It has become more and more apparent that the way an EMR vendor implements the meaningful use requirements is going to be critically important to a doctor’s successful adoption of the meaningful use criteria which is of course essential to get the $44,000 in EMR stimulus money.
I think it’s easy for doctors and practice managers that aren’t as familiar with the various EMR software and with the details of the EMR stimulus to get confused. On face, it seems that the effort to get the EMR stimulus money shouldn’t be affected by which EMR software you choose as long as it is an ONC-ATCB certified EMR. However, this is just categorically WRONG!
The EHR certification is meant to tell you that it CAN meet the meaningful use guidelines. It doesn’t tell you how easily it is to meet the meaningful use guidelines. It doesn’t tell you how well they integrated the meaningful use guidelines into your regular workflow. It doesn’t tell you how well it lets you delegate the meaningful use tasks to other staff members so you can optimize the doctors time. So, yes, EHR certification should mean it’s possible to show meaningful use. EHR certification does not make any claims to how effective that EHR software will actually accomplish the task.
Here’s a simple analogy:
If I wanted to dig a hole for a footing on a house, I could probably use a spoon to dig the hole. It would take forever to actually dig the hole, but a spoon could work. It would not be easy to use a spoon to dig the hole and quite honestly I’d probably give up before I finished, but with enough blood sweat and tears I could get the hole dug.
Of course, if I had a shovel, digging the hole would be much easier. I could get it done with just a bit of hard work. It would obviously go a lot faster than a spoon. Now, if I had a backhoe, digging the hole would basically be academic. Achieving the goal would be simple to accomplish, because the tool was designed perfectly to achieve it.
It’s worth asking yourself whether the EMR you use or the EMR you choose is a golden spoon or a powerful backhoe when it comes to achieving meaningful use. Maybe both can achieve the goal of meaningful use, but is it just made to look nice and shiny or was it really designed to make achieving meaningful use as painless as possible?
EMR And HIPAA
Dec 18, 2010
Saturday, December 18, 2010
New England Journal Of Medicine Cites A Lack Of Patient Safety
In 1999, the Institute of Medicine released a study noting that medical mistakes were responsible for over 98,000 deaths and more than one million injuries each year. Since that time, hospitals have been focusing on different ways to improve patient safety. Despite efforts by hospitals to decrease the chances and rates of injuries to patients, a recent study published in the New England Journal of Medicine questions whether any progress has been made.
As part of the study, 14 hospitals in North Carolina were asked to participate, with 10 of the 14 being selected for inclusion. From 2002 to 2007, 10 admissions records from each hospital were randomly selected for review every quarter. After reviewing nearly 2,400 adult admissions records, the researchers concluded that 18 percent of patients were injured during their stay. Overall, there were 588 injuries to 423 patients, meaning some patients were injured more than once in a single visit.
Approximately 42 percent of the harms experienced by the patient were temporary, but nearly 43 percent of all harms required some intervention by doctors or nurses and resulted in an extended stay in the hospital. Three percent of the identified harms resulted in a permanent injury and 8.5 percent were life-threatening. In almost 3 percent of the cases in the study, the injury resulted in or contributed to the death of the patient.
North Carolina was selected for the study because it has been noted as one of the leaders in patient safety reform. Despite the state's focus on preventing hospital errors, the study found no statistically significant drop in the rates of mistakes over the six year period of the study.
In a Bloomberg interview, Christopher Landrigan, the lead author of the report, noted that the use of electronic medical records and better methods of tracking patient safety are key to reducing medical mistakes over time. The study notes that only 1.5 percent of U.S. hospitals have a comprehensive system of electronic records and only 9.1 percent have any form of electronic record keeping in use.
The study shows that despite efforts of hospitals and doctors to make patient safety a priority, injuries frequently occur while under their care. If you have been injured by the negligence of your provider or by any act of medical malpractice, it is important to discuss your options with an experienced attorney as soon as possible.
24/7 Press Release
Dec 18, 2010
As part of the study, 14 hospitals in North Carolina were asked to participate, with 10 of the 14 being selected for inclusion. From 2002 to 2007, 10 admissions records from each hospital were randomly selected for review every quarter. After reviewing nearly 2,400 adult admissions records, the researchers concluded that 18 percent of patients were injured during their stay. Overall, there were 588 injuries to 423 patients, meaning some patients were injured more than once in a single visit.
Approximately 42 percent of the harms experienced by the patient were temporary, but nearly 43 percent of all harms required some intervention by doctors or nurses and resulted in an extended stay in the hospital. Three percent of the identified harms resulted in a permanent injury and 8.5 percent were life-threatening. In almost 3 percent of the cases in the study, the injury resulted in or contributed to the death of the patient.
North Carolina was selected for the study because it has been noted as one of the leaders in patient safety reform. Despite the state's focus on preventing hospital errors, the study found no statistically significant drop in the rates of mistakes over the six year period of the study.
In a Bloomberg interview, Christopher Landrigan, the lead author of the report, noted that the use of electronic medical records and better methods of tracking patient safety are key to reducing medical mistakes over time. The study notes that only 1.5 percent of U.S. hospitals have a comprehensive system of electronic records and only 9.1 percent have any form of electronic record keeping in use.
The study shows that despite efforts of hospitals and doctors to make patient safety a priority, injuries frequently occur while under their care. If you have been injured by the negligence of your provider or by any act of medical malpractice, it is important to discuss your options with an experienced attorney as soon as possible.
24/7 Press Release
Dec 18, 2010
Health Professionals Need Not “Reinvent The Wheel” For EMR/EHR Compliance
Electronic Medical Records (aka Electronic Health Records) are becoming a requirement for health care professionals in the coming years. December 13 marked a notable turning point in the healthcare debate - the Virginia Federal Courts rejected the Minimum Essential Coverage Provision of the Patient Protection and Affordable Care Act (PPACA), declaring it as unconstitutional. While Virginia’s decision is only the most recent ruling, it sets the stage for the potential dismantling of Obamacare. Because the United States House of Representatives will transfer control to the Republicans, health care professionals have begun to question the safety of EMR/EHR funding. “The Health Information Technology for Economic and Clinical Health (HITECH) Act, from which the EMR/EHR funding and incentives originates, is a different statute than the PPACA,” says Justin Barnes of the Healthcare Blog, a respected independent voice in the healthcare industry. Barnes points out that the funding for HITECH is grounded in law, and is drawn from the Medicare Trust Funds held by the US Treasury. As a result, physicians must prepare for when the EMR/EHR legislation takes effect over the next several years.
In other words, the Obama Health Insurance plan, and the EMR/EHR Mandate are two very different pieces of legislation.
PRLog
Dec 18, 2010
In other words, the Obama Health Insurance plan, and the EMR/EHR Mandate are two very different pieces of legislation.
PRLog
Dec 18, 2010
Thursday, December 16, 2010
Blumenthal Says Docs Eventually 'Will All Support EHRs'
Returning to the 2004 roots of the national health IT coordinator's role as cheerleader-in-chief for EHRs, Dr. David Blumenthal took advantage of a public speech last week to say that EHRs will indeed be in widespread use nationwide in the not-too-distant future.
"History has shown that things that improve healthcare become part of what is used. I propose to you that in a few years doctors will all support EHRs," Blumenthal said at the 18th National HIPAA Summit in Washington, according to Healthcare IT News. "Using EHRs will become a core competency for physicians. And once we've established that, it will be considered an absolute requisite."
The national coordinator then said EHR adoption will take an escalator-like trajectory once federal financial incentives kick in next year. "I think we're going to see the upward slope of the adoption curve within a year or two, but it will be difficult to predict the slope," Blumenthal said.
Another top HHS IT booster, Agency for Healthcare Research and Quality Director Dr. Carolyn Clancy, said that the pace of adoption will depend on how useful electronic health data is to physicians. "Information is the lifeblood of medicine," Clancy told the gathering. "Clinicians are trained to look at patients one at a time. But, what's missing is aggregated information." AHRQ, of course, is in charge of comparative-effectiveness research, and thus will be providing such aggregated information to help establish standards of care.
FierceEMR
Dec 16, 2010
"History has shown that things that improve healthcare become part of what is used. I propose to you that in a few years doctors will all support EHRs," Blumenthal said at the 18th National HIPAA Summit in Washington, according to Healthcare IT News. "Using EHRs will become a core competency for physicians. And once we've established that, it will be considered an absolute requisite."
The national coordinator then said EHR adoption will take an escalator-like trajectory once federal financial incentives kick in next year. "I think we're going to see the upward slope of the adoption curve within a year or two, but it will be difficult to predict the slope," Blumenthal said.
Another top HHS IT booster, Agency for Healthcare Research and Quality Director Dr. Carolyn Clancy, said that the pace of adoption will depend on how useful electronic health data is to physicians. "Information is the lifeblood of medicine," Clancy told the gathering. "Clinicians are trained to look at patients one at a time. But, what's missing is aggregated information." AHRQ, of course, is in charge of comparative-effectiveness research, and thus will be providing such aggregated information to help establish standards of care.
FierceEMR
Dec 16, 2010
Wednesday, December 15, 2010
Berwick: Repealing Healthcare Reform Would Be A Big Mistake
In his first appearance before Congress after his highly criticized recess appointment, CMS head Donald Berwick told a Senate panel that repealing the healthcare reform would be a big mistake, The Hill reports.
"I can't think of a worse plan," Berwick told the Senate Finance Committee. If the bill were repealed, seniors would not get the 50 percent discount for prescription drugs, senior access to preventive services like colonoscopy and mammography would vanish and plans to improve the care of chronic illnesses and be more transparent would disappear. "It would be a terrible plan," he said.
Berwick contends that "every person in America, and certainly every beneficiary of Medicare and Medicaid, should be able to get all the care they want and need, when and how they want and need it."
For Republicans, their first chance to grill Berwick was anti-climactic, despite irritation over how President Obama appointed him (bypassing a Senate confirmation). The hearing, which lasted 90 minutes didn't leave much time for questions at the end, something Sen. Orrin Hatch (R-Utah) took issue with, according to The Hill. "It's like asking us to drain the Pacific Ocean with a thimble," he said. "We ought to have time to ask the most important man in healthcare sufficient questions."
FierceHealthCare
Dec 15, 2010
"I can't think of a worse plan," Berwick told the Senate Finance Committee. If the bill were repealed, seniors would not get the 50 percent discount for prescription drugs, senior access to preventive services like colonoscopy and mammography would vanish and plans to improve the care of chronic illnesses and be more transparent would disappear. "It would be a terrible plan," he said.
Berwick contends that "every person in America, and certainly every beneficiary of Medicare and Medicaid, should be able to get all the care they want and need, when and how they want and need it."
For Republicans, their first chance to grill Berwick was anti-climactic, despite irritation over how President Obama appointed him (bypassing a Senate confirmation). The hearing, which lasted 90 minutes didn't leave much time for questions at the end, something Sen. Orrin Hatch (R-Utah) took issue with, according to The Hill. "It's like asking us to drain the Pacific Ocean with a thimble," he said. "We ought to have time to ask the most important man in healthcare sufficient questions."
FierceHealthCare
Dec 15, 2010
Governor-Appointed Panel In Virginia Calls For Reform 'Regardless' Of Law
Calling Virginia's health system performance "mediocre," a panel appointed by Republican Gov. Bob McDonnell recommended that the state work toward implementing the federal health law's provisions--and toward improving performance as a whole--despite a ruling by a Richmond-based federal judge on Monday deeming part of that same law unconstitutional.
Despite a fundamental opposition to the law, McDonnell--as well as all other governors both for and against reform--still must be prepared for whatever outcome is decided, reports Kaiser Health News, hence, the panel. The panel recommended creating an exchange run by the state where both individuals and citizens could obtain health coverage; increasing the number of doctors in the state thus, addressing the physician shortage; and a more team-based approach to healthcare that includes turning more decision-making authority over to nurses.
Still, the panel pointed out that most of its suggestions could be implemented regardless of the law's outcome.
"Health reform is a process, and successful health reform is a participation sport," the panel wrote. "The vast majority of these suggested actions are independent of the new federal law. This accentuates the fundamental point that health system reform can be in the Commonwealth's interest regardless of federal actions or inactions."
Bill Hazel, the state's Health and Human Services secretary, reiterated that point when announcing the panel's findings on Tuesday. "[I]t's easy to assume we are not interested in health reform, but we very much are," he said, according to KHN.
The panel cited the lack of individuals and small business with insurance access, despite the state's ranking No. 6 in the nation in terms of median family income, as just one reason for change.
"Since so many recommendations hold promise to improve quality, lower cost, or make insurance and care more affordable and accessible, opportunities for 'early adoption' should be prudently explored and acted upon," they wrote."
In related news, in response to the aforementioned judge's ruling Monday, the Justice Department said it will appeal the decision, reports the Wall Street Journal.
FierceHealthCare
Dec 15, 2010
Despite a fundamental opposition to the law, McDonnell--as well as all other governors both for and against reform--still must be prepared for whatever outcome is decided, reports Kaiser Health News, hence, the panel. The panel recommended creating an exchange run by the state where both individuals and citizens could obtain health coverage; increasing the number of doctors in the state thus, addressing the physician shortage; and a more team-based approach to healthcare that includes turning more decision-making authority over to nurses.
Still, the panel pointed out that most of its suggestions could be implemented regardless of the law's outcome.
"Health reform is a process, and successful health reform is a participation sport," the panel wrote. "The vast majority of these suggested actions are independent of the new federal law. This accentuates the fundamental point that health system reform can be in the Commonwealth's interest regardless of federal actions or inactions."
Bill Hazel, the state's Health and Human Services secretary, reiterated that point when announcing the panel's findings on Tuesday. "[I]t's easy to assume we are not interested in health reform, but we very much are," he said, according to KHN.
The panel cited the lack of individuals and small business with insurance access, despite the state's ranking No. 6 in the nation in terms of median family income, as just one reason for change.
"Since so many recommendations hold promise to improve quality, lower cost, or make insurance and care more affordable and accessible, opportunities for 'early adoption' should be prudently explored and acted upon," they wrote."
In related news, in response to the aforementioned judge's ruling Monday, the Justice Department said it will appeal the decision, reports the Wall Street Journal.
FierceHealthCare
Dec 15, 2010
Thursday, December 9, 2010
Radiation Overdose, Alarm Fatigue Top List Of Health Technology Hazards
Considering that just last week, 700 healthcare providers at the Radiological Society of North America's annual conference signed a pledge to use less radiation, it should come as no surprise that the No. 1 health technology hazard heading into 2011, according to the ECRI Institute's list of top 10 hazards, is radiation therapy overdose.
"There's been a rapid growth in the number of treatment systems and an increase in their complexity," Jim Keller, ECRI's vice president for health technology evaluation and safety, told the Wall Street Journal.
Alarm hazards caused by desensitization, or "alarm fatigue" ranked No. 2 on ECRI's list while cross-contamination from flexible endoscopes, last year's top hazard, ranked third.
Flexible endoscope contamination issues "can inconvenience patients and create anxiety," the ECRI report says, according to WSJ. "[A]t worst, they can lead to life-threatening infections."
High radiation doses of CT scans and data loss leading to repeated testing, injury or death rounded out the top five hazards.
The rest of the top 10 hazards included:
Luer misconnections: Essentially, tubes, needles and catheters incorrectly connected with one another.
Oversedation during use of patient-controlled analgesia (PCA) infusion pumps: Too much of a painkiller being administered to a patient on a medicine drip.
Needle sticks: Patients, providers or other staff members accidentally being stuck by needles.
