Thomson Reuters names top 10 U.S. health systems

Ten U.S. health systems have been identified by Thomson Reuters as performing at the top when it comes to quality of care, efficiency and patient satisfaction - metrics that are boosted with the use of information technology.

Thomson Reuters released its third annual study Wednesday identifying the 10 top:

1. Advocate Health Care*  ― Oak Brook, IL


2. Cape Cod Healthcare ― Hyannis, MA


3. CareGroup Healthcare System ― Boston, MA


4. Kettering Health Network* ― Dayton, OH


5. Maury Regional Healthcare System ― Columbia, TN


6. Mayo Foundation**  ― Rochester, MN


7. NorthShore University HealthSystem ― Evanston, IL


8. OhioHealth* ― Columbus, OH


9. Partners Healthcare ― Boston, MA


10. Spectrum Health** ― Grand Rapids, MI

*Denotes three-time winner
 **Denotes two-time winner

Compared with their peers, the Thomson Reuters 10 Top Health Systems saved more lives, caused fewer medical complications, made fewer medical errors, followed recommended standards of care more closely, released patients half a day sooner on average, and scored better on patient satisfaction surveys.

"This year, the 10 Top Health Systems set a new standard for high quality of care across all of the communities they serve," said Jean Chenoweth, senior vice president for performance improvement and 100 Top Hospitals programs at Thomson Reuters.

"To produce consistent, strong performance across multiple hospitals, health system leaders must be providing crystal clear goals and communication as well as the means for staff to execute effectively," Chenoweth said. "These systems are positioned to continue performing well as we move further into the era of healthcare reform."

These 10 health systems rose to the top when researchers from the Thomson Reuters 100 Top Hospitals program analyzed the performance of 285 health systems based on eight metrics:

• In-hospital mortality


• Medical complications


• Patient safety


• Average length of stay


• 30-day mortality rate (post-discharge)


• 30-day readmission rate (post discharge)


• Adherence to clinical standards of care (evidence-based core measures published by the Centers for Medicare and Medicaid Services


• Hospital Consumer Assessment of Healthcare Providers and Systems patient survey score (part of a national initiative sponsored by the U.S. Department of Health and Human Services to measure the quality of care in hospitals).

The study evaluated U.S. health systems with two or more short-term, acute care, non-federal hospitals that treat a broad spectrum of patients. Researchers used public data from the Medicare Provider Analysis and Review (MedPAR) dataset and the CMS Hospital Compare datasets.

The Thomson Reuters 100 Top Hospitals program has analyzed and reported on the performance of hospitals since 1993. For more information, visit www.100tophospitals.com.

 

 

No New Health-Law Waivers to Be Given

The Obama administration on Friday said it would stop granting new waivers to the health-care overhaul in September following sharp opposition from Republicans who cited the waivers in their bid to undermine the law.

As of the end of May, the administration had granted 1,433 waivers to a part of the 2010 law that prevents employers and other health-plan providers from capping annual benefit payouts below $750,000 a year. Those entities, and any others that secure a waiver by Sept. 22, will be able to keep their one-year waivers, and apply for extensions through 2013.

But the Department of Health and Human Services said it would stop accepting new applications for the program after Sept. 22. The waivers largely went to low-wage employers who offer "mini-med" plans with limited benefits, including McDonald's Corp. and the Foot Locker Inc. athletic chain.

By cutting off applications, the administration will avoid the bursts of attention each time it granted a new batch. Opponents of the law contended that the administration had shown favoritism in granting the waivers, prompting federal health officials to disclose the names of recipients and the application process for granting them.

Steve Larsen, a Health and Human Services official responsible for insurance oversight, said the department is cutting off new applications because "the vast majority of plans that would need a waiver…are the ones that would have applied and did apply this year." He said waivers were granted to plans covering about 2% of privately insured Americans.

Critics of the health-care overhaul seized on the administration's move as a sign that the law is flawed. "They are shutting it down because it's become clear that the only way to keep what you have and like is to be exempted from the very law they said would lower costs," Sen. Orrin Hatch (R., Utah) and House Ways and Means Committee Chairman Dave Camp (R., Mich.) said in a joint statement.



