Heats Up
July 12, 2010
The Health Care M&A Monthly, published by Levin Associates, reports that a “heated competition” is emerging between strategic and financial buyers for healthcare companies.
A financial buyer, often a private equity group, generally buys the company to spruce it up and sell it later.
A strategic buyer, usually a larger healthcare company, is looking to buy the assets and fold them into its own company. As the newsletter notes, strategic buyers can generally outbid financial buyers because it can wring synergies out of the business.
The June issue the monthly newsletter reported a total of 34 deals in May in the health care services sector with a total price of $6.5 billion.
For more information on the newsletter, see www.healthcaremanda.com
Real Time Claims – Really!
July 6, 2010
I’ve been hearing about the need for real times claim adjudication since I worked at CIGNA 12 years ago. Now, a New York Times article reports that widespread adoption of electronic medical records could make it possible for many medical offices.
Providers have long accused the insurance industry of being opposed to RTCA so they can enjoy “the float” – they want to hang on to the premium dollar and earn interest as long as possible.
Insurers have been skeptical of RTCA, but not because they want to protect their float. They are concerned about claim accuracy and fraud.
According to the Times’ article, “It is doctors who seem to be the primary obstacle. Doctors are paid for seeing patients, not for sorting through more than 14,000 diagnostic codes and 4,500 procedure codes while a patient sits on the exam table.”
The article reported on one physicians with an assistant “whose sole responsibility was to sit at the doctor’s side, entering data into the electronic record as the doctor-patient conversation proceeded.”
Most primary care physicians, of course, can’t afford that.
Are Consumers Inured to Data Breaches?
July 2, 2010
The definition of inure is to “become accustomed to something undesirable.” Like Michael Jackson ring tones or construction delays on the 405.
In the last two days healthcare organizations have announces two separare, massive data breaches.
On Tuesday, Anthem Blue Cross said it had accidentally exposed 435,000 names on the Internet. Today, Lincoln Medical Center in the Bronx said FedEx had lost seven discs containing 135,000 patient names. I’ve been using FedEx for 20 years and they have never lost one of my packages, but there is always a first time.
Recent polls show the public has little enthusiasm for personal health records (and EMRs for that matter).
It’s no mystery why people don’t trust their information being collected and stored by third parties. The industry’s track record on privacy is dismal.