Surgical fires: Which, according to WSJ, are nearly as common as wrong-site surgeries.
Defibrillator failures in emergency resuscitation attempts.
FierceHealthCare 12-9-2010
"There's been a rapid growth in the number of treatment systems and an increase in their complexity," Jim Keller, ECRI's vice president for health technology evaluation and safety, told the Wall Street Journal.
Alarm hazards caused by desensitization, or "alarm fatigue" ranked No. 2 on ECRI's list while cross-contamination from flexible endoscopes, last year's top hazard, ranked third.
Flexible endoscope contamination issues "can inconvenience patients and create anxiety," the ECRI report says, according to WSJ. "[A]t worst, they can lead to life-threatening infections."
High radiation doses of CT scans and data loss leading to repeated testing, injury or death rounded out the top five hazards.
The rest of the top 10 hazards included:
Luer misconnections: Essentially, tubes, needles and catheters incorrectly connected with one another.
Oversedation during use of patient-controlled analgesia (PCA) infusion pumps: Too much of a painkiller being administered to a patient on a medicine drip.
Needle sticks: Patients, providers or other staff members accidentally being stuck by needles.
Surgical fires: Which, according to WSJ, are nearly as common as wrong-site surgeries.
Defibrillator failures in emergency resuscitation attempts.
FierceHealthCare 12-9-2010
Friday, October 22, 2010
CMS To Fight Medicare, Medicaid Fraud With High-Tech 'Bounty Hunters'
Medicare and Medicaid fraud cost American taxpayers some $54 billion last year. (We've long believed that Medicare fraud is the unofficial state sport of Florida.) CMS has tried many approaches to catching some of the perpetrators, notably through the Recovery Audit Contractor program, but the bad guys always seem to be one step ahead of the G-men.
The Obama administration wants to go high-tech in its pursuit of fraudsters, sending out "bounty hunter auditors" to find waste, fraud and abuse in Medicare and Medicaid, according to the Huffington Post.
"We're told the auditor's weapons will be sophisticated new computer programs to scan Medicare and Medicaid billing records nationwide to check for patterns of bogus claims," writes columnist Diane Dimond. "And like the early bounty hunters of the old West these modern day crime fighters will get to keep a percentage of what they recoup for taxpayers. It seems like a win-win idea. Pilot programs in California, New York and Texas over the last three years re-captured $900 million that would have otherwise gone into the crook's pockets."
The administration estimates such cybersleuths could recover at least $2 billion in wasteful and fraudulent spending over the next three years. If fraud continues at its current pace, that's less than 1.5 percent of the $162 billion CMS will squander in that three-year period, but hey, it's a start, right?
FierceHealthCare IT
10-22-2010
The Obama administration wants to go high-tech in its pursuit of fraudsters, sending out "bounty hunter auditors" to find waste, fraud and abuse in Medicare and Medicaid, according to the Huffington Post.
"We're told the auditor's weapons will be sophisticated new computer programs to scan Medicare and Medicaid billing records nationwide to check for patterns of bogus claims," writes columnist Diane Dimond. "And like the early bounty hunters of the old West these modern day crime fighters will get to keep a percentage of what they recoup for taxpayers. It seems like a win-win idea. Pilot programs in California, New York and Texas over the last three years re-captured $900 million that would have otherwise gone into the crook's pockets."
The administration estimates such cybersleuths could recover at least $2 billion in wasteful and fraudulent spending over the next three years. If fraud continues at its current pace, that's less than 1.5 percent of the $162 billion CMS will squander in that three-year period, but hey, it's a start, right?
FierceHealthCare IT
10-22-2010
Company Used Dementia Patients In $200M Medicare Scam
In what Justice Department officials are calling the largest fraudulent billing plot ever prosecuted by by a healthcare fraud strike force, HHS and FBI agents arrested four people--Lawrence Duran, Marianella Valera, Judith Negron and Margarita Acevedo-- for their alleged role in masterminding an unprecedented plot to defraud the Medicare program of close to $200 million.
The people involved were owners and senior managers of American Therapeutic Corporation (ATC) and Medlink Professional Management Group, Inc. The business model of the two Miami-based businesses was Medicare fraud. The companies allegedly netted $83 million in illicit payments from Medicare since 2003, The Christian Science Monitor reports. The four people and two companies were charged in a 13-count indictment for billing Medicare for community-based mental health services that were unnecessary or never actually provided.
The alleged illegal conduct in the indictment is "unlike anything we've seen before in terms of the nature and size of the scheme," Assistant Attorney General, Lanny Breuer said in a statement yesterday.
Unlike so much Medicare fraud that involves medical equipment and services, this case involves Medicare's Partial Hospitalization program, which gives mental health patients much-needed services in outpatient settings.
ATC and other defendants preyed on some of the most vulnerable patients, paying kickbacks to owners and operators of assisted living facilities and halfway houses in exchange for patient referrals. At ATC branches, bogus mental health therapy sessions were organized where elderly and infirm patients were left in rooms for hours, and received no legitimate or medically necessary therapy. Some of the patients suffered from Alzheimer's disease or dementia, and did not even know where they were. Others simply came to make money through kickbacks.
Some of the defendants were also charged with having "charting parties," where senior managers met regularly to write up fake patient medical charts.
Patient recruiters would find people who needed a place to stay overnight and offer them free temporary housing, cash or other bribes in exchange for agreeing to pose as patients.
Since the inception of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) to fight Medicare fraud in 2007, Strike Force operations have led to charges against more than 825 defendants who falsely billed Medicare for more than $2 billion.
FierceHealthCare
10-22-2010
The people involved were owners and senior managers of American Therapeutic Corporation (ATC) and Medlink Professional Management Group, Inc. The business model of the two Miami-based businesses was Medicare fraud. The companies allegedly netted $83 million in illicit payments from Medicare since 2003, The Christian Science Monitor reports. The four people and two companies were charged in a 13-count indictment for billing Medicare for community-based mental health services that were unnecessary or never actually provided.
The alleged illegal conduct in the indictment is "unlike anything we've seen before in terms of the nature and size of the scheme," Assistant Attorney General, Lanny Breuer said in a statement yesterday.
Unlike so much Medicare fraud that involves medical equipment and services, this case involves Medicare's Partial Hospitalization program, which gives mental health patients much-needed services in outpatient settings.
ATC and other defendants preyed on some of the most vulnerable patients, paying kickbacks to owners and operators of assisted living facilities and halfway houses in exchange for patient referrals. At ATC branches, bogus mental health therapy sessions were organized where elderly and infirm patients were left in rooms for hours, and received no legitimate or medically necessary therapy. Some of the patients suffered from Alzheimer's disease or dementia, and did not even know where they were. Others simply came to make money through kickbacks.
Some of the defendants were also charged with having "charting parties," where senior managers met regularly to write up fake patient medical charts.
Patient recruiters would find people who needed a place to stay overnight and offer them free temporary housing, cash or other bribes in exchange for agreeing to pose as patients.
Since the inception of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) to fight Medicare fraud in 2007, Strike Force operations have led to charges against more than 825 defendants who falsely billed Medicare for more than $2 billion.
FierceHealthCare
10-22-2010
Monday, October 18, 2010
Obesity-Related Medical Costs Double Earlier Findings
Spending on obesity is worse than we thought. A National Bureau of Economic Research study found that obesity actually accounts for 17 percent of all medical costs annually, as opposed to 9 percent as previously determined last year.
The NBER research, conducted by John Cawley of Cornell University and Chad Meyerhoefer of Lehigh University, concluded medical costs in relation to obesity are closer to $170 billion per year than $150 billion due in large part to understated self-reporting and overly cautious research gathering, reports the Associated Press. The new report tries to take both factors into account and adjusts the statistics accordingly via balanced "repeated replications to estimate standard errors," the study's authors write.
"The authors tried to better establish that excess weight was a cause for medical costs," the AP reports. "Previous studies stopped short of saying obesity caused the costs because there was too great a chance other factors could be responsible."
The researchers compiled statistics from the exact same database used to come up with the $150 billion figure, which included information on 24,000 non-elderly adults gathered from 2000 to 2005. While the earlier estimate determined that obesity added $1,400 to a person's annual medical bill, the new calculations found that number to be more than $2,800.
Cawley and Meyerhoefer point out that the motivation behind their research is not to push for more funding related to the treatment of obesity, but simply to inform. "This paper does not estimate the medical care cost of obesity in order to argue that treatment of obesity should be prioritized above treatment of other conditions, but so that the medical care consequences of obesity will be more accurately known," they write.
FierceHealthCare
10-18-2010
The NBER research, conducted by John Cawley of Cornell University and Chad Meyerhoefer of Lehigh University, concluded medical costs in relation to obesity are closer to $170 billion per year than $150 billion due in large part to understated self-reporting and overly cautious research gathering, reports the Associated Press. The new report tries to take both factors into account and adjusts the statistics accordingly via balanced "repeated replications to estimate standard errors," the study's authors write.
"The authors tried to better establish that excess weight was a cause for medical costs," the AP reports. "Previous studies stopped short of saying obesity caused the costs because there was too great a chance other factors could be responsible."
The researchers compiled statistics from the exact same database used to come up with the $150 billion figure, which included information on 24,000 non-elderly adults gathered from 2000 to 2005. While the earlier estimate determined that obesity added $1,400 to a person's annual medical bill, the new calculations found that number to be more than $2,800.
Cawley and Meyerhoefer point out that the motivation behind their research is not to push for more funding related to the treatment of obesity, but simply to inform. "This paper does not estimate the medical care cost of obesity in order to argue that treatment of obesity should be prioritized above treatment of other conditions, but so that the medical care consequences of obesity will be more accurately known," they write.
FierceHealthCare
10-18-2010
Most Expensive Hospital Stays Cost About $18,000 A Day
The priciest hospital stays are also among the most futile. Among the top 0.5 percent of most expensive hospital stays, the average length of stay runs about 48 days and costs more than $500,000, yet more than eight in 10 of the patients involved face a major or extreme chance of dying, regardless.
This finding comes from data in Agency for Healthcare Research and Quality's newly released report, Most Expensive Hospitalizations, 2008, which uses data from a database of hospital inpatient stays in all short-term, non-Federal hospitals. Data are drawn from hospitals that comprise 90 percent of all discharges in the U.S. and include patients, regardless of insurance type.
The top 5 percent of hospital stays averaged about $18,000 in charges per day in U.S. hospitals in 2008, according to the AHRQ. Hospitals charges for the most expensive stays tended to be for patients who were getting treated for septicemia, or blood infection, hardening of the arteries and heart attacks.
The average cost for the most expensive patient stays was based on the top 5 percent of stays by cost, or about 2 million inpatient stays. The stays lasted just under three weeks (19 days). The hospitals charged on average $191,984 for those stays.
Compared with the less expensive visits, patients on more expensive hospital stays also:
Were much sicker. They were about 10 times more likely to experience extreme loss of function (39 percent vs. 4 percent).
Faced a greater risk of dying in the hospital (9 times more likely to be in the highest category for risk of death in the hospital (28 percent vs. 3 percent).
Were older. Their average age was 59 vs. 48.
The most commonly listed procedures among the top 5 percent were blood transfusion (28 percent), respiratory intubation and mechanical ventilation (27 percent) and diagnostic cardiac catheterization/coronary arteriography (13 percent).
The most expensive hospital stays occur at a higher rate in the Northeast and West and least in the Midwest.
FierceHealthCare
10-18-2010
This finding comes from data in Agency for Healthcare Research and Quality's newly released report, Most Expensive Hospitalizations, 2008, which uses data from a database of hospital inpatient stays in all short-term, non-Federal hospitals. Data are drawn from hospitals that comprise 90 percent of all discharges in the U.S. and include patients, regardless of insurance type.
The top 5 percent of hospital stays averaged about $18,000 in charges per day in U.S. hospitals in 2008, according to the AHRQ. Hospitals charges for the most expensive stays tended to be for patients who were getting treated for septicemia, or blood infection, hardening of the arteries and heart attacks.
The average cost for the most expensive patient stays was based on the top 5 percent of stays by cost, or about 2 million inpatient stays. The stays lasted just under three weeks (19 days). The hospitals charged on average $191,984 for those stays.
Compared with the less expensive visits, patients on more expensive hospital stays also:
Were much sicker. They were about 10 times more likely to experience extreme loss of function (39 percent vs. 4 percent).
Faced a greater risk of dying in the hospital (9 times more likely to be in the highest category for risk of death in the hospital (28 percent vs. 3 percent).
Were older. Their average age was 59 vs. 48.
The most commonly listed procedures among the top 5 percent were blood transfusion (28 percent), respiratory intubation and mechanical ventilation (27 percent) and diagnostic cardiac catheterization/coronary arteriography (13 percent).
The most expensive hospital stays occur at a higher rate in the Northeast and West and least in the Midwest.
FierceHealthCare
10-18-2010
Costs Of Veterans HealthCare Could Grow By 75%
More veterans and higher care costs in the next 10 years will result in billions of dollars more being spent on veterans' health care in the next decade, states a Congressional Budget Office estimate released Oct. 7.
Veterans Health Administration care costs will increase to between $69 billion and $85 billion by 2020, up from $48 billion in 2010. The number of veterans eligible for VA care -- now at 8 million -- is expected to grow by between 700,000 and 1.3 million veterans by 2020. The wide gap in the CBO estimates is due to different assumptions about several factors: the number of troops in Iraq and Afghanistan; the speed at which per-enrollee spending will grow; and the degree to which the VA relaxes enrollment restrictions. The lower forecast assumes that combined troop levels in both wars will decrease to 30,000 in 2013 and remain there until 2020, and that per-enrollee health care spending increases by 5% annually, about the same rate as in the rest of the U.S. health system.
The VA provides care to veterans at a level determined by veterans' military service. However, the VA also adjusts the care provided based on its annual congressional appropriations. VA spending increased by more than 9% on average each year between 2004 and 2009, reaching $44 billion, in 2009.
Amednews.com
10-18-2010
Veterans Health Administration care costs will increase to between $69 billion and $85 billion by 2020, up from $48 billion in 2010. The number of veterans eligible for VA care -- now at 8 million -- is expected to grow by between 700,000 and 1.3 million veterans by 2020. The wide gap in the CBO estimates is due to different assumptions about several factors: the number of troops in Iraq and Afghanistan; the speed at which per-enrollee spending will grow; and the degree to which the VA relaxes enrollment restrictions. The lower forecast assumes that combined troop levels in both wars will decrease to 30,000 in 2013 and remain there until 2020, and that per-enrollee health care spending increases by 5% annually, about the same rate as in the rest of the U.S. health system.
The VA provides care to veterans at a level determined by veterans' military service. However, the VA also adjusts the care provided based on its annual congressional appropriations. VA spending increased by more than 9% on average each year between 2004 and 2009, reaching $44 billion, in 2009.
Amednews.com
10-18-2010
Thursday, October 14, 2010
4,000 Social Security Numbers Possibly Exposed In VA Mismailing
Breaking news: A Veterans Benefit Administration office in Boston sent 6,299 benefit summary letters to the wrong addresses in September, more than half of them containing complete social security numbers, FierceGovernmentIT reports. Of the letters, 3,936 contained all nine digits of someone else's social security number, and 2,386 contained the VBA claim number of veterans based in the state. That's according to an update on data breaches the VA sends to Congress each month. The report blames the incident on a programming error.
FierceGovernmentIT
10-14-2010
FierceGovernmentIT
10-14-2010
When it comes to health plans, big spenders don't always deliver the best care, according to the new State of Health Care Quality report from the National Committee for Quality Assurance, a private, nonprofit organization dedicated to improving healthcare quality.