A Government Accountability Office report this past week found that the administration mostly granted waivers for those who said they would have to raise premiums by more than 10% and cut benefits if they didn't get a waiver. It largely denied applications that projected a premium increase of 6% or less.

The Obama administration described the waivers as a bridge until 2014, when new health-insurance exchanges are expected to largely eliminate such limited-benefit plans and give consumers a chance to shop for better coverage. In the meantime, health plans with waivers must tell consumers their coverage is subject to an annual dollar limit lower than usually allowed under the law, according to new disclosure requirements the administration released Friday.

Beginning in September, that allowable annual limit increases to $1.25 million. For plan years beginning September 2012, it rises to $2 million.

This article was originally posted at http://online.wsj.com/article/SB10001424052702303635604576392200148966610.html

5 Strategies to Combat Health Reform Pressures

Health plan executives say their three major challenges are figuring out how to deal with healthcare reform, the health insurance industry's systemic shift from wholesale to retail business and bending the cost curve.

Resolving the challenges will require health plans to shift their focus from group to individual sales, identify and test new behavior predictors and shorten the timeline of product development.

The findings were part of a session about predicting and managing change presented at the annual conference for America's Health Insurance Plans. The session was based on a study developed from interviews with 40 senior healthcare executives by SAS, a Cary, N.C.-based business analytics firm, and Chicago-based Stonegate Advisors, a healthcare research and analytics company.

"Health plans are facing a fundamental change in how they do business," explained Sarah Rittman, a senior industry consultant for SAS. "Accurately predicting market shifts will be imperative for developing go-to-market strategies."

The study, Tackling U.S. Health Plan Challenges with Advanced Analytics, presents these strategies for health plans:

1. Predict market changes in new and creative ways

Today's healthcare market depends on traditional actuarial and underwriting principles to predict risk. But the post-reform market will require health plans to combine third party data – like credit information, social media and purchase data ? with claims data to help understand potential market shifts.

2. Get to know your customers as unique individuals

Reform is expected to bring a flood of individuals into the health insurance market. Member-centric product and service strategies haven't been a focus but now "health plans will need to understand what individuals like and what they want," says Rittman. That includes learning their price and product sensitivity and how they like to communicate and how often. "It will take years for the healthcare industry to figure out how to influence consumers.

3. Do retail like pros

Healthcare needs to learn from other industries – like banking, telecommunications and airlines – that have been through a similar process. "These industries re-invented themselves," explains Marc Pierce, president and founder of Stonegate Advisors. He said that to succeed health plans will need to shorten their product development cycle, add service and loyalty programs, and develop sophisticated pricing strategies.

4. Manage the cost of care

In post healthcare reform managing expenses at a plan member level will be critical to keeping premiums affordable and maintaining the required MLR of 80% to 85%. Plans will need to develop analytics to monitor services, treatment patterns and cost trends to identify medical expense concerns. "Health plans will need to know what customers they can impact and how. They'll need a way to identify those members who are on the edge in terms of willingness to change a behavior and then develop a program that will influence them," says Pierce.

5. Collaborate more effectively with providers

Controlling healthcare will require that health plans work with their providers to develop payer/provider models to see what works based on financial viability and sustainability, including pay for performance, patient centered medical home, an integrated care system and an accountable care organization. Collaboration should include the ability to share clinical, claims and pharmaceutical data to track and analyze outcomes. "This is very valuable information for both the payer and the provider," says Rittman.

This article was originally posted at http://www.healthleadersmedia.com/page-2/TEC-267558/5-Strategies-to-Combat-Health-Reform-Pressures

 

 

A necessary dose of e-prescribing flexibility

Physicians understand the potential of health information technology to help improve patient care, and doctors are willing to work with the federal government through incentive programs designed to encourage more practices to go paperless. But the government went too far when designing the punitive side of some of these incentives, tying penalties to burdensome, unfair and even unrealistic mandates on many of the practices that are trying to work toward the same goals.

That's why the Centers for Medicare & Medicaid Services made the right move in adjusting its Medicare electronic prescribing incentive program to correct several key shortfalls in the original plan. The program offers a 1% bonus next year to eligible practices that e-prescribe a minimum number of times in 2011, but it also will impose a 1% penalty on those that don't. Under a new proposed rule released in late May, CMS outlined a number of revisions to the details of this plan that members of organized medicine, including the American Medical Association, had insisted were sorely needed.

