MU Payments Doubted
October 28, 2010
Many hospitals and medical groups are eagerly awaiting the first Meaningful Use (MU) payments, which are scheduled to begin in May 2011 and continue for another four years (and total some $5 billion).
Some executives, however, doubt that the government will ultimately deliver. An online poll conducted last month by Health Data Management magazine found 54 percent of poll respondents saying the government won’t make the payments.
Only 26 percent of respondents said that both the Medicare and Medicaid programs will pay as promised while another 20% believe Medicare will pay as promised, but Medicaid won’t.
Online polls are often unreliable and often express skepicism(perhaps people blowing off steam at work). Still, I think it does reflect a lot of healthcare executives’ growing nervousness about healthcare reform and whether it is going to “stick.”
Facing the Digital Divide
October 26, 2010
Dr. David Blumenthal, national health IT coordinator, last week called attention to the “digital divide,” the low rate of EHR adoption among rural and inner-city providers.
In a letter posted online Oct. 18, Dr. Blumenthal said it was “absolutely necessary that the leading EHR vendors work together” to make electronic health records and other health IT available to physicianstreating patients in underserved communities.
One of the little-discussed facts of the HIT industry is that few vendors actively market to inner-city medical groups or rural and community hospitals.
For example, the U.S. has 1315 critical access hospitals, these are facilities in remote rural communities, almost all of which have less than 50 beds (many less than 25 beds). I have worked with CAH executives who told me they could not get a major HIT vendor interested in making a proposal to them.
These hospitals have limited funds, few (if any) IT staff and are located hundreds of miles from major cities. I am not as well acquainted with the problems of inner-city medical groups, but I’ll bet they have similar limitations in terms of budget and staff.
A hundred years ago, rural areas faced the same problem in obtaining electrical service. Few major utilities wanted to spend money to reach them. The federal government created the Rural Electrification Administration and other agencies to bring electricity to these areas.
Will it take a similar effort to bring EHRs to rural areas and other underserved communities?
Mooving to Outcomes MU
October 24, 2010
Should the next round (i.e. year 2015) of meaningful use requirements be pegged to clinical outcome measurements rather than focused on EHR structures and processes?
The concept is that by focusing on outcome measurements providers would have greater freedome to innovate. In other words, ”we don’t care how you get there, just get there.”
The suggestion was made at a recent meeting of the federal Health IT Policy Committee by Paul Tang, M.D., VP, CMIO of the Palo Alto Medical Foundation and co-chair of the committee’s Meaningful Use Work Group.
Examples of outcome measures enabled by health IT might include reducing prescribed major drug interactions by a certain percentage or reducing 30-day hospital readmission rate by 10 percent.
Other committee members were less enthusiastic, noting that outcome measures take a long time to develop. One member said health executives in the United Kingdom have been trying for several years to develop measures but have been having trouble defining them.
UK EMR: 3 Million and Counting
October 20, 2010
It’s always interesting to check in on the UK with its National Health System. The London Daily Telegraph reported recently on changes the new Conservative government is considering.
One proposal: make all NHS “summary of care” (i.e. individual EMRs) available online. Patients would be able to access a range of data, from their own records with their doctors and hospitals to personal care plans if they have a long-term condition. They would also be able to compare different hospitals and physicians. Following their care, they will be asked to rate the treatment they received.
A cost comparison: so far the NHS has spent about $16 billion on its system and has created three million individual EMRs. Kaiser has spent less than half that amount and created around one million EMRs so far. This may be comparing apples and oranges, since the NHS is spread across a wider area and includes many more clinics and physician offices.
rhment Three million summary care records, a type of record aimed at emergency care settings, have already been created under the controversial £12.7 billion NHS National Programme for IT. But last week the Department of Health put a limit on the amount of data that will feature on them, insisting there would only be patients’ demographic details, medications, allergies and adverse reactions.
NHS care records will be viewable online, according to proposals published today that also insist the government is “abandoning” a top-down approach to hospital technology choices.
Patients will be able to access a range of data, from their own records with their GP and hospitals, to medical letters and personal care plans if they have a long-term condition.
As part of the initiative, patients will be able to compare different hospitals and physicians (BBC News, 10/18). Following their care, patients will be asked to rate the treatment they received, which the U.K. Department of Health hopes will strengthen care standards (Winnett, London Telegraph, 10/18).
The government has not yet released information on any security standards it will apply to the EHR system.
Under the new plans, patients will have the power of veto over any information beyond emergency data that is added to the SCR over time. The record will now only contain patients’ demographic details, medications, allergies and adverse reactions. A number of doctors had long complained that there had been no clear limits to what would be added, which could potentially have resulted in long and complex files full of data patients were unaware o
Doctor Shortages Seen in 2015
October 18, 2010
The Association of American Medical Colleges, the trade association for our nation’s academic medical centers, has a new study stating that U.S. physician shortages in 2015 will be 50% worse than previously predicted because health reform will provide insurance coverage to 32 million more Americans.