Here's one striking example: Vaccination rates for kids with private plans dropped by nearly 4 percentage points, while rates continued to rise for children on Medicaid plans in 2009. It's possible that a popular misconception that ties vaccines to autism has driven some parents away from evidence-based recommendations.
The report examined quality data from over 1,000 health plans that collectively cover 118 million Americans and compared types of plan by category.
There's been a drop in patient satisfaction with health plans and physicians, according to NCQA. For example, while 64 percent of members with Medicare plans said they usually or always manage to get needed care, only 53 percent of members with commercial plans felt the same. The latter was a drop from a high of 80 percent in 2005.
Another area where commercial plans lag behind Medicare and Medicaid plans is monitoring of drugs, such as Digoxin, diuretics, anticonvulsants and ACE inhibitors, which patients use for at least six months.
Medicare (83 percent) and Medicaid plans (77 percent) also fared better than commercial plans when one compares the share of members who received persistent beta-blocker treatment for six months after discharge with a heart attack diagnosis. But the report does note that commercial health plans have seen a dramatic rise in those rates, more than 34 percent since 1996 to 74 percent in 2009. "Ultimately," the report notes, "what gets measured gets improved."
FierceHealthCare
10-14-2010
Here's one striking example: Vaccination rates for kids with private plans dropped by nearly 4 percentage points, while rates continued to rise for children on Medicaid plans in 2009. It's possible that a popular misconception that ties vaccines to autism has driven some parents away from evidence-based recommendations.
The report examined quality data from over 1,000 health plans that collectively cover 118 million Americans and compared types of plan by category.
There's been a drop in patient satisfaction with health plans and physicians, according to NCQA. For example, while 64 percent of members with Medicare plans said they usually or always manage to get needed care, only 53 percent of members with commercial plans felt the same. The latter was a drop from a high of 80 percent in 2005.
Another area where commercial plans lag behind Medicare and Medicaid plans is monitoring of drugs, such as Digoxin, diuretics, anticonvulsants and ACE inhibitors, which patients use for at least six months.
Medicare (83 percent) and Medicaid plans (77 percent) also fared better than commercial plans when one compares the share of members who received persistent beta-blocker treatment for six months after discharge with a heart attack diagnosis. But the report does note that commercial health plans have seen a dramatic rise in those rates, more than 34 percent since 1996 to 74 percent in 2009. "Ultimately," the report notes, "what gets measured gets improved."
FierceHealthCare
10-14-2010
Hospitalizations for long-term care residents have become too routine, although they could be prevented, according to a report from the Kaiser Family Foundation.
The report, To Hospitalize or Not to Hospitalize, offers insights into factors behind high hospitalization rates and suggests solutions. It is based on interviews with physicians, nurses, social workers and family members of residents of long-term care facilities.
LTC residents account for a disproportionately large share of Medicare spending. According to KFF, 1.7 million Medicare beneficiaries in long-term care for all of 2006--or who died in care before the year's end--cost the program an average of $14,538 per person, more than twice the average expenditure for all Medicare beneficiaries. Medicare covers LTC residents' ER visits, hospitalizations and other medical treatments, but not stays in nursing homes, assisted living facilities or other long-term care programs.
Strategies the report suggests to cut avoidable hospitalizations include beefing up staff with more medical support and a philosophy shift about the appropriateness of hospitalization, instead of viewing it as the path of least resistance.
Among factors that drive hospitalization of LTC residents, interview participants said there were no disincentives to sending an LTC resident to the ER when a medical issue is suspected. Not only does hospitalizing a medically compromised resident reduce liability concerns and allow for more timely diagnostic tests, it also can be more convenient for physicians.
Staff and doctors may assume that the family prefers more aggressive treatment. And a lack of qualified staff, protocols and license restrictions, have further exacerbated the tendency to default to hospitalization. Often the perception of best care is 'Let's send Mrs. M to the emergency room and see what the ER finds,'" Dr. Cheryl Phillips, chief medical officer of the Bay Area nonprofit On Lok Lifeways, told Kaiser Health News. Some of the interviewees noted that residents often return from the hospital disoriented, on different meds and with new infections.
Dr. Donald Berwick, head of the Centers for Medicare and Medicaid Services, told Kaiser Health News that better coordination was needed, saying too many people experience "disintegrated care."
"The goal is to change through redesigning the system," he said.
FierceHealthCare
10-14-2010
The report, To Hospitalize or Not to Hospitalize, offers insights into factors behind high hospitalization rates and suggests solutions. It is based on interviews with physicians, nurses, social workers and family members of residents of long-term care facilities.
LTC residents account for a disproportionately large share of Medicare spending. According to KFF, 1.7 million Medicare beneficiaries in long-term care for all of 2006--or who died in care before the year's end--cost the program an average of $14,538 per person, more than twice the average expenditure for all Medicare beneficiaries. Medicare covers LTC residents' ER visits, hospitalizations and other medical treatments, but not stays in nursing homes, assisted living facilities or other long-term care programs.
Strategies the report suggests to cut avoidable hospitalizations include beefing up staff with more medical support and a philosophy shift about the appropriateness of hospitalization, instead of viewing it as the path of least resistance.
Among factors that drive hospitalization of LTC residents, interview participants said there were no disincentives to sending an LTC resident to the ER when a medical issue is suspected. Not only does hospitalizing a medically compromised resident reduce liability concerns and allow for more timely diagnostic tests, it also can be more convenient for physicians.
Staff and doctors may assume that the family prefers more aggressive treatment. And a lack of qualified staff, protocols and license restrictions, have further exacerbated the tendency to default to hospitalization. Often the perception of best care is 'Let's send Mrs. M to the emergency room and see what the ER finds,'" Dr. Cheryl Phillips, chief medical officer of the Bay Area nonprofit On Lok Lifeways, told Kaiser Health News. Some of the interviewees noted that residents often return from the hospital disoriented, on different meds and with new infections.
Dr. Donald Berwick, head of the Centers for Medicare and Medicaid Services, told Kaiser Health News that better coordination was needed, saying too many people experience "disintegrated care."
"The goal is to change through redesigning the system," he said.
FierceHealthCare
10-14-2010
Court OKs Nurse Anesthetists To Practice Unsupervised
In the latest shift in physicians' fight to preserve their turf from encroachment by nurses, advocates of physician supervision of certified registered nurse anesthetists lost a battle on Oct. 8. That's when the San Francisco Superior Court ruled in favor of Gov. Arnold Schwarzenegger and the California Association of Nurse Anesthetists, affirming that California state law does not require nurse anesthetists be supervised by a physician.
The court's summary judgment affirmed California's opt-out of the federal supervision requirement. California initially opted out in July 2009, when the governor informed CMS of the opt-out in a letter.
The California Society of Anesthesiologists and California Medical Association lawsuit, which was filed in February 2010, called for the court to make the governor withdraw the opt-out letter and declare that under state law, a CRNA is not authorized to administer anesthesia except under the supervision of a physician. According to the CMA/CSA, the suit alleged that Schwarzenegger acted contrary to state law, which states that nurses who give patients anesthesia must be supervised by a licensed physician.
The judge didn't agree. He concluded that no state statute specifically stipulates that physicians must supervise nurse anesthetists who administer anesthesia and that federal regulations allow the governor discretion to opt out of the Medicare supervision rule and still follow state law.
The judge noted that current state law does not refer to supervision and that judicially adding a supervision requirement to the law would create ambiguity. State lawmakers may impose a supervision requirement if they wish. CSA noted that earlier court opinions came to a different conclusion.
A CMA press release echoes some of the ideas in an AMA press release last week that responded to an IOM report calling for nurses to play bigger roles in healthcare. Both press releases note that nurses are critical to the healthcare team, but don't have the same education and training as doctors, which must be code language physicians are increasingly deploying to tell nurses to stay off their turf. CSA and CMA may appeal the ruling.
California is one of 16 states that has opted out and allows CRNAs to administer anesthesia without physician supervision. Earlier this month, Colorado became the 16th opt-out state.
FierceHealthCare
10-14-2010
The court's summary judgment affirmed California's opt-out of the federal supervision requirement. California initially opted out in July 2009, when the governor informed CMS of the opt-out in a letter.
The California Society of Anesthesiologists and California Medical Association lawsuit, which was filed in February 2010, called for the court to make the governor withdraw the opt-out letter and declare that under state law, a CRNA is not authorized to administer anesthesia except under the supervision of a physician. According to the CMA/CSA, the suit alleged that Schwarzenegger acted contrary to state law, which states that nurses who give patients anesthesia must be supervised by a licensed physician.
The judge didn't agree. He concluded that no state statute specifically stipulates that physicians must supervise nurse anesthetists who administer anesthesia and that federal regulations allow the governor discretion to opt out of the Medicare supervision rule and still follow state law.
The judge noted that current state law does not refer to supervision and that judicially adding a supervision requirement to the law would create ambiguity. State lawmakers may impose a supervision requirement if they wish. CSA noted that earlier court opinions came to a different conclusion.
A CMA press release echoes some of the ideas in an AMA press release last week that responded to an IOM report calling for nurses to play bigger roles in healthcare. Both press releases note that nurses are critical to the healthcare team, but don't have the same education and training as doctors, which must be code language physicians are increasingly deploying to tell nurses to stay off their turf. CSA and CMA may appeal the ruling.
California is one of 16 states that has opted out and allows CRNAs to administer anesthesia without physician supervision. Earlier this month, Colorado became the 16th opt-out state.
FierceHealthCare
10-14-2010
Wednesday, October 13, 2010
Medicare "Meaningful Use" Payouts And How It Works
There’s been a lot of talk (including myself) about the EHR stimulus money. It seems like meaningful use has taken the cake with most of the discussion with certified EHR taking a cozy second place. What I haven’t seen very much of is some practical analysis of the EHR stimulus money and the amount of money various practices will receive. So, I’m going to try to do my part to create some of this practical EHR stimulus money content.
Basically, the schedule shows you that you can earn UP TO $18,000 in 2011 (assuming of course that you can show “meaningful use” on a “certified EHR”). What hasn’t been discussed is how many doctors will be eligible for the full $18,000 in stimulus money and how many would only be eligible for $10k or $5k in stimulus money and how much allowable Medicare charges you’ll need to have to receive the full reimbursement.
The EHR stimulus Medicare payments will be paid based on 75% of the submitted allowable charges. For example, a doctors office which has allowable Medicare charges totally $24k or more will be eligible to receive the full $18k in EHR stimulus money. A clinic with $13.3k in allowable Medicare charges would only be eligible for $10k in EHR stimulus money. You can do the math for your own clinic.
Maybe this is a non issue for most clinics. I don’t know. I’ve never seen any published average reimbursement rates for a doctor. $24k doesn’t seem like a lot of Medicare reimbursement, but certainly there are some doctors who are under that amount. Later today I’ll post a poll so we can get a better idea of the average reimbursement rates for a doctor.
John Lynn
EMR And HIPAA.Com
10-13-2010
Basically, the schedule shows you that you can earn UP TO $18,000 in 2011 (assuming of course that you can show “meaningful use” on a “certified EHR”). What hasn’t been discussed is how many doctors will be eligible for the full $18,000 in stimulus money and how many would only be eligible for $10k or $5k in stimulus money and how much allowable Medicare charges you’ll need to have to receive the full reimbursement.
The EHR stimulus Medicare payments will be paid based on 75% of the submitted allowable charges. For example, a doctors office which has allowable Medicare charges totally $24k or more will be eligible to receive the full $18k in EHR stimulus money. A clinic with $13.3k in allowable Medicare charges would only be eligible for $10k in EHR stimulus money. You can do the math for your own clinic.
Maybe this is a non issue for most clinics. I don’t know. I’ve never seen any published average reimbursement rates for a doctor. $24k doesn’t seem like a lot of Medicare reimbursement, but certainly there are some doctors who are under that amount. Later today I’ll post a poll so we can get a better idea of the average reimbursement rates for a doctor.
John Lynn
EMR And HIPAA.Com
10-13-2010
Doctors Offer Discount Services Through Social Media
In addition to Facebook and Twitter, healthcare companies are also using online discount coupon sites like Groupon to promote their services, attracting a large number of uninsured people with their bargain prices, reports the Baltimore Sun.
In fact, nearly 15 percent of Groupon deals nationwide are for healthcare services, Julie Anne Mossler, a spokeswoman for the Chicago-based company, told the Sun. The website offered discounted eye exams, teeth-cleaning, electrolysis and chiropractic services, among others.
Katzen Eye Group promoted an exam and glasses deal for $50 via a Groupon deal-of-the-day email sent to tens of thousands of Baltimore area subscribers and millions nationwide. The offer "greatly exceeded our expectation," and attracted more than 300 patients, CEO Richard Edlow told the Sun.
But healthcare providers must bear in mind that sites like Groupon can just as easily deter clients, as companies can't control how their services or brands are conveyed on social media outlets, notes the Sun. For example, customers can post about a bad experience on Twitter or Facebook for others to see.
In addition, offering discount services can pose a financial risk. Companies could lose money if an offer becomes too popular, Chad Capellman, director of social media for Genuine Interactive, told iHealthBeat.
And as with other social media tools, healthcare companies must make sure they obey privacy laws when posting information to online discount websites, he added.
FierceHealthCare
In fact, nearly 15 percent of Groupon deals nationwide are for healthcare services, Julie Anne Mossler, a spokeswoman for the Chicago-based company, told the Sun. The website offered discounted eye exams, teeth-cleaning, electrolysis and chiropractic services, among others.
Katzen Eye Group promoted an exam and glasses deal for $50 via a Groupon deal-of-the-day email sent to tens of thousands of Baltimore area subscribers and millions nationwide. The offer "greatly exceeded our expectation," and attracted more than 300 patients, CEO Richard Edlow told the Sun.
But healthcare providers must bear in mind that sites like Groupon can just as easily deter clients, as companies can't control how their services or brands are conveyed on social media outlets, notes the Sun. For example, customers can post about a bad experience on Twitter or Facebook for others to see.
In addition, offering discount services can pose a financial risk. Companies could lose money if an offer becomes too popular, Chad Capellman, director of social media for Genuine Interactive, told iHealthBeat.
And as with other social media tools, healthcare companies must make sure they obey privacy laws when posting information to online discount websites, he added.
FierceHealthCare
Hospitals Go On A "Doctor" Shopping Spree
It may sound odd in a year that has seen massive hospital layoffs, but some hospitals are on a doctor-shopping spree, according to NPR/Kaiser Health News.
WakeMed employs 138 doctors, up from 47 in 2000. And it plans to hire another 60 over the next six months. Rex Healthcare, which is part of the University of North Carolina's healthcare system, has hired 30 physicians over the past few years and plans to hire another 55, according to Steve Burris, senior vice president in charge of physician employment at Rex.
Because Raleigh, N.C., is a superheated market, Burris will have to act quickly. Just this week, it was reported that UNC Hospitals nearly doubled the pay of a heart surgeon to $600,000 to ensure they retained him.
Besides ensuring a steady flow of patient referrals, hiring doctors makes it easier to coordinate services. And having more doctors on board is one way to prepare for the new healthcare reform law to kick in, rewarding the creation of more efficient, integrated approaches to care.
Losing the loyalty of local physicians can disrupt the flow of patient referrals and affect a hospital's bottom line, Burris told NPR/Kaiser Health News. In the Raleigh area, only around 67 practices aren't affiliated with a hospital; Burris predicts most eventually will be. "If we don't accommodate the needs they have, they're going to look to someone else," he said.