The changes, which are set to be finalized this summer, provide a measure of relief to physician practices that were worried about being subject to Medicare e-prescribing penalties even though they are actually early technology adopters.

Because CMS did not align the requirements for its e-prescribing program with those for its separate electronic medical records meaningful use program, some practices had to contemplate installing a stand-alone paperless drug order system -- on top of the EMR they already had -- just to be compliant. Some practices took this duplicative step earlier in the year just to be sure.

With its latest changes, the Medicare agency has confirmed that practices that already have certified EMRs can use those systems to meet the e-prescribing mandate as well. CMS recognized that in most cases, approved EMRs have the same level of functionality when it comes to sending paperless drug orders as the systems called for by the e-prescribing program.

In future reporting years, physicians who use certified EMRs will know for sure that their systems will be acceptable to the government when it comes to e-prescribing.

Better aligning the requirements of the e-prescribing and EMR programs was only one of the revisions that CMS needed to make. Many other physicians were facing Medicare penalties for practice circumstances that truly were out of their hands.

CMS initially only proposed exemptions to the e-prescribing requirements for rural physicians with limited Internet access and those living in areas where pharmacies don't accept paperless medication orders. That left too many other physicians who still would have faced a 1% penalty in 2012 simply because they had limited opportunities to prescribe electronically. Now CMS also will offer exemptions to doctors who don't prescribe enough drugs in the first place, who are barred by law from issuing enough electronic drug orders (such as under prohibitions on e-prescribing of controlled substances), or who prescribe drugs only during patient encounters that don't count under the program (such as many surgeons). Practices also will be able to avoid the penalty if they did not e-prescribe by the June deadline because they were planning instead to adopt and use EMRs in 2011 to qualify for meaningful use bonuses.

When the proposed changes are finalized, physicians not meeting the e-prescribing requirements will have until Oct. 1 to apply for one of these waivers. The agency predicts that more than 200,000 doctors and health professionals might be eligible to claim a hardship. By expanding the exemption list and the deadline to file, CMS is acknowledging that many practices will not meet the minimum this year not because they don't want to, but because they can't.

When it comes to providing needed regulatory relief to doctors, the Obama administration shouldn't stop with the changes it already has proposed. Medicare and Medicaid have a whole host of burdensome, redundant or unnecessary rules for physicians, including certain regulations pertaining to translators, claims audits, documentation and enrollment.

Now that CMS has shown it can be flexible on the e-prescribing requirements, it needs to devote its attention to these rules.

This article was originally posted at http://www.ama-assn.org/amednews/2011/06/13/edsa0613.htm

 

 

CMS to align e-Rx incentive with EHR program

The Centers for Medicare and Medicaid Services (CMS) plans to modify its electronic prescribing incentives schedule to better align with its electronic health record incentive program so physicians can both avoid e-prescribing penalties and also participate in CMS’ EHR Incentive Program.

E-prescribing is  a requirement for meaningful use of electronic health records (EHRs) to qualify for incentives.

CMS released the proposed rule on May 27 and it will be published in the June 1 Federal Register. The public will be able to comment for 60 days.

In 2009, CMS started the E-prescribing (eRx) Incentive Program. To qualify for eRx incentives this year, providers must e-prescribe 10 orders between Jan. 1 and June 30, 2011.

Medicare providers cannot earn an incentive under both incentive programs for the same year. However, providers will be subject to an e-prescribing payment adjustment if they do not meet the requirements under the eRx Incentive Program, regardless of whether the eligible provider participates in and earns an incentive under EHR incentive program.

[Q&A: PwC's Bruce Henderson on why the proposed ACO regs are so "onerous and grinding."]

“Stakeholders claim that the requirements under both programs are administratively confusing, cumbersome, and unnecessarily duplicative,” the proposed rule said.

The proposed rule will expand the exemptions and the time to report them so providers can avoid the payment penalties. Exemptions will include putting off deploying an e-prescribing system because they are participating in the EHR incentive program. The rule would also revise the description of qualified e-prescribing systems to include certified EHR technology under meaningful use.