I take this with a grain of salt, because the AAMC has been predicting physician shortages for the last 30 years. In fact, we are currently short of physicians, particularly in rural communities.
The new report seems to assume that the 32 million Americans who are projected to obtain health insurance under the new law will rush to see a physician for various illnesses they have been ignoring.
Two other factors cited by the AAMC are 1) a 36 percent growth in the number of Americans over age 65; 2) nearly one-third of all physicians are expected to retire in the next decade.
The AAMC’s solution is to have Congress support a 15 percent increase in residency training (adding 4,000 more new physicians per year). Given the current demands for cutting healthcare spending, this seems like a long shot.
QALY Quashed
October 14, 2010
An article in the current New England Journal of Medicine (www.nejm.org) points out the current restriction on using QALY (quality adjusted life-years) as a metric for health outcomes. The recently enacted Patient Protection and Affordable Care Act (ACA) created a Patient-Centered Outcomes Research Institute (PCORI) to conduct comparative effectiveness research but prohibited it from using cost per QALY measures.
QALYs are used in Britain, Canada and other countries with a national health system as a basis for recommending new treatments and technologies. QALYs give priority to interventions that offer the most benefit for the longest period of time.
Why did Congress ban QALYs? Probably a concern about “big-government” and “death panels.”
The NEJM editorial says “The antagonism toward cost-per-QALY comparison suggests a bit of magical thinking – the notion that the country can avoid the difficult trade-offs that cost-utility analysis helps illuminate.”
This refusal to talk about “rationing” in a rational manner was was reflected in President Obama’s decision to name Don Berwick as head of CMS as a recess appointment.
Zombie Legislation
October 11, 2010
A news item on Reuters recently is disturbing for those looking to take advantage of EHR subsidies or health information exchanges.
The report said some Republicans, anticipating winning a majority in the House, are planning to “defund” health care reform. A legislative analyst at the Brookings Institution said they could pass a bill barring the HHS (Health and Human Services Department) from writing or issuing regulations or engaging in any other federal activity related to the creation of health insurance exchanges.
This is possible because the massive health care reform bill passed earlier this year authorizes spending, but the actual cash must be appropriated in a second process. The bill had more than 100 separate authorizations calling for spending of well over $105 billion between now and 2019.
The subsidies for EHRs weren’t specifically mentioned, but they are projected to cost $5 billion, so they could be a target too.
No one can be sure what will happen, but that is the point. This kind of uncertainty makes planning difficult.
Sharing Means Caring
October 7, 2010
A new health information web site will launch tomorrow. Called Sharecare.com, it offers more than 100,000 Q&As on health and wellness topics. The New York Times reports that some of the answers will be contributed by marketers.
For example, a Q&A on ”Why is good skin care important?” has been inserted by Dove, a sponsor. Most answers, however, will be contributed by independent organizations including the American Cancer Society, the American Heart Association, the American Red Cross and the Cleveland Clinic.
The sponsor/contributors are paying an $1-7 million each to be a part of Sharecare.com. The initial roster is composed of Colgate-Palmolive, Ortho-McNeil-Janssen Pharmaceuticals, Pfizer and Unilever,
Where do the editors and sponsors draw the line on product referrals?
A Pfizer spokesman said his company would provide answers to questions “in the areas of fibromyalgia and smoking cessation” but “not around any products we offer” in those areas, which are, respectively, the prescription drugs Lyrica and Chantix.
This is part of a broader trend where “objective” editorial content is being seemlessly merged with advertising. I’ve noticed in the last year that large sections of Forbes, Fortune and other business magazines are paid advertorial that can not be easily distinguished from the “real” news coverage.
The front page of the Los Angeles Times is literally for sale. In recent months readers have been treated to a series of phoney, scary front pages sponsored by TV shows and amusement parks.
Med Groups Cost City Money
October 4, 2010
Many cities want medical group offices. Most physicians pay high rents, have nice offices and lend prestige to a city.
Some officials in Beverly Hills, however, say the city has too many medical offices.
Here are some of their criticisms of medical groups:
-they generate high traffic and parking demands;
-they employe many lower-paid workers;
- they push-out other desirable tenants such as high-end retail shops and restaurants.
Beverly Hills is probably a unique case. Most cities would be delighted to have more medical offices.
Nation’s Top Health Problems
October 1, 2010
If you had to list the top six health problems in the U.S., what would they be?
According to the director for the Centers for Disease Control, they are: smoking, AIDS, obesity, teen pregnancy, auto injuries and healthcare infections.
The director, Dr. Thomas Frieden, said he selected these because they are “winnable.” He is highlighting (prioritizing) them because he believes government can make a real impact on these issues.
Of those listed, healthcare infections is the only issue in which healthcare IT can play a major role.
Several studies have shown that HIT can improve early detection of infections and alert key clinicians to take action (isolation, medication).
Auto safety is a tough one. At least today’s teens are aware of the need for seatbelts.