According to the Medical Group Management Association, half of new doctors were hired by hospitals last year. For doctors like Dr. Alden Parsons, a thoracic surgeon who just finished 15 years of medical training, it's a lifestyle choice. She didn't want long hours and the administrative headaches of running her own practice, reports NPR/Kaiser Health News.
The article, however, fails to point out another "push" factor. Cuts in Medicare reimbursements as high as 30 percent will take effect Dec. 1. They could help explain why doctors with their own practices might consider cutting and running.
FierceHealthCare
10-13-2010
WakeMed employs 138 doctors, up from 47 in 2000. And it plans to hire another 60 over the next six months. Rex Healthcare, which is part of the University of North Carolina's healthcare system, has hired 30 physicians over the past few years and plans to hire another 55, according to Steve Burris, senior vice president in charge of physician employment at Rex.
Because Raleigh, N.C., is a superheated market, Burris will have to act quickly. Just this week, it was reported that UNC Hospitals nearly doubled the pay of a heart surgeon to $600,000 to ensure they retained him.
Besides ensuring a steady flow of patient referrals, hiring doctors makes it easier to coordinate services. And having more doctors on board is one way to prepare for the new healthcare reform law to kick in, rewarding the creation of more efficient, integrated approaches to care.
Losing the loyalty of local physicians can disrupt the flow of patient referrals and affect a hospital's bottom line, Burris told NPR/Kaiser Health News. In the Raleigh area, only around 67 practices aren't affiliated with a hospital; Burris predicts most eventually will be. "If we don't accommodate the needs they have, they're going to look to someone else," he said.
According to the Medical Group Management Association, half of new doctors were hired by hospitals last year. For doctors like Dr. Alden Parsons, a thoracic surgeon who just finished 15 years of medical training, it's a lifestyle choice. She didn't want long hours and the administrative headaches of running her own practice, reports NPR/Kaiser Health News.
The article, however, fails to point out another "push" factor. Cuts in Medicare reimbursements as high as 30 percent will take effect Dec. 1. They could help explain why doctors with their own practices might consider cutting and running.
FierceHealthCare
10-13-2010
Friday, October 8, 2010
HHS Hands Out $727M To Upgrade Community Health Centers
The Department of Health and Human Services has awarded more than $727 million in grants from the Affordable Care Act to help upgrade 143 community health centers, according to an announcement made earlier today by Secretary Kathleen Sebelius. The funds will support construction and renovation of community health centers around the country and extend access to another 745,000 underserved patients, according to an HHS press release.
The community health centers will help Americans who have lost coverage or are between jobs still get healthcare services, according to Sebelius. "There is no question that the economic downturn has made it harder for some Americans to get healthcare and important preventive services," she said.
The move also has the potential of lightening the burden placed on stressed out emergency departments that have been serving as safety nets, often offering non-emergency care to the indigent.
The largest share of health center patients are not insured (38 percent), 37 percent are on Medicaid, 15 percent have private insurance and 7 percent are on Medicare, according to the Health Resources and Services Administration.
The funds were made available under the healthcare reform law, which is expected to provide $11 billion over the next five years to community health centers. The funds will go toward operating, expanding and building community health centers, nearly doubling the number of patients who can receive care, regardless of insurance status or ability to pay.
FierceHealthCare
10-8-2010
The community health centers will help Americans who have lost coverage or are between jobs still get healthcare services, according to Sebelius. "There is no question that the economic downturn has made it harder for some Americans to get healthcare and important preventive services," she said.
The move also has the potential of lightening the burden placed on stressed out emergency departments that have been serving as safety nets, often offering non-emergency care to the indigent.
The largest share of health center patients are not insured (38 percent), 37 percent are on Medicaid, 15 percent have private insurance and 7 percent are on Medicare, according to the Health Resources and Services Administration.
The funds were made available under the healthcare reform law, which is expected to provide $11 billion over the next five years to community health centers. The funds will go toward operating, expanding and building community health centers, nearly doubling the number of patients who can receive care, regardless of insurance status or ability to pay.
FierceHealthCare
10-8-2010
Judge Rules Health Reform To Be Constitutional
In the first ruling on the multi-state lawsuit against health reform, a U.S. District Judge in Detroit sided with the Obama administration in rejecting the claim that requiring Americans to buy health insurance is unconstitutional.
"The economic burden due to the Individual Mandate is felt by plaintiffs regardless of their specific financial behavior," Judge George Steeh said in his ruling. "The [Affordable Care] Act does not make insurance more costly, [and] in fact the contrary is expected; rather the Act requires plaintiffs to purchase insurance when they otherwise would not have done so."
Furthermore, Steeh refers to the plaintiffs in the case as "participants in the healthcare services market" and "not outside the market," explaining that the healthcare market isn't one created by Congress, but rather one that is fundamentally necessary.
Robert Muise, an attorney with Thomas More Law Center in Ann Arbor, Mich., who opposes the ruling, believes that the case ultimately will go to the U.S. Supreme Court, according to the Detroit Free Press. "I think it's important that this decision be reversed to prevent Congress from overreaching the way it did in passing the original mandate," he told the newspaper.
However, Timothy Jost, a professor at the Washington and Lee University School of Law writing on the Health Affairs Blog, couldn't be happier with the decision. In his post, he called the arguments made by those who brought the lawsuit "nonsense," echoing Steeh's decision by explaining that one of the roles of insurance is to prevent the shifting of costs to others by the insured.
"They claim that if Congress can require the purchase of health insurance, it will soon be passing laws requiring people to buy cars or eat spinach," Jost wrote. "You cannot drive a car in most states without liability insurance, or get a loan to purchase a home without homeowner's insurance....But if you don't own a home or drive a car, there is no reason to require the purchase of these auto liability or homeowner's insurance. Everyone can get sick or injured, however, and thus everyone must have health insurance to avoid cost-shifting."
FierceHealthCare
10-8-2010
"The economic burden due to the Individual Mandate is felt by plaintiffs regardless of their specific financial behavior," Judge George Steeh said in his ruling. "The [Affordable Care] Act does not make insurance more costly, [and] in fact the contrary is expected; rather the Act requires plaintiffs to purchase insurance when they otherwise would not have done so."
Furthermore, Steeh refers to the plaintiffs in the case as "participants in the healthcare services market" and "not outside the market," explaining that the healthcare market isn't one created by Congress, but rather one that is fundamentally necessary.
Robert Muise, an attorney with Thomas More Law Center in Ann Arbor, Mich., who opposes the ruling, believes that the case ultimately will go to the U.S. Supreme Court, according to the Detroit Free Press. "I think it's important that this decision be reversed to prevent Congress from overreaching the way it did in passing the original mandate," he told the newspaper.
However, Timothy Jost, a professor at the Washington and Lee University School of Law writing on the Health Affairs Blog, couldn't be happier with the decision. In his post, he called the arguments made by those who brought the lawsuit "nonsense," echoing Steeh's decision by explaining that one of the roles of insurance is to prevent the shifting of costs to others by the insured.
"They claim that if Congress can require the purchase of health insurance, it will soon be passing laws requiring people to buy cars or eat spinach," Jost wrote. "You cannot drive a car in most states without liability insurance, or get a loan to purchase a home without homeowner's insurance....But if you don't own a home or drive a car, there is no reason to require the purchase of these auto liability or homeowner's insurance. Everyone can get sick or injured, however, and thus everyone must have health insurance to avoid cost-shifting."
FierceHealthCare
10-8-2010
Wednesday, October 6, 2010
Dramatic Increase In CT, MRI Scans For ER Patients
The use of CT scans or MRIs in emergency departments nearly tripled over a 10-year period without a corresponding change in the prevalence of life-threatening conditions among ER patients, according to a study published in the Journal of the American Medical Association.
Between 1998 and 2007, the share of injury-related ER patients who received MRI or CT scans rose to 15 percent up from 6 percent, based on a nationwide sample of more than 300,000 ED visits from the Center for Disease Control and Prevention's National Hospital Ambulatory Medical Care Survey.
Dr. Frederick Korley, lead author and an assistant professor of emergency medicine at Johns Hopkins University, characterized the change as "a really significant increase," Reuters reports. "It implies there is a potential amount of overuse or use that is not directly yielding any meaningful clinical results," he said.
Although researchers did not say the use of advanced imaging was unwarranted, MedPage Today reports, they did call for more investigation into why CT or MRIs are increasingly used in EDs "to optimize the risk-benefit balance of advanced radiology use."
Besides raising healthcare costs with scans that can cost several hundred to a few thousand dollars, the possibly unnecessary radiation exposure and longer ER stays (an average of two hours longer) are issues worth considering, according to the authors.
What's behind the growing use of scans?
The pressure to get patients discharged as quickly as possible might drive the decision to order an imaging test, Dr. Levon Nazarian, a professor of radiology at Thomas Jefferson University Hospital in Philadelphia, told HealthDay News. He added that fear of lawsuits due to missed diagnosis is another factor.
Another expert told HealthDay that the authors failed to address the significance of a negative scan. The ability to rule out an intracranial hemorrhage, for example, is invaluable, said Dr. Raul Uppot, director of the Abdominal Imaging Fellowship Division at Massachusetts General Hospital.
FierceHealthCare
10-6-2010
Between 1998 and 2007, the share of injury-related ER patients who received MRI or CT scans rose to 15 percent up from 6 percent, based on a nationwide sample of more than 300,000 ED visits from the Center for Disease Control and Prevention's National Hospital Ambulatory Medical Care Survey.
Dr. Frederick Korley, lead author and an assistant professor of emergency medicine at Johns Hopkins University, characterized the change as "a really significant increase," Reuters reports. "It implies there is a potential amount of overuse or use that is not directly yielding any meaningful clinical results," he said.
Although researchers did not say the use of advanced imaging was unwarranted, MedPage Today reports, they did call for more investigation into why CT or MRIs are increasingly used in EDs "to optimize the risk-benefit balance of advanced radiology use."
Besides raising healthcare costs with scans that can cost several hundred to a few thousand dollars, the possibly unnecessary radiation exposure and longer ER stays (an average of two hours longer) are issues worth considering, according to the authors.
What's behind the growing use of scans?
The pressure to get patients discharged as quickly as possible might drive the decision to order an imaging test, Dr. Levon Nazarian, a professor of radiology at Thomas Jefferson University Hospital in Philadelphia, told HealthDay News. He added that fear of lawsuits due to missed diagnosis is another factor.
Another expert told HealthDay that the authors failed to address the significance of a negative scan. The ability to rule out an intracranial hemorrhage, for example, is invaluable, said Dr. Raul Uppot, director of the Abdominal Imaging Fellowship Division at Massachusetts General Hospital.
FierceHealthCare
10-6-2010
Surgeon Shortage Jeopardizes Patient Care
Shortages of surgeons--especially in small, rural communities--threaten patient access to safe, high-quality and affordable care, concludes the American College of Surgeons. Currently, population demand for surgical care is undersupplied by about 30 percent.
"Places with greater resources and better living situations attract practitioners with relative ease; while areas with fewer amenities and struggling economies may be challenged to retain surgeons or attract new ones," noted the ACS at the 96th Annual Clinical Congress in Washington.
To help practitioners, policy makers and patients identify areas lacking adequate access to surgeons, the ACS launched the Surgical Workforce Atlas. The interactive, web-based map shows the geographic distribution of surgeons relative to populations in 2009.
"This website allows users to quickly identify the supply of surgeons in their county and compare it to all other counties in the U.S.," said Thomas C. Ricketts, PhD, MPH, managing director of the ACS Health Policy Research Institute. "[W]e hope it will help decision makers understand the needs some communities have for access to surgical care."
According to the Atlas, patients in need of surgery should steer clear of Nevada, as it retains the least number of per-capita surgeons with only 34. Of its 16 counties, seven have no surgeons at all. But patients in the District of Columbia have access to the most surgeons per 100,000 people--118.
On a county level, Montour, Pa., is the best bet for surgical services, as it has about 454 surgeons per 100,000 people, the largest density of surgeons nationwide.
ACS said it is already developing a second version of the Atlas that will include surgical subspecialties, overlay facilities and visual displays using alternative geographic units.
FierceHealthCare
10-6-2010
"Places with greater resources and better living situations attract practitioners with relative ease; while areas with fewer amenities and struggling economies may be challenged to retain surgeons or attract new ones," noted the ACS at the 96th Annual Clinical Congress in Washington.
To help practitioners, policy makers and patients identify areas lacking adequate access to surgeons, the ACS launched the Surgical Workforce Atlas. The interactive, web-based map shows the geographic distribution of surgeons relative to populations in 2009.
"This website allows users to quickly identify the supply of surgeons in their county and compare it to all other counties in the U.S.," said Thomas C. Ricketts, PhD, MPH, managing director of the ACS Health Policy Research Institute. "[W]e hope it will help decision makers understand the needs some communities have for access to surgical care."
According to the Atlas, patients in need of surgery should steer clear of Nevada, as it retains the least number of per-capita surgeons with only 34. Of its 16 counties, seven have no surgeons at all. But patients in the District of Columbia have access to the most surgeons per 100,000 people--118.
On a county level, Montour, Pa., is the best bet for surgical services, as it has about 454 surgeons per 100,000 people, the largest density of surgeons nationwide.
ACS said it is already developing a second version of the Atlas that will include surgical subspecialties, overlay facilities and visual displays using alternative geographic units.
FierceHealthCare
10-6-2010
AMA: Nurses Are Not Our Equals
The American Medical Association was swift to respond to yesterday's Institute of Medicine report that called for nurses to take on a larger, more independent role in transforming healthcare in America. By 2 p.m., it had shot out a board member's response to media outlets. It's main message: Nurses are not equal to physicians. Besides reinforcing the importance of a physician-led team approach, the statement underlined the difference in education and training between nurses and physicians.
The statement issued by Dr. Rebecca Patchin, an AMA board member, notes, "Nurses are critical to the healthcare team, but there is no substitute for education and training." She goes on to compare physicians' seven or more years of postgraduate education and more than 10,000 hours of clinical experience with nurse practitioners' two to three years of postgraduate education and less clinical experience than that of a first-year medical resident.
It's possible the physicians fear the report's proposals could lead nurses encroaching on their turf and reimbursements. The Institute of Medicine report recommends that CMS reimburse advanced practice nurses--such as nurse practitioners and anesthetists--at the same reimbursement level as physicians, and calls on the FTC to ensure state laws do not overly restrict nurses' scope of practice.
Not surprisingly, Dr. Marla Weston, CEO of the American Nurses Association, told FierceHealthcare that her group was pleased with the report's recommendations. In response to the AMA's comments, she noted that the IOM report was evidence-based and that decades of research show that advanced practice nurses can function independently as primary-care providers.
She argued against limiting their practice to whatever could be supervised by physicians. "If an advanced practice registered nurse in a rural community is willing to provide care and a physician is 200 miles away, then we've just cut off access to primary care in that community," she said. "We're not using nurses to the full extent. They are an untapped resource."
FierceHealthCare
10-6-2010
The statement issued by Dr. Rebecca Patchin, an AMA board member, notes, "Nurses are critical to the healthcare team, but there is no substitute for education and training." She goes on to compare physicians' seven or more years of postgraduate education and more than 10,000 hours of clinical experience with nurse practitioners' two to three years of postgraduate education and less clinical experience than that of a first-year medical resident.
It's possible the physicians fear the report's proposals could lead nurses encroaching on their turf and reimbursements. The Institute of Medicine report recommends that CMS reimburse advanced practice nurses--such as nurse practitioners and anesthetists--at the same reimbursement level as physicians, and calls on the FTC to ensure state laws do not overly restrict nurses' scope of practice.