Among the requirements, e-prescribing systems must be able to generate and transmit prescriptions and active medication list; check for drug-drug interactions; and check whether drugs are in a health plan’s formulary or preferred drug list.

The American Medical Association welcomed the flexibility of the proposed rule and the elimination of unreasonable penalties. “Physicians who are working to adopt e-prescribing and other health IT should not be unfairly penalized for practice patterns that do not fit neatly within the current, limited exemption process,” said Dr. Cecil Wilson, AMA president, in a statement..

In February, the Government Accountability Office had said that CMS should reconcile the inconsistencies between the two programs.

The EHR program provides incentives from 2011 to 2016 and introduces penalties beginning in 2015, while the e-prescribing program provides incentives from 2009 to 2013 and provides for penalties from 2012 to 2014, when the program ends. Both programs require providers to adopt and use technology that can perform similar electronic prescribing-related activities.

[Related: VA, DOD test joint EHR interface in Hawaii. See also: HHS proposed rule on disclosure highlights access reports.]

The EHR program requires providers to adopt and use EHR systems that are certified to meet criteria which include electronic prescribing-related capabilities, while the e-prescribing program does not have a certification requirement.]

According to the e-prescribing program, a physician or group practice in 2011 can qualify for an incentive equal to 1 percent of its total estimated Medicare Part B physician fee schedule allowed charges for covered professional services.

In 2012, a payment adjustment will begin for those who do not e-prescribe and increase each year through 2014. Specifically, those physicians will receive 99 percent of the fee in 2012, 98.5 percent in 2013 and 98 percent in 2014.

This article was originally posted at http://ping.fm/kzxqb

 

Medicare to offer more waivers from e-prescribing penalty

[caption id="" align="alignnone" width="468" caption="New revisions to Medicare e-prescribing incentives are part of a larger administration effort to identify burdensome federal regulations. A review by the White House Office of Management and Budget, led by Director Jack Lew, has uncovered some rules that appear redundant. [Photo by AP / Wide World Photos"]"][/caption]

Physicians who see Medicare patients would have more opportunities to avoid being penalized for failing to prescribe medications electronically by a June 30 deadline under a proposed rule from the Centers for Medicare & Medicaid Services.

The proposed revisions would provide relief to eligible physicians who do not expect to report at least 10 paperless drug orders to CMS by June 30. Medicare will penalize doctors for failing to meet 2011 e-prescribing requirements by reducing payments by 1% in 2012. On May 26, the Medicare agency said it would give doctors a second chance to avoid the penalty after the deadline. It would allow physicians who did not meet the minimum reporting requirements to claim one of several hardship exemptions through a special website by Oct. 1.

The proposed rule also would apply to physician practices that already have adopted certified electronic medical record systems in an effort to earn Medicare or Medicaid meaningful use bonuses. Those practices could use those systems to satisfy the e-prescribing requirements as well. Under the current program, practices that use certified EMRs to send paperless drug orders will satisfy the e-prescribing requirement as long as the system meets four specific functionalities. If the proposed rule is finalized later this year, certified EMRs will be acceptable for e-prescribing in future reporting years even if they don't technically meet the four specific functionalities.

In addition to the expanded hardship exemptions, the revised language on the certified EMRs was a change requested by members of organized medicine, including the American Medical Association. Physicians complained that because the requirements for the e-prescribing incentive program and the EMR meaningful use incentive program were different, some paperless practices were concerned that they would need to buy and use a stand-alone e-prescribing system to avoid the 1% reduction in 2012.

"Eliminating unreasonable penalties and burdensome requirements, and providing physicians with more flexibility through an exemption process, will help ensure more physicians are able to successfully participate in the e-prescribing incentive program," said AMA President Cecil B. Wilson, MD. "The AMA has continually stressed to CMS that these changes were essential and is pleased to see them become a reality in a rule that will be finalized later this summer."

The Medical Group Management Assn. also was pleased with the proposed rule. However, some practices already had taken special steps earlier this year just to avoid the penalty -- actions that now have become unnecessary, said Anders Gilberg, MGMA's vice president of public and private economic affairs.