Not surprisingly, Dr. Marla Weston, CEO of the American Nurses Association, told FierceHealthcare that her group was pleased with the report's recommendations. In response to the AMA's comments, she noted that the IOM report was evidence-based and that decades of research show that advanced practice nurses can function independently as primary-care providers.
She argued against limiting their practice to whatever could be supervised by physicians. "If an advanced practice registered nurse in a rural community is willing to provide care and a physician is 200 miles away, then we've just cut off access to primary care in that community," she said. "We're not using nurses to the full extent. They are an untapped resource."
FierceHealthCare
10-6-2010
Tuesday, October 5, 2010
Should Nurses Scope Of Practice Be Expanded?
The manner in which nurses work in America needs to change in order to meet the rising demand for care, according to a report released today by the Institute of Medicine.
Perhaps the most striking recommendation to come out of the report is the IOM's call for government and healthcare organizations to remove scope of practice limits that prevent nurses from practicing "to the full extent of their education and training." The rationale is that millions more patients are expected to gain access to healthcare through the healthcare reform.
The report notes that of the roughly 3 million nurses in the U.S., more than 250,000 are advanced practice registered nurses, who have master's or doctoral degrees and have passed national certification exams. Yet what they are allowed to do at work varies, depending on state regulations, which may limit their scope of practice. Already about 28 states are considering expanding the role of nurse practitioners to fill the void created by the primary-care physician shortage.
Because the healthcare system today does not offer enough incentives for nurses to pursue higher degrees and more training, the U.S. faces a shortage of nursing professors and advanced practice nurses. The report calls on public and private organization to offer resources to help nurses with associate's degrees and diplomas to go on to get their bachelor's degrees in nursing.
With the doctor shortage projected to hit 63,000 by 2015, it's not surprising that the report calls for nurses to play a bigger role in healthcare. In a potentially controversial recommendation, it suggests that nurses become "full partners" with physicians and other healthcare professionals in redesigning healthcare in America. In the past, the American Medical Association has warned that broadening nurses' authority could pose a danger to patients.
FierceHealthCare
10-5-2010
Perhaps the most striking recommendation to come out of the report is the IOM's call for government and healthcare organizations to remove scope of practice limits that prevent nurses from practicing "to the full extent of their education and training." The rationale is that millions more patients are expected to gain access to healthcare through the healthcare reform.
The report notes that of the roughly 3 million nurses in the U.S., more than 250,000 are advanced practice registered nurses, who have master's or doctoral degrees and have passed national certification exams. Yet what they are allowed to do at work varies, depending on state regulations, which may limit their scope of practice. Already about 28 states are considering expanding the role of nurse practitioners to fill the void created by the primary-care physician shortage.
Because the healthcare system today does not offer enough incentives for nurses to pursue higher degrees and more training, the U.S. faces a shortage of nursing professors and advanced practice nurses. The report calls on public and private organization to offer resources to help nurses with associate's degrees and diplomas to go on to get their bachelor's degrees in nursing.
With the doctor shortage projected to hit 63,000 by 2015, it's not surprising that the report calls for nurses to play a bigger role in healthcare. In a potentially controversial recommendation, it suggests that nurses become "full partners" with physicians and other healthcare professionals in redesigning healthcare in America. In the past, the American Medical Association has warned that broadening nurses' authority could pose a danger to patients.
FierceHealthCare
10-5-2010
Monday, October 4, 2010
What The HealthCare Reform Bill Will Mean For You
The Patient Protection and Affordable Health Care Act went into effect this past March. This important piece of legislation has the potential to impact the lives of every American, from the way they receive health care from their doctors to the types of coverages they receive from their insurers.
The main provisions of the health care reform bill strive not only to ensure that more than 90% of Americans have meaningful health insurance coverage, but also to fix some of the biggest problems facing the US health care system. These include wasteful spending on excess tests and procedures, unacceptable rates of infection and medical errors and high rates of hospital re-admittance.
Below you will find information on some of the key provisions of the law and how they may impact the way you receive medical care.
Changing the Delivery of Care
Care teams
The health care reform bill will impact the way patients interact with their physicians and other health care professionals. For example, a team of professionals, referred to as a "care team", will handle patient care. The members of the team will vary depending on the patient's circumstances, but may include nurse practioners, physician assistants, specialists, nutritionists and others in addition to the patient's primary care physician. Many believe that a team approach can help cut down on medical errors because more than one person is responsible for overseeing the patient's care.
Electronic medical records
Requiring the use of electronic medical records is another way the health care reform bill may help reduce medical errors and improve patient care. Putting patient records in an electronic format will make it more accessible to members of the patient's care team and cut down on the time it takes to transfer records from one care facility to another, or even between physicians. Electronic records also can help eliminate the problem of ineligible handwriting and missing pages from a patient's file.
Improved treatments
As part of the Affordable Health Care Act, the federal government is funding research through the Patient-Centered Outcomes Research Institute that will help physicians pinpoint the best, most efficient types of treatments for certain medical conditions. Once this research is complete and doctors begin using it in practice, it can help cut back on the number of unnecessary tests and treatments physicians may use to diagnose and treat a patient.
Focus on keeping patients healthy
The new health care law also hopes to re-orientate the practice of medicine from only helping those who are sick to keeping patients healthy. In practice, this may mean check-in calls from family practioners to remind patients to come in for physicals and have other preventative treatments, like cancer screenings. It also may mean home visits from nurses after patients with serious illnesses and injuries have been discharged from the hospital.
New Insurance Rules
For 2010, the biggest changes under the health care reform bill will affect insurance coverages. These changes include:
-Insurers cannot deny coverage to children due to pre-existing condition
-No more lifetime caps on insurance coverage
-Coverage under employer-sponsored group policies will cover dependent children up to age 26
-Insurers will have to provide coverage for certain preventative measures, including screenings for high blood pressure, osteoporosis, diabetes and sexually transmitted diseases; colonoscopies and smoking cessation counseling
-Those with serious health conditions who have been unable to obtain private insurance can purchase a policy subsidized by the federal government at rates similar to those for healthy adults
More Changes to Come in 2014
Many of the measures under the health care reform bill are not set to go into effect until 2014. Some of these measures include:
- Pre-existing conditions: health insurers will no longer be able to deny coverage due to pre-existing conditions
- Penalties: those who have not purchased a health insurance policy will be assessed a penalty of $95 or up to 1% of their income for individuals, whichever is greater. The fine increases to $695 or 2.5% of an individual's income in 2016.
- Insurance exchange: insurance premiums subsidized by the federal government under the state-based insurance exchange will become available for those who fall within income guidelines. Currently, those with incomes above 133% of the federal poverty level and below 400% of the federal poverty level will be eligible on a sliding scale for the subsidies.
- Maternity care: insurance companies will be required to provide coverage for maternity care
- Nursing mothers: employers will be required to provide nursing mothers unpaid reasonable break times for pumping breast milk as well as a private place other than a bathroom to do it in
- Continuing coverage: those who quit or lose their jobs will not lose their health coverage. They will have the option to purchase coverage subsidized by the federal government through the insurance exchange. Those whose only source of income is unemployment benefits may be eligible for Medicaid.
- Expansion of Medicaid: the Medicaid program will be made available to any adult under 65 years of age who falls within the income guidelines, currently set at 133% of the federal poverty limit, or less than $29,327 for a family of four.
Conclusion
Once all of the provisions of the Patient Protection and Affordable Health Care Act go into effect, it will have a profound impact on the US health care system. Whether or not it will be able to tackle all of the problems facing the nation's health care system has yet to be seen. However, these reforms could go a long way towards improving patient care, including decreasing the number of medical errors currently plaguing our system.
24/7 PressRelease
10-4-2010
The main provisions of the health care reform bill strive not only to ensure that more than 90% of Americans have meaningful health insurance coverage, but also to fix some of the biggest problems facing the US health care system. These include wasteful spending on excess tests and procedures, unacceptable rates of infection and medical errors and high rates of hospital re-admittance.
Below you will find information on some of the key provisions of the law and how they may impact the way you receive medical care.
Changing the Delivery of Care
Care teams
The health care reform bill will impact the way patients interact with their physicians and other health care professionals. For example, a team of professionals, referred to as a "care team", will handle patient care. The members of the team will vary depending on the patient's circumstances, but may include nurse practioners, physician assistants, specialists, nutritionists and others in addition to the patient's primary care physician. Many believe that a team approach can help cut down on medical errors because more than one person is responsible for overseeing the patient's care.
Electronic medical records
Requiring the use of electronic medical records is another way the health care reform bill may help reduce medical errors and improve patient care. Putting patient records in an electronic format will make it more accessible to members of the patient's care team and cut down on the time it takes to transfer records from one care facility to another, or even between physicians. Electronic records also can help eliminate the problem of ineligible handwriting and missing pages from a patient's file.
Improved treatments
As part of the Affordable Health Care Act, the federal government is funding research through the Patient-Centered Outcomes Research Institute that will help physicians pinpoint the best, most efficient types of treatments for certain medical conditions. Once this research is complete and doctors begin using it in practice, it can help cut back on the number of unnecessary tests and treatments physicians may use to diagnose and treat a patient.
Focus on keeping patients healthy
The new health care law also hopes to re-orientate the practice of medicine from only helping those who are sick to keeping patients healthy. In practice, this may mean check-in calls from family practioners to remind patients to come in for physicals and have other preventative treatments, like cancer screenings. It also may mean home visits from nurses after patients with serious illnesses and injuries have been discharged from the hospital.
New Insurance Rules
For 2010, the biggest changes under the health care reform bill will affect insurance coverages. These changes include:
-Insurers cannot deny coverage to children due to pre-existing condition
-No more lifetime caps on insurance coverage
-Coverage under employer-sponsored group policies will cover dependent children up to age 26
-Insurers will have to provide coverage for certain preventative measures, including screenings for high blood pressure, osteoporosis, diabetes and sexually transmitted diseases; colonoscopies and smoking cessation counseling
-Those with serious health conditions who have been unable to obtain private insurance can purchase a policy subsidized by the federal government at rates similar to those for healthy adults
More Changes to Come in 2014
Many of the measures under the health care reform bill are not set to go into effect until 2014. Some of these measures include:
- Pre-existing conditions: health insurers will no longer be able to deny coverage due to pre-existing conditions
- Penalties: those who have not purchased a health insurance policy will be assessed a penalty of $95 or up to 1% of their income for individuals, whichever is greater. The fine increases to $695 or 2.5% of an individual's income in 2016.
- Insurance exchange: insurance premiums subsidized by the federal government under the state-based insurance exchange will become available for those who fall within income guidelines. Currently, those with incomes above 133% of the federal poverty level and below 400% of the federal poverty level will be eligible on a sliding scale for the subsidies.
- Maternity care: insurance companies will be required to provide coverage for maternity care
- Nursing mothers: employers will be required to provide nursing mothers unpaid reasonable break times for pumping breast milk as well as a private place other than a bathroom to do it in
- Continuing coverage: those who quit or lose their jobs will not lose their health coverage. They will have the option to purchase coverage subsidized by the federal government through the insurance exchange. Those whose only source of income is unemployment benefits may be eligible for Medicaid.
- Expansion of Medicaid: the Medicaid program will be made available to any adult under 65 years of age who falls within the income guidelines, currently set at 133% of the federal poverty limit, or less than $29,327 for a family of four.
Conclusion
Once all of the provisions of the Patient Protection and Affordable Health Care Act go into effect, it will have a profound impact on the US health care system. Whether or not it will be able to tackle all of the problems facing the nation's health care system has yet to be seen. However, these reforms could go a long way towards improving patient care, including decreasing the number of medical errors currently plaguing our system.
24/7 PressRelease
10-4-2010
Friday, October 1, 2010
Brief Consultations Cut Chronic Pain Patient Visits to ED
A simple 15- to 30-minute behavioral health consultation can cut chronic pain patients' visits to emergency rooms, according to a study in the September issue of the Journal of Emergency Nursing. The reduction in visits is especially pronounced for frequent pain patients who pre-intervention visited a hospital ED more than four times in six months.
Although hospital emergency rooms are not the best place to get help for less pressing health issues, patients with chronic pain continue to turn to them, regardless. Researchers hypothesize that a behavioral health intervention would better serve chronic pain patients and help hospitals provide cost-effective treatment at the appropriate level of care. They conducted their study in a small acute-care hospital with a 15-bed emergency department that sees 16,500 patients a year.
The intervention involved 15- to 30-minutes of counseling during which someone taught the patient pain management strategies and reinforced the need for a primary-care physician to manage pain medication, HealthDay News reports. Six months after the consultations were added, a low-use group used the ED an average of 1.4 times compared with 1.8 times in the six months before the intervention. The high-use group, saw its mean utilization drop to 4.0 ED visits from 6.8 visits in six months.
"This study suggests that an emergency department-based behavioral health consultation may be useful for reducing high utilization of emergency department services by some chronic pain patients, particularly those who consume the most services," the authors conclude.
FierceHealthCare
10-1-2010
Although hospital emergency rooms are not the best place to get help for less pressing health issues, patients with chronic pain continue to turn to them, regardless. Researchers hypothesize that a behavioral health intervention would better serve chronic pain patients and help hospitals provide cost-effective treatment at the appropriate level of care. They conducted their study in a small acute-care hospital with a 15-bed emergency department that sees 16,500 patients a year.
The intervention involved 15- to 30-minutes of counseling during which someone taught the patient pain management strategies and reinforced the need for a primary-care physician to manage pain medication, HealthDay News reports. Six months after the consultations were added, a low-use group used the ED an average of 1.4 times compared with 1.8 times in the six months before the intervention. The high-use group, saw its mean utilization drop to 4.0 ED visits from 6.8 visits in six months.
"This study suggests that an emergency department-based behavioral health consultation may be useful for reducing high utilization of emergency department services by some chronic pain patients, particularly those who consume the most services," the authors conclude.
FierceHealthCare
10-1-2010
Doctor Shortage Expected To Hit 63,000 By 2015
By 2015, one year after health reforms will take effect in the U.S., there will be a physician shortage of roughly 63,000 doctors, according to new estimates from the Association of American Medical Colleges. Earlier figures had pegged the doctor shortage at slightly less than 40,000.
The AAMC calls for an end to a freeze on Medicare support for residency training to stem the potential problem. A fact sheet accompanying the estimates notes that since 1997, Medicare support for doctors in training has not grown, despite an increase in the number of actual residents.
"Because of the concern with likely shortages, the number of medical schools is increasing, and there will be an additional 7,000 graduates every year over the next decade," the AAMC argues. "Medicare must continue paying for its share of training costs by supporting at least a 15 percent increase in GME positions, allowing teaching hospitals to prepare for another 4,000 physicians a year to meet the needs of 2020 and beyond."
While the U.S. can expect a 36 percent increase in the number of Americans over age 65 within the next 10 years, the number of doctors to treat those American will grow by only 7 percent, AAMC notes.
"In addition to the 15 million patients who will become eligible for Medicare, 32 million younger Americans will become newly insured as a result of healthcare reform," the AAMC adds, "and thereby intensify the demand for physicians even further."
FierceHealthCare
10-1-2010
The AAMC calls for an end to a freeze on Medicare support for residency training to stem the potential problem. A fact sheet accompanying the estimates notes that since 1997, Medicare support for doctors in training has not grown, despite an increase in the number of actual residents.
"Because of the concern with likely shortages, the number of medical schools is increasing, and there will be an additional 7,000 graduates every year over the next decade," the AAMC argues. "Medicare must continue paying for its share of training costs by supporting at least a 15 percent increase in GME positions, allowing teaching hospitals to prepare for another 4,000 physicians a year to meet the needs of 2020 and beyond."
While the U.S. can expect a 36 percent increase in the number of Americans over age 65 within the next 10 years, the number of doctors to treat those American will grow by only 7 percent, AAMC notes.
"In addition to the 15 million patients who will become eligible for Medicare, 32 million younger Americans will become newly insured as a result of healthcare reform," the AAMC adds, "and thereby intensify the demand for physicians even further."
FierceHealthCare
10-1-2010
Thursday, September 30, 2010
CMS: First Payments For Meaningful Use Will Go Out In May
The first round of incentive payments for "meaningful use" of EMRs will go out in May 2011, a top CMS official says.
Speaking at last week's meeting of the Health IT Standards Committee, Karen Trudel, deputy director of the CMS Office of E-Health Standards and Services, said that the first group of hospitals and physicians to achieve meaningful use will start seeing Medicare bonuses in mid-May. Providers must demonstrate meaningful use for a minimum of 90 consecutive days to receive a full year's credit for 2011, meaning "that no one will be able to attest [to compliance] before April," Trudel said, Government Health IT reports.
It appears that hospitals will not be able to qualify earlier, even though the hospital side of the incentive program begins Oct. 1 since Medicare Part A--inpatient care--follows the federal fiscal year, while the ambulatory Part B is tied to the calendar year. Trudel said CMS will open registration for stimulus money in January.
CMS is hard at work setting up the systems and processes to handle registration, attestation and payments for meaningful use. "We're now engineering back into the system all the changes that occurred in the final rule," Trudel told the federal advisory committee.
Eligible providers will have to have a national provider identifier and be registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS) in order to participate. Most hospitals and physicians providers also will need to have an active user account in the National Plan and Provider Enumeration System (NPPES), according to Government Health IT.
Many state Medicaid programs will be on a slightly different payment schedule than CMS. Trudel said CMS will send policy guidance to state Medicaid directors this fall.
FierceEMR
9-30-2010
Speaking at last week's meeting of the Health IT Standards Committee, Karen Trudel, deputy director of the CMS Office of E-Health Standards and Services, said that the first group of hospitals and physicians to achieve meaningful use will start seeing Medicare bonuses in mid-May. Providers must demonstrate meaningful use for a minimum of 90 consecutive days to receive a full year's credit for 2011, meaning "that no one will be able to attest [to compliance] before April," Trudel said, Government Health IT reports.
It appears that hospitals will not be able to qualify earlier, even though the hospital side of the incentive program begins Oct. 1 since Medicare Part A--inpatient care--follows the federal fiscal year, while the ambulatory Part B is tied to the calendar year. Trudel said CMS will open registration for stimulus money in January.
CMS is hard at work setting up the systems and processes to handle registration, attestation and payments for meaningful use. "We're now engineering back into the system all the changes that occurred in the final rule," Trudel told the federal advisory committee.
Eligible providers will have to have a national provider identifier and be registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS) in order to participate. Most hospitals and physicians providers also will need to have an active user account in the National Plan and Provider Enumeration System (NPPES), according to Government Health IT.
Many state Medicaid programs will be on a slightly different payment schedule than CMS. Trudel said CMS will send policy guidance to state Medicaid directors this fall.
FierceEMR
9-30-2010
Practices Will Lose Value If They Don't Adopt EHR'S, Says HIT Coordinator
Kudos to InformationWeek's Marianne Kolbasuk McGee for scoring a comprehensive interview with Dr. David Blumenthal, who's been hard to pin down since he took the job as national health IT coordinator in April 2009. While Blumenthal is legally prohibited from discussing what's going to be in the final rules for meaningful use until HHS actually issues the standards, he is happy to discuss physician adoption of EHRs, the penalties for non-compliance with meaningful use and the legislation that created the health IT subsidy program.
While Medicare and Medicaid penalties for not using EHRs don't kick in until 2015, Blumenthal says it's important for providers to get on board with meaningful use sooner rather than later. "In future stages of meaningful use, our goal is to make sure that information follows patients. Organizations that participate in the care of patients must support the gathering of information in ways that meet the full needs of patients regardless of where they get their care," he tells McGee.
Blumenthal believes physicians will see the value of their practices plummet if they don't adopt EHRs. Older doctors may have trouble selling their practices and will struggle to recruit younger doctors. "This new generation of physicians isn't going to tolerate a paper world," Blumenthal says.
And preparing for retirement should no longer be an excuse to resist technology, according to Blumenthal. "If you're a 50- to 60-year-old physician, you're in the prime of your professional career and your patient panel is expanding. You probably want to bring on a new partner-maybe two or three-so you'll be recruiting. There's a physician shortage, so what's going to make your practice competitive?"
He also says that paper charts "are just not adequate" for reporting to Accountable Care Organizations unless practices continue to rely on claims data and incomplete documentation.
FierceEMR
9-30-2010
While Medicare and Medicaid penalties for not using EHRs don't kick in until 2015, Blumenthal says it's important for providers to get on board with meaningful use sooner rather than later. "In future stages of meaningful use, our goal is to make sure that information follows patients. Organizations that participate in the care of patients must support the gathering of information in ways that meet the full needs of patients regardless of where they get their care," he tells McGee.
Blumenthal believes physicians will see the value of their practices plummet if they don't adopt EHRs. Older doctors may have trouble selling their practices and will struggle to recruit younger doctors. "This new generation of physicians isn't going to tolerate a paper world," Blumenthal says.
And preparing for retirement should no longer be an excuse to resist technology, according to Blumenthal. "If you're a 50- to 60-year-old physician, you're in the prime of your professional career and your patient panel is expanding. You probably want to bring on a new partner-maybe two or three-so you'll be recruiting. There's a physician shortage, so what's going to make your practice competitive?"
He also says that paper charts "are just not adequate" for reporting to Accountable Care Organizations unless practices continue to rely on claims data and incomplete documentation.
FierceEMR
9-30-2010
Blumenthal Calls Meaningful Use A "One Time Offer"
If you aren't going to achieve meaningful use this time around, don't expect the federal government to give you another shot at Medicare and Medicaid subsidies for EHRs.
"[The] federal government is making a one-time offer. We'll put money on the table to help you now but we're not going to put money on the table later," national health IT coordinator Dr. David Blumenthal says in an interview with CMIO, shortly after last week's release of the final rules for Stage 1 of the bonus program.
While HHS only specified the requirements for Stage 1, Blumenthal offers some hints about what to expect in Stage 2, which begins in 2013. For example, some of the measures that are optional in 2011 and 2012 will become "core objectives" later. "We also, I suspect, will be looking at more demanding forms of health information exchange and probably more decision support, more robust use of physician order entry and also administrative simplification," Blumenthal says. "All those things are possible targets for 2013 and beyond."
He believes the federal incentive program will drive improvement in EHRs themselves, thanks to increased demand for better systems. "As physicians and other health professionals adopt EHRs, they are going to become increasingly demanding of vendors for better functionality, better usability and more comprehensive capabilities, and I think they will move the market using their professional understanding of what their patients need," Blumenthal explains. "I also think they will demand of the hospitals that the systems they use work for them and work for their patients."
FierceEMR
9-30-2010
"[The] federal government is making a one-time offer. We'll put money on the table to help you now but we're not going to put money on the table later," national health IT coordinator Dr. David Blumenthal says in an interview with CMIO, shortly after last week's release of the final rules for Stage 1 of the bonus program.
While HHS only specified the requirements for Stage 1, Blumenthal offers some hints about what to expect in Stage 2, which begins in 2013. For example, some of the measures that are optional in 2011 and 2012 will become "core objectives" later. "We also, I suspect, will be looking at more demanding forms of health information exchange and probably more decision support, more robust use of physician order entry and also administrative simplification," Blumenthal says. "All those things are possible targets for 2013 and beyond."
He believes the federal incentive program will drive improvement in EHRs themselves, thanks to increased demand for better systems. "As physicians and other health professionals adopt EHRs, they are going to become increasingly demanding of vendors for better functionality, better usability and more comprehensive capabilities, and I think they will move the market using their professional understanding of what their patients need," Blumenthal explains. "I also think they will demand of the hospitals that the systems they use work for them and work for their patients."
FierceEMR
9-30-2010
Blumenthal: Meaningful Use Is Not Asking Too Much, Too Soon
In a post on the ONC's Health IT Buzz blog, national health IT coordinator Dr. David Blumenthal seems to reject the argument from many camps that the proposed standards for meaningful use are too difficult to attain, instead siding with those who believe that EMRs are a centerpiece of true health reform. "The question healthcare providers are facing today is whether we are pushing too hard, too fast to make this important change. I respectfully submit, no. In turn, I ask, 'Can we make these changes expeditiously enough?'" Blumenthal writes.
"This is the time to realize the promise of health IT. Information technology has improved every aspect of our lives, we need to channel information technology to improve our health and care. Providing patients with improved quality and safety, more efficient care and better outcomes is paramount," Blumenthal says.
Blumenthal recalls his days of practicing internal medicine at Massachusetts General Hospital in Boston, noting that he resisted switching to an EMR himself. "Over time, however, I found that working with health IT made me a better and safer physician. Most importantly, my patients received better, safer care and improved outcomes," he says. It's time, according to Blumenthal, for all Americans to get better care delivered at a lower cost.
FierceEMR
9-30-2010
"This is the time to realize the promise of health IT. Information technology has improved every aspect of our lives, we need to channel information technology to improve our health and care. Providing patients with improved quality and safety, more efficient care and better outcomes is paramount," Blumenthal says.
Blumenthal recalls his days of practicing internal medicine at Massachusetts General Hospital in Boston, noting that he resisted switching to an EMR himself. "Over time, however, I found that working with health IT made me a better and safer physician. Most importantly, my patients received better, safer care and improved outcomes," he says. It's time, according to Blumenthal, for all Americans to get better care delivered at a lower cost.
FierceEMR
9-30-2010
Texas Hospital Patient Data For Sale
If you've been a patient in a Texas hospital over the past 10 years, chances are high that the details of your stay have wandered the U.S. and popped up in all kinds of places. The Texas Department of State Health Services (DSHS) has sold or given away hospital patient data on more than 27 million hospital stays since 1999, according to a report by the Austin Bulldog, an investigative journalism nonprofit organization.
Attorney Jim Harrington, director of the Texas Civil Rights Project, told the Bulldog, that DSHS data sales represent a "wholesale invasion of families' medical privacy" and a "shocking breach of people's constitutional rights."?DSHS makes public use data files available through its website. The data files contain more than 200 kinds of information, naming your insurance coverage, whether the stay involved placement of a heart stent, sterilization, abortion performed due to rape, and any tests or medications you may have received.
Buyers can obtain two versions of the hospital patient files, one version containing complete personal info--which includes date of birth, date of admissions and discharge, and the patient's full address--and a second, "de-identified" version with some, but not all, personal information removed by DSHS. Data security experts claim that it's easy to re-identify people in de-identified data files by comparing them with other files, the Bulldog reports.
The data files DSHS distributes often go to non-physicians who use, sell, and re-sell hospital patient data, putting personal privacy at risk. The insurance lobby group America's Health Insurance Plans, in 2009, was one of many entities approved to buy the unrestricted research version patient data files. Since January 1, 2009, 98 customers bought patient data from Texas. Several are listed in the Bulldog article.
When asked to comment on the data downloads, Deborah Peel, an Austin psychiatrist and privacy advocate told the Bulldog, "The problem is, once [hospital patient data] gets out, there's no way to know where it went forever." She heads up Patient Privacy Rights, which is a foundation that's part of a network of organizations working to restore patients' right to control access to their sensitive health records. "There is no control over any third-party use," Peel noted.
FierceHealthCare
9-30-2010
Attorney Jim Harrington, director of the Texas Civil Rights Project, told the Bulldog, that DSHS data sales represent a "wholesale invasion of families' medical privacy" and a "shocking breach of people's constitutional rights."?DSHS makes public use data files available through its website. The data files contain more than 200 kinds of information, naming your insurance coverage, whether the stay involved placement of a heart stent, sterilization, abortion performed due to rape, and any tests or medications you may have received.
Buyers can obtain two versions of the hospital patient files, one version containing complete personal info--which includes date of birth, date of admissions and discharge, and the patient's full address--and a second, "de-identified" version with some, but not all, personal information removed by DSHS. Data security experts claim that it's easy to re-identify people in de-identified data files by comparing them with other files, the Bulldog reports.
The data files DSHS distributes often go to non-physicians who use, sell, and re-sell hospital patient data, putting personal privacy at risk. The insurance lobby group America's Health Insurance Plans, in 2009, was one of many entities approved to buy the unrestricted research version patient data files. Since January 1, 2009, 98 customers bought patient data from Texas. Several are listed in the Bulldog article.
When asked to comment on the data downloads, Deborah Peel, an Austin psychiatrist and privacy advocate told the Bulldog, "The problem is, once [hospital patient data] gets out, there's no way to know where it went forever." She heads up Patient Privacy Rights, which is a foundation that's part of a network of organizations working to restore patients' right to control access to their sensitive health records. "There is no control over any third-party use," Peel noted.
FierceHealthCare
9-30-2010
Wednesday, September 29, 2010
States Clash Over AMA's Role In HealthCare Reform
The Maine Medical Association denounced Florida doctors' criticisms that the American Medical Association supported healthcare reform without representing physicians' interests. Doctors in Maine are calling for members to support AMA leaders, reports Health News Florida.
Florida's vote of "no confidence" of the AMA jeopardizes the organization's ability to "effectively advocate for physicians and the patients they serve," said the Maine chapter in a letter to the national group, reports The Hill's Healthwatch blog.
"At a time when it is critically important for physicians, as a profession, to stand together, this action threatens the very principles that our AMA was founded upon," wrote Dr. Jo Linder, president of the MMA. "Now is not the time to squander our influence in petty bickering," she said.
The FMA took offense to Maine chapter's letter. The MMA should "respect the right of other state medical associations" to express their opinions, said FMA spokeswoman Erin Van Sickle in response, reports Health News Florida.
"The FMA is simply saying what the vast majority of physicians already think and what many members of Congress have already stated publicly," she added. The FMA hopes AMA leaders will conduct an internal examination to improve the organization, she said.
FierceHealthCare
9-29-2010
Florida's vote of "no confidence" of the AMA jeopardizes the organization's ability to "effectively advocate for physicians and the patients they serve," said the Maine chapter in a letter to the national group, reports The Hill's Healthwatch blog.
"At a time when it is critically important for physicians, as a profession, to stand together, this action threatens the very principles that our AMA was founded upon," wrote Dr. Jo Linder, president of the MMA. "Now is not the time to squander our influence in petty bickering," she said.
The FMA took offense to Maine chapter's letter. The MMA should "respect the right of other state medical associations" to express their opinions, said FMA spokeswoman Erin Van Sickle in response, reports Health News Florida.
"The FMA is simply saying what the vast majority of physicians already think and what many members of Congress have already stated publicly," she added. The FMA hopes AMA leaders will conduct an internal examination to improve the organization, she said.
FierceHealthCare
9-29-2010
Tuesday, September 28, 2010
Primary Care To Get A $320 Million Booster Shot From HHS
In an attempt to bring some relief to the seemingly endless primary-care shortage situation, Department of Health and Human Services Secretary Kathleen Sebelius announced this week that $320 million in grants will go toward "strengthening the healthcare workforce." Most of the money--$253 million--will be divided up among six programs specifically designed to beef up the workforce and aiding in disease prevention, while the remaining $67 million will help educate and train low-income individuals.