Some groups used temporary e-prescribing software, independent of their EMRs, and discarded the systems after reporting the minimum 10 e-prescribing encounters per physician. Others, such as some surgery practices, struggled to find ways to prescribe medications during office visits just so they would not be penalized in 2012.

"It's unfortunate it took until almost June for the proposed rule to come out," Gilberg said.

Expanded hardship exemptions

Approximately 109,000 to 209,000 physicians and other health care professionals could be eligible to file for hardship exemptions to the e-prescribing penalty by Oct. 1, CMS said in the proposed rule. The Medicare agency has proposed developing a special website for doctors and others to claim one of several hardships. CMS would approve the claims on a case-by-case basis, said Michael Rapp, MD, director of the CMS Quality Measurement and Health Assessment Group.

The initial rules had provided only two hardship exemption categories -- for physicians who practiced in rural areas with limited high-speed Internet access or for those who worked in areas with a limited number of pharmacies that accept electronic drug orders. CMS had required one of these exemptions to be reported before June 30.

The proposed rule would allow doctors to choose from these two hardships as well as four new exemptions on the website by the October deadline. The site would go live sometime after the rule is finalized in August, Dr. Rapp said.

The expanded list of hardship exemptions would include:

• Physicians who register to participate in the Medicare or Medicaid EMR incentive program, and adopt and use certified EMR technology by the 2011 deadline.


• Physicians who cannot prescribe enough drug orders electronically due to local, state or federal laws, such as those prohibiting paperless orders for narcotics.


• Physicians with limited prescribing activity.


• Physicians with insufficient opportunities to report the e-prescribing measures because the types of patient visits they claim are not eligible under the program.

"There will be an opportunity for physicians to indicate that they feel that they fit, and are requesting to be classified, in one of these hardship categories," Dr. Rapp said. "Then those individuals would be taken off the list to be 'subject to the negative payment adjustment.' "

Those who report that they e-prescribed 10 times before June 30 automatically would not be subject to the 2012 penalty, Dr. Rapp added. Of that subset, those physicians who report 25 e-prescribing encounters by Dec. 31 would receive a 1% bonus in 2012, assuming they do not opt instead for a Medicare bonus for meaningful EMR use in 2011.

More regulatory relief on the way?

The softening of the e-prescribing requirements is part of the Obama administration's initiative to provide regulatory relief across the federal government. Dept. of Health and Human Services officials are considering revising several of its regulations over the next two years. CMS also will identify and address conflicting requirements between the Medicare and Medicaid programs.

An initial review of the rules has determined that some regulations appear to be redundant and unhelpful, said Jack Lew, director of the White House Office of Management and Budget.

"It will be asked if some of these actually benefit patients or are they a matter of bureaucratic, anachronistic rules," Lew said.

The Medicare agency already has gathered input on revising potentially burdensome rules identified by the AMA and other members of organized medicine. They include:

• Requirements to provide translators for Medicare and Medicaid patients with hearing impairments or limited English proficiency.


• Misaligned incentive programs, such as EMR meaningful use and the physician quality reporting system.


• Overlapping claims reviews by auditors, such as Medicare administrative contractors and recovery audit contractors.


• Various Medicare documentation requirements.


• The prohibition on the use of Medicare consultation codes.


• Burdensome Medicare enrollment requirements.

This article was originally posted at http://www.ama-assn.org/amednews/2011/06/06/gvl10606.htm

 

HHS Releases NPRM Altering HIPAA Accounting Rule

the Department of Health and Human Services (HHS) released for public review a Notice of Proposed Rulemaking (NPRM) about the accounting provisions of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.  An advance copy of this NPRM is here.  The Federal Register publication of the rule is available here. There will be a 60-day comment period from the time of publication.

This proposed rule implements a statutory provision from the Health Information Technology for Economic and Clinical Health (HITECH) law.  It dramatically alters the current HIPAA accounting rule, with substantially increased burdens for covered entities and business associates.  For example, it requires a much broader set of disclosures to be tracked by covered entities and business associates.  More significantly, it also creates-based on HHS' general authority under HIPAA rather than the HITECH law-a new obligation for covered entities and business associates to track internal "access" to protected health information in a designated record set.

Over the next few weeks, companies in the health care industry-including all covered entities and their business associates-should evaluate these proposals carefully and should determine promptly whether they wish to comment on this proposed rule.

This article was originally posted at http://ping.fm/IybCT

 

Mass. extension center enrolls 2,500 providers to deploy EHRs

The Massachusetts Regional Extension Center has signed up more than 2,500 primary care providers to assist them in becoming meaningful users of health IT, making it the leader of the nation’s 62 centers in meeting its recruitment goal one year into the program.

After enrolling physicians, the next milestone will be for the extension centers to help physicians go live with certified electronic health records (EHRs) with electronic prescribing and quality reporting capabilities, according to a May 25 announcement from the Office of the National Coordinator for Health IT.

The health IT experience and skills of the extension center staff were crucial to reaching its goal so quickly, said Bethany Gilboard, director of health technologies for the Massachusetts eHealth Institute, which become the extension center in April 2010.

“We have three clinical relationship managers who are exceptional in working with the small physician practice,” she said.

The extension center program established by ONC is charged with helping 100,000 providers to overcome the hurdles of deploying certified EHRs and becoming meaningful users by 2012 to 2014.

Each extension center sets its own goal based on the number of providers that fit the description of a priority primary care provider. The Massachusetts center members include 45 percent of providers in small practices, 29 percent from community health centers, 16 percent from small practice consortia, and 10 percent from public hospitals.

The center has organized a roadmap that lays out the steps and expectations of physicians, consultants, and vendors to achieve meaningful use. If followed, the center guarantees that providers will qualify as meaningful users to be eligible for Medicare and Medicaid incentive payments from the Centers for Medicare and Medicaid Services, Gilboard said.

“We take a lot of the guesswork out for the small provider who has no one to turn to,” she said.
Provider members also have access to a special member portal of the extension center website where physicians can ask questions of their colleagues and learn from each other.

The Massachusetts center also systematically canvassed the state with emphasis on community hospitals with less capital resources to support their physicians in the transition to EHRs.

Staff contacted CIOs at all 72 hospitals in the state and found out if they had a strategy for establishing EHRs. They asked about the number of employed and independent primary care providers associated with the hospital. For those hospitals with a physician hospital organization or an independent practice association, the center offered a wholesale approach to membership for all primary care physicians. Alternatively, they supplied a draft letter that explained the benefits of the extension center and encouraged individual physicians to join.

Center staff also met with providers around the state at hospitals or medical society meetings through 25 educational summits and presentations. Once physicians enroll in the center, they’re invited to local meetings to share stories and hear about the experiences of local physicians who have already migrated to EHRs, known as meaningful use vanguards or MUVers.

This article was originally posted at http://ping.fm/45FMd

 

 

Patients more comfortable with doctors who use EHRs

Good news if you use an electronic health record (EHR) system—and a tip on how best to use it, courtesy of the Sage Healthcare Insights survey: Patients feel more comfortable with physicians who use an EHR system, and they believe that the information contained in the medical record is more accurate when they physically see the information being entered electronically.

The Sage Healthcare Division of software firm Sage North America conducted the survey among patients and physicians to determine attitudes regarding EHR adoption. “What we learned is patients like to see their verbatim information entered into the record as they said it, not as the doctor interpreted it,” says Betty Otter-Nickerson, president of the Sage Healthcare Division.

Other findings:

• About 42% physicians use an EHR system to document patient care, and about one-third use an EHR during patient encounters.


• 62% of physicians and 81% of patients have positive perceptions of documenting patient care electronically.


• 45% of patients had a “very positive” perception of their physicians or clinicians documenting patient care with a computer or other electronic device.


• More than 60% of physicians believe that the best benefit to using EHR is the access they have to patient records in real time.


• Physicians also believe that the ability to seamlessly share information with other doctors, pharmacies, and payers are among the most important benefits.


• The majority of survey respondents agreed with the statement that EHR systems will help improve the quality of healthcare (78% of patients, 62% of physicians).


• Although both physicians and patients believe that EHRs will help improve the quality of healthcare, both groups have concerns about privacy and the security of EHRs (81% of patients