The news comes a little more than a week after an announcement from Sebelius that HHS will spend more than $130 million on similar projects that include enhanced equipment training for health professionals and loan repayment.
"Investing in our primary-care workforce will strengthen the role that wellness and prevention play in our healthcare system," she said, according to a press release. "With these grants, Americans from all backgrounds will have new opportunities to enter the healthcare workforce."
Known as Prevention and Public Health Fund Workforce Grants, $253 million will be divided as follows:
$167.3 million for Primary Care Residency Expansion
$30.1 million toward the Expansion of Physician Assistant Training (EPAT)
$31 million toward Advanced Nursing Education Expansion (ANEE)
$14.8 million for Nurse Managed Health Clinics (NMHC)
$5.6 million for State Health Workforce Development
$4.2 million for Personal and Home Care Aide State Training (PHCAST)
The $67 million set aside in Health Profession Opportunity Grants will help to train low-income individuals to become home care aides, certified nursing assistants, emergency medical technicians and registered nurses, among others.
"[Temporary Assistance for Needy Families] recipients and other low-income individuals want to succeed in the workplace, but sometimes lack the skills to do so," Earl Johnson, director for the Office of Family Assistance, said. "The Health Profession Opportunity Grants will offer quality training and an opportunity to enter a dynamic job sector with real opportunities for career development."
"FierceHealthCare"
9-28-2010
The news comes a little more than a week after an announcement from Sebelius that HHS will spend more than $130 million on similar projects that include enhanced equipment training for health professionals and loan repayment.
"Investing in our primary-care workforce will strengthen the role that wellness and prevention play in our healthcare system," she said, according to a press release. "With these grants, Americans from all backgrounds will have new opportunities to enter the healthcare workforce."
Known as Prevention and Public Health Fund Workforce Grants, $253 million will be divided as follows:
$167.3 million for Primary Care Residency Expansion
$30.1 million toward the Expansion of Physician Assistant Training (EPAT)
$31 million toward Advanced Nursing Education Expansion (ANEE)
$14.8 million for Nurse Managed Health Clinics (NMHC)
$5.6 million for State Health Workforce Development
$4.2 million for Personal and Home Care Aide State Training (PHCAST)
The $67 million set aside in Health Profession Opportunity Grants will help to train low-income individuals to become home care aides, certified nursing assistants, emergency medical technicians and registered nurses, among others.
"[Temporary Assistance for Needy Families] recipients and other low-income individuals want to succeed in the workplace, but sometimes lack the skills to do so," Earl Johnson, director for the Office of Family Assistance, said. "The Health Profession Opportunity Grants will offer quality training and an opportunity to enter a dynamic job sector with real opportunities for career development."
"FierceHealthCare"
9-28-2010
Monday, September 13, 2010
Technology Buzzword, EHR
EHR – an electronic health record is the digital version of your overstuffed filing cabinets. EHRs are much more efficient because they can coordinate medical records from various sources. They allow you to streamline the data retrieval system by replacing the arduous collection of data from various sources to a single point-and-click process. Electronic medical records allow the doctor to access information as varied as patient demographics, medical history, exam reports, x-ray images, and billing records in one place.
The majority of new EHR programs are HIPAA compliant.
That is, these programs comply with the Health Insurance Portability and Accountability Act provision that “requires the establishment of national standard for electronic healthcare transactions and national identifiers for providers, health insurance plans, and employers.”
EHRs are sometimes referred to as electronic medical records (EMRs) and these phrases are often used interchangeably.
ChiroEco 9-13-10
The majority of new EHR programs are HIPAA compliant.
That is, these programs comply with the Health Insurance Portability and Accountability Act provision that “requires the establishment of national standard for electronic healthcare transactions and national identifiers for providers, health insurance plans, and employers.”
EHRs are sometimes referred to as electronic medical records (EMRs) and these phrases are often used interchangeably.
ChiroEco 9-13-10
Wednesday, September 1, 2010
EMR Meaningful Use Checklist
Everyone should keep in mind that there are no systems “Certified” at this point.
Here are some things to check as you get ready to claim your incentives for EHR Meaningful Use under the HITECH Act. This information is based on (EPs) qualifying for the Medicare incentives.
1) Start talking to your vendor about their plans to submit their EHR software for certification as “Certified EHR Technology”. The system does not have to be certified as of January 1, but it does need to be certified by the end of the 90-day period you are using to attest to your EHR Meaningful Use.
2) Keep in mind that if you are using a stand-alone EMR product with an existing legacy practice management (PM) system, the system needs to be Certified EHR Technology also. This is because some of the functions of a certified system, such as recording patient demographics electronically, are most likely functions of your PM system, not the EMR product. So talk to that vendor, too.
3) Verify that any eligible provider attesting to meeting EHR Meaningful Use objectives provides 10% or more of his/her Medicare services in an outpatient setting (not inpatient or in a hospital ED). CMS will look at the percent of services rendered in an outpatient setting for the fiscal year ending 09/30/2010 to determine the IP/OP percentages. Your EHR healthcare consultant must be qualified to do the analytical and reporting work in preparing the self-attestation report, based on the current fiscal year and the individual EHR Meaningful Use objectives in place, starting January 2011.
4) Make sure all eligible providers you are planning to certify for EHR Meaningful Use have an NPI number and are enrolled in PECOS.
5) For EPs in group practices, confirm the tax Id number – group or personal – of each provider for payment of the incentive amount. Payments can be made to either number.
6) CMS will be establishing an Internet-based enrollment process for EPs planning to apply for incentive payments. Keep checking this site for the Registration process, and enroll when it is available.
7) As soon as you start the clock on your 90-day period, make sure you are meeting all the EHR Meaningful Use objectives applicable to your practice, and, for objectives with numerical thresholds, that you are attaining the levels specified. If your EHR system is Certified EHR Technology, it should be capable of supporting all Stage 1 Meaningful Use objectives.
8) Monitor the CMS website on EHR Incentive Programs to determine the format of the attestation for 2011. And keep in mind that accuracy is paramount; attesting to EHR Meaningful Use is making a claim to a Federal program. And the penalties for false claims are significant!
Attestations can be completed as early as April, 2011, and CMS has stated payments will be made in May. For EPs seeking incentive payments under the Medicaid / Medical program, visit the CMS website for further information.
John Lynn EMR and HIPAA
August 9, 2010
Here are some things to check as you get ready to claim your incentives for EHR Meaningful Use under the HITECH Act. This information is based on (EPs) qualifying for the Medicare incentives.
1) Start talking to your vendor about their plans to submit their EHR software for certification as “Certified EHR Technology”. The system does not have to be certified as of January 1, but it does need to be certified by the end of the 90-day period you are using to attest to your EHR Meaningful Use.
2) Keep in mind that if you are using a stand-alone EMR product with an existing legacy practice management (PM) system, the system needs to be Certified EHR Technology also. This is because some of the functions of a certified system, such as recording patient demographics electronically, are most likely functions of your PM system, not the EMR product. So talk to that vendor, too.
3) Verify that any eligible provider attesting to meeting EHR Meaningful Use objectives provides 10% or more of his/her Medicare services in an outpatient setting (not inpatient or in a hospital ED). CMS will look at the percent of services rendered in an outpatient setting for the fiscal year ending 09/30/2010 to determine the IP/OP percentages. Your EHR healthcare consultant must be qualified to do the analytical and reporting work in preparing the self-attestation report, based on the current fiscal year and the individual EHR Meaningful Use objectives in place, starting January 2011.
4) Make sure all eligible providers you are planning to certify for EHR Meaningful Use have an NPI number and are enrolled in PECOS.
5) For EPs in group practices, confirm the tax Id number – group or personal – of each provider for payment of the incentive amount. Payments can be made to either number.
6) CMS will be establishing an Internet-based enrollment process for EPs planning to apply for incentive payments. Keep checking this site for the Registration process, and enroll when it is available.
7) As soon as you start the clock on your 90-day period, make sure you are meeting all the EHR Meaningful Use objectives applicable to your practice, and, for objectives with numerical thresholds, that you are attaining the levels specified. If your EHR system is Certified EHR Technology, it should be capable of supporting all Stage 1 Meaningful Use objectives.
8) Monitor the CMS website on EHR Incentive Programs to determine the format of the attestation for 2011. And keep in mind that accuracy is paramount; attesting to EHR Meaningful Use is making a claim to a Federal program. And the penalties for false claims are significant!
Attestations can be completed as early as April, 2011, and CMS has stated payments will be made in May. For EPs seeking incentive payments under the Medicaid / Medical program, visit the CMS website for further information.
John Lynn EMR and HIPAA
August 9, 2010
Thursday, July 29, 2010
Do You Have to Use a CCHIT Certified EHR Vendor
EMR Stimulus Q&A: Do You Have to Use a CCHIT Certified EHR Vendor?
Is it necessary to get CCHIT certified vendor just because you want to qualify for incentives or regardless you MUST go for a certified solution?
Because I make the case that one should go with the one that provides the most amount of value.
You only need to use a certified EHR (doesn’t have to be CCHIT certified either, but HHS Certified) if you want to get the EMR stimulus money. The only caveat is that if you don’t show “meaningful use” of a “certified EHR,” then in a few years there are 1-5% Medicare penalties for not using one and showing meaningful use.
So, there’s nothing forcing physicians to use a certified EMR solution. More and more people are doing as you describe, ” go with the one that provides the most amount of value.” They make the valid argument that if you get $44k in EMR stimulus money and lose $50k in productivity then you would have been better to go with an EMR that can’t get you stimulus money, but still maintains or even improves your productivity (among other EMR benefits).
At one of my EMR stimulus speaking engagements, a physician came up to me after the presentation and asked, “If I don’t accept Medicare or Medicaid, then do I care about meaningful use or certified EHR?” The easy answer was, nope. He can just decide on the right EMR without having to worry about government requirements.
Mr Lynn
EMR & HIPAA
7-29-10
Is it necessary to get CCHIT certified vendor just because you want to qualify for incentives or regardless you MUST go for a certified solution?
Because I make the case that one should go with the one that provides the most amount of value.
You only need to use a certified EHR (doesn’t have to be CCHIT certified either, but HHS Certified) if you want to get the EMR stimulus money. The only caveat is that if you don’t show “meaningful use” of a “certified EHR,” then in a few years there are 1-5% Medicare penalties for not using one and showing meaningful use.
So, there’s nothing forcing physicians to use a certified EMR solution. More and more people are doing as you describe, ” go with the one that provides the most amount of value.” They make the valid argument that if you get $44k in EMR stimulus money and lose $50k in productivity then you would have been better to go with an EMR that can’t get you stimulus money, but still maintains or even improves your productivity (among other EMR benefits).
At one of my EMR stimulus speaking engagements, a physician came up to me after the presentation and asked, “If I don’t accept Medicare or Medicaid, then do I care about meaningful use or certified EHR?” The easy answer was, nope. He can just decide on the right EMR without having to worry about government requirements.
Mr Lynn
EMR & HIPAA
7-29-10
Wednesday, June 9, 2010
Electronic Prescriptions for Controlled Substances
Electronic Prescriptions for Controlled Substances
--------------------------------------------------------------------------------
On March 24, 2010, the Office of the Federal Register made available for public inspection an Interim Final Rule with Request for Comment from the Drug Enforcement Administration (DEA) entitled “Electronic Prescriptions for Controlled Substances” [Docket No. DEA-218, RIN 1117-AA61]. On March 31, 2010 the rule was published in the Federal Register. The official rule may be viewed at the Federal Register Web site. An unofficial copy of the rule is found below. The rule will become effective June 1, 2010.
The rule revises DEA regulations to provide practitioners with the option of writing prescriptions for controlled substances electronically. The regulations also permit pharmacies to receive, dispense, and archive these electronic prescriptions. These regulations are an addition to, not a replacement of, the existing rules. The regulations provide pharmacies, hospitals, and practitioners with the ability to use modern technology for controlled substance prescriptions while maintaining the closed system of controls on controlled substances.
U.S. Department of Justice
Office of Diversion Control
June 9, 2010
--------------------------------------------------------------------------------
On March 24, 2010, the Office of the Federal Register made available for public inspection an Interim Final Rule with Request for Comment from the Drug Enforcement Administration (DEA) entitled “Electronic Prescriptions for Controlled Substances” [Docket No. DEA-218, RIN 1117-AA61]. On March 31, 2010 the rule was published in the Federal Register. The official rule may be viewed at the Federal Register Web site. An unofficial copy of the rule is found below. The rule will become effective June 1, 2010.
The rule revises DEA regulations to provide practitioners with the option of writing prescriptions for controlled substances electronically. The regulations also permit pharmacies to receive, dispense, and archive these electronic prescriptions. These regulations are an addition to, not a replacement of, the existing rules. The regulations provide pharmacies, hospitals, and practitioners with the ability to use modern technology for controlled substance prescriptions while maintaining the closed system of controls on controlled substances.
U.S. Department of Justice
Office of Diversion Control
June 9, 2010
Tuesday, June 8, 2010
Revolution In The Evolution Of The Electronic Health Record
The healthcare IT world is abuzz with excitement because the Electronic Health Record has finally gained recognition as a critical element in the restructuring of healthcare. For years Democrats and Republicans, clinicians and administrators have all talked about how automation would create the missing efficiency in the healthcare system. But, in reality, little was done about increasing the rate of EHR adoption.
Financial healthcare transactions received a boost in 1996 when HIPAA established rules for the use of electronic claims and other financial transactions. Since then electronic financial transaction volume in healthcare has climbed dramatically, benefitting all.
Electronic prescribing also received a nudge in 2003 from the Medicare Modernization Act, which established rules for the use of electronic prescribing and provided mandates and financial incentives. As a result ePrescribing has steadily gained traction, resulting in increased efficiency and lower medication errors.
Most recently, the economic downturn spurred the American Recovery and Reconstruction Act of 2009 which committed $19 billion to healthcare information technology. The Health Information Technology for Economic and Clinical Health Act, or the "HITECH" portion of ARRA, established standards, implementation specifications, and certification criteria for EHR technology. It also established programs under Medicare and Medicaid to provide financial incentives, including payments and penalties, to encourage the "meaningful use" of EHRs. (The full 556-page document defining meaningful use can be downloaded here).
Healthcare is one of the most information intensive industries, yet it has been one of the least automated. Today, many life and death decisions are made by physicians using barely readable documents transmitted by decades old FAX machines. Other developed countries, such as Denmark, are far ahead of the US in adoption of EHRs. The US needs automation to increase efficiency and reduce errors. The core functionality for healthcare clinical automation is the Electronic Health Record, also known as the Electronic Medical Record.
To understand EHR adoption in today’s US market, it is important to understand “Meaningful Use” the incentive scheme used by ARRA to motivate providers and hospitals to adopt and utilize EHRs. Proposed rules were issued on December 30th and final rules are expected by late spring
According to the proposed rules, hospitals will be measured by 23 indicators of meaningful use which will become increasingly stringent over time. A recent article in HealthCare IT News summarizes the 23 Stage 1 Meaningful Use criteria for eligible hospitals. These criteria include:
Communicating clinical orders electronically
Automatically checking for unintended drug interactions
Maintaining an up-to-date problem list of current and active diagnoses
Keeping an electronic list of each patient’s medications
Maintaining a list of the patient’s medication allergies
For doctor’s offices, there are 25 indicators of meaningful use. These include many of the same indicators as those used for hospitals. The full list is available here. Some examples are:
Recording and charting changes in vital signs
Recording smoking status
Incorporating clinical lab results as structured data
Generating lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach
Since the announcement of Meaningful Use, a great debate has arisen among EHR vendors and pundits. Many complain that Meaningful Use will delay adoption as hospitals and physicians wait to see which EHR vendors survive the certification process. Others say that Meaningful Use is stifling innovation as vendors focus their development efforts on fulfilling Meaningful Use requirements rather than inventing new features and functions.
However, one could argue that Meaningful Use does not promote technology for technology’s sake but instead requires providers and hospital to use EHRs to reduce medical errors and more effectively care for patients. This regulation could drive the transformation of American medicine in a positive direction, reducing medication errors and facilitating evidence-based medical practices.
Healthcare vendors may need to face the fact that EHR adoption and utilization in the US has been growing at a pitifully slow rate. Even if Meaningful Use creates a few initial hiccups, it is difficult to imagine that this innovative regulatory scheme, along with $19 billion dollars, won’t pick up the pace of EHR adoption as well as innovation.
MedHealthWorld
Ed Daniels
June 3, 2010
Financial healthcare transactions received a boost in 1996 when HIPAA established rules for the use of electronic claims and other financial transactions. Since then electronic financial transaction volume in healthcare has climbed dramatically, benefitting all.
Electronic prescribing also received a nudge in 2003 from the Medicare Modernization Act, which established rules for the use of electronic prescribing and provided mandates and financial incentives. As a result ePrescribing has steadily gained traction, resulting in increased efficiency and lower medication errors.
Most recently, the economic downturn spurred the American Recovery and Reconstruction Act of 2009 which committed $19 billion to healthcare information technology. The Health Information Technology for Economic and Clinical Health Act, or the "HITECH" portion of ARRA, established standards, implementation specifications, and certification criteria for EHR technology. It also established programs under Medicare and Medicaid to provide financial incentives, including payments and penalties, to encourage the "meaningful use" of EHRs. (The full 556-page document defining meaningful use can be downloaded here).
Healthcare is one of the most information intensive industries, yet it has been one of the least automated. Today, many life and death decisions are made by physicians using barely readable documents transmitted by decades old FAX machines. Other developed countries, such as Denmark, are far ahead of the US in adoption of EHRs. The US needs automation to increase efficiency and reduce errors. The core functionality for healthcare clinical automation is the Electronic Health Record, also known as the Electronic Medical Record.
To understand EHR adoption in today’s US market, it is important to understand “Meaningful Use” the incentive scheme used by ARRA to motivate providers and hospitals to adopt and utilize EHRs. Proposed rules were issued on December 30th and final rules are expected by late spring
According to the proposed rules, hospitals will be measured by 23 indicators of meaningful use which will become increasingly stringent over time. A recent article in HealthCare IT News summarizes the 23 Stage 1 Meaningful Use criteria for eligible hospitals. These criteria include:
Communicating clinical orders electronically
Automatically checking for unintended drug interactions
Maintaining an up-to-date problem list of current and active diagnoses
Keeping an electronic list of each patient’s medications
Maintaining a list of the patient’s medication allergies
For doctor’s offices, there are 25 indicators of meaningful use. These include many of the same indicators as those used for hospitals. The full list is available here. Some examples are:
Recording and charting changes in vital signs
Recording smoking status
Incorporating clinical lab results as structured data
Generating lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach
Since the announcement of Meaningful Use, a great debate has arisen among EHR vendors and pundits. Many complain that Meaningful Use will delay adoption as hospitals and physicians wait to see which EHR vendors survive the certification process. Others say that Meaningful Use is stifling innovation as vendors focus their development efforts on fulfilling Meaningful Use requirements rather than inventing new features and functions.
However, one could argue that Meaningful Use does not promote technology for technology’s sake but instead requires providers and hospital to use EHRs to reduce medical errors and more effectively care for patients. This regulation could drive the transformation of American medicine in a positive direction, reducing medication errors and facilitating evidence-based medical practices.
Healthcare vendors may need to face the fact that EHR adoption and utilization in the US has been growing at a pitifully slow rate. Even if Meaningful Use creates a few initial hiccups, it is difficult to imagine that this innovative regulatory scheme, along with $19 billion dollars, won’t pick up the pace of EHR adoption as well as innovation.
MedHealthWorld
Ed Daniels
June 3, 2010
Tuesday, April 20, 2010
More Doctors Prescribing Meds Electronically
Doctors are increasingly prescribing medications electronically, abandoning the traditional paper scripts that can result in drug errors due to hard-to-read writing or coverage denials by a patient's insurer.
The number of e-prescriptions nearly tripled last year to 191 million from the previous year's 68 million, representing about 12% of the 1.63 billion original prescriptions, excluding refills, according to Surescripts LLC, whose online network handles the bulk of the electronic communications. The growth has accelerated. For the first three months of this year, nearly one in five prescriptions was filed electronically, Surescripts says. About 25% of all office-based doctors currently have the technology to e-prescribe, more than twice as many as at the end of 2008, Surescripts says.
E-prescription programs display lists of drugs for doctors to select from. Symbols may indicate the cheapest or best option for the patient.
Industry officials expect the growth in e-prescribing to continue, helped in part by a regulatory ruling last month that will soon allow doctors to start prescribing controlled medications such as narcotics and anti-depressants electronically. Under Drug Enforcement Administration rules, doctors previously had to hand out paper prescriptions for controlled drugs, even while other drugs could be e-prescribed.
The recent DEA ruling "is what we've all been waiting for," says John Halamka, an emergency-room physician at Beth Israel Deaconess Medical Center in Boston, who has used e-prescribing for three years. Being able to digitally zap some prescriptions to a pharmacy, while having to use a pad and paper for other medicines has disrupted work flow at the hospital, he says. "Now we can write prescriptions for [cholesterol drug] Lipitor and Valium [a controlled anti-anxiety medication] on the same program," he says.
Doctors transmit e-prescriptions via a secured Internet network directly to pharmacies from their computers or hand-held devices. Nearly all chain drug stores and 62% of independent pharmacies now accept e-prescriptions that are uploaded directly to their computers. For medical practices, the cost of e-prescribing software and hardware, such as laptops, as well as training can range from about $1,000 to $1,750 per physician, according to software makers.
Displayed on the doctor's e-prescribing screen are an array of drugs and their prices. Doctors select among different doses and either generic or name-brand medications. Also listed are which medications are covered, and which are not, by a patient's insurance company. For some e-prescribing programs, symbols in the form of small faces appear on the screen: A green smiley face means the medication will be the cheapest for a patient, or that it's the preferred drug based on other medications the patient is taking. Yellow and red faces indicate less desirable options.
"Wall Street Journal April 20, 2010"
The number of e-prescriptions nearly tripled last year to 191 million from the previous year's 68 million, representing about 12% of the 1.63 billion original prescriptions, excluding refills, according to Surescripts LLC, whose online network handles the bulk of the electronic communications. The growth has accelerated. For the first three months of this year, nearly one in five prescriptions was filed electronically, Surescripts says. About 25% of all office-based doctors currently have the technology to e-prescribe, more than twice as many as at the end of 2008, Surescripts says.
E-prescription programs display lists of drugs for doctors to select from. Symbols may indicate the cheapest or best option for the patient.
Industry officials expect the growth in e-prescribing to continue, helped in part by a regulatory ruling last month that will soon allow doctors to start prescribing controlled medications such as narcotics and anti-depressants electronically. Under Drug Enforcement Administration rules, doctors previously had to hand out paper prescriptions for controlled drugs, even while other drugs could be e-prescribed.
The recent DEA ruling "is what we've all been waiting for," says John Halamka, an emergency-room physician at Beth Israel Deaconess Medical Center in Boston, who has used e-prescribing for three years. Being able to digitally zap some prescriptions to a pharmacy, while having to use a pad and paper for other medicines has disrupted work flow at the hospital, he says. "Now we can write prescriptions for [cholesterol drug] Lipitor and Valium [a controlled anti-anxiety medication] on the same program," he says.
Doctors transmit e-prescriptions via a secured Internet network directly to pharmacies from their computers or hand-held devices. Nearly all chain drug stores and 62% of independent pharmacies now accept e-prescriptions that are uploaded directly to their computers. For medical practices, the cost of e-prescribing software and hardware, such as laptops, as well as training can range from about $1,000 to $1,750 per physician, according to software makers.
Displayed on the doctor's e-prescribing screen are an array of drugs and their prices. Doctors select among different doses and either generic or name-brand medications. Also listed are which medications are covered, and which are not, by a patient's insurance company. For some e-prescribing programs, symbols in the form of small faces appear on the screen: A green smiley face means the medication will be the cheapest for a patient, or that it's the preferred drug based on other medications the patient is taking. Yellow and red faces indicate less desirable options.
"Wall Street Journal April 20, 2010"
Monday, April 12, 2010
Stimulus Money Available to Implement Electronic Medical Records
With federal stimulus money available to defray the cost of going high tech, physicians and hospitals across the area are looking to get rid of paper in favor of electronic medical records.
And with cuts coming to Medicare and Medicaid reimbursements in 2015 for those that don’t make the switch, many doctors and hospitals are preparing to go electronic now.
“There’s a revolution coming,” said Peter A. Levine, executive director of the Genesee County Medical Society. “There are a lot of physicians’ offices looking at this right now, but have not made decisions yet. The process of selecting an electronic medical records system is pretty complicated.”
An estimated 44 percent of office-based physicians used at least some electronic medical or health records in 2009, according to the National Center for Health Statistics. But only about 6.3 percent of those doctors are using a fully functional electronic system, according to the center.
The stimulus funding provides about $19 billion for Medicare and Medicaid health information technology incentives over a five-year period. Doctors and hospitals that adopt use of electronic medical records and show a “meaningful use” of the technology can receive incentives of about $44,000 per physician.
Flint Journal 4-11-10
And with cuts coming to Medicare and Medicaid reimbursements in 2015 for those that don’t make the switch, many doctors and hospitals are preparing to go electronic now.
“There’s a revolution coming,” said Peter A. Levine, executive director of the Genesee County Medical Society. “There are a lot of physicians’ offices looking at this right now, but have not made decisions yet. The process of selecting an electronic medical records system is pretty complicated.”
An estimated 44 percent of office-based physicians used at least some electronic medical or health records in 2009, according to the National Center for Health Statistics. But only about 6.3 percent of those doctors are using a fully functional electronic system, according to the center.
The stimulus funding provides about $19 billion for Medicare and Medicaid health information technology incentives over a five-year period. Doctors and hospitals that adopt use of electronic medical records and show a “meaningful use” of the technology can receive incentives of about $44,000 per physician.
Flint Journal 4-11-10
Wednesday, March 24, 2010
EMR Trends
Summary
Traditionally, larger EMR vendors were thought to have advantages over smaller providers
For smaller practices, a smaller EMR vendor may be more attractive because of price and infrastructure
There should be a large push in 2010 for small practices to adopt EMR's because of the government incentives available in 2011
Analysis
The conventional belief in electronic medical records (EMR) has always been that the bigger the better. The idea was that larger providers of EMR's, such as GE Healthcare or Allscripts, offered stability to reassure physicians that their EMR service was going to being secure for many years. In addition, by choosing a larger provider, physicians may reap the benefits of being part of a larger market share where compatibility with other providers may be made easier.
However, for several reasons, the marketplace has begun to shift its attention towards smaller EMR providers. The larger vendors had initially targeted large institutions such as hospital networks. As a result, their infrastructure and pricing tends to neglect the small practice, which has been the slowest adopter of EMR's.
In 2011, government incentives will begin for practices who are using EMR's. Therefore, look for 2010 to be a buyer's market as practices begin to adopt EMR's, and in all likelihood, this will be a boon for smaller EMR vendors.
GLG Healthcare Council
Money.CNN.Com March 2010
Traditionally, larger EMR vendors were thought to have advantages over smaller providers
For smaller practices, a smaller EMR vendor may be more attractive because of price and infrastructure
There should be a large push in 2010 for small practices to adopt EMR's because of the government incentives available in 2011
Analysis
The conventional belief in electronic medical records (EMR) has always been that the bigger the better. The idea was that larger providers of EMR's, such as GE Healthcare or Allscripts, offered stability to reassure physicians that their EMR service was going to being secure for many years. In addition, by choosing a larger provider, physicians may reap the benefits of being part of a larger market share where compatibility with other providers may be made easier.
However, for several reasons, the marketplace has begun to shift its attention towards smaller EMR providers. The larger vendors had initially targeted large institutions such as hospital networks. As a result, their infrastructure and pricing tends to neglect the small practice, which has been the slowest adopter of EMR's.
In 2011, government incentives will begin for practices who are using EMR's. Therefore, look for 2010 to be a buyer's market as practices begin to adopt EMR's, and in all likelihood, this will be a boon for smaller EMR vendors.
GLG Healthcare Council
Money.CNN.Com March 2010
Stimulus Fuels Push for Electronic Medical Records
Under the stimulus law, medical offices that buy or update electronic systems can receive up to $44,000 in bonus Medicare payments per doctor over five years, starting in 2011. They can get the money regardless of how much they pay for the unit. Hospitals are eligible for a $2 million bonus payment in the first year, millions more later on.
Congress jolted the market by rewarding doctors and hospitals that jump on board quickly and penalizing those who resist. The faster they get up and running, the more money they can get. On the flip side, Medicare plans to cut payments to those who fail to get wired up by 2015.
"The law is very well crafted," said John D. Halamka of Harvard Medical School, who is vice-chairman of a government advisory panel on health technology standards.
Halamka's advice to doctors and hospitals? Start shopping.
Federal Computer Week Jan. 2010
Congress jolted the market by rewarding doctors and hospitals that jump on board quickly and penalizing those who resist. The faster they get up and running, the more money they can get. On the flip side, Medicare plans to cut payments to those who fail to get wired up by 2015.
"The law is very well crafted," said John D. Halamka of Harvard Medical School, who is vice-chairman of a government advisory panel on health technology standards.
Halamka's advice to doctors and hospitals? Start shopping.
Federal Computer Week Jan. 2010
Tuesday, March 23, 2010
Cutting through the Confusion: Beware of Vendors Bearing Promises
Cutting through the Confusion: Beware of Vendors Bearing PromisesChiroEco.com March 23, 2010
In order to qualify for stimulus funds, the onus is ultimately on a doctor to demonstrate 'meaningful use' of a certified EMR solution. The problem, Hollis says, is that the federal government has yet to specify the software certification standard that will be used and has not yet finalized specifics on the exact requirements for doctors to achieve meaningful use. The ONC has never stated that any prior or current certification by the Certification Commission for Health Information Technology (CCHIT) will qualify an EHR system in advance or in lieu of the upcoming certification standard.
Stimulus and EMR.
We found this article to be right on the money on the adoption of EMR. More here.
Federal stimulus money and the promise of incentive payments are pushing health care providers toward digital information. Just as moving from ledgers to computers changed banking, going to electronic medical records is expected to change health care, proponents say. Beginning next year, health care providers can recoup some of their costs from incentives that were part of the stimulus package.
Those making "meaningful use" of electronic records are eligible for as much as $18,000 in fiscal 2011, and lesser amounts in the four years following, to an estimated total of $40,000 or more. Hospitals can get more than $2 million a year for four years. Proponents say the benefits are as enticing as the funds. Record-keeping will become more efficient. Tests and X-rays won't need to be repeated, and staff time won't have to be spent pulling or filing paper charts. Information will be mined in ways that can improve health care, by showing which treatments are most effective, for example. And mistakes can be reduced, such as those that can come from misinterpreted handwriting.
SunHerald.com March 2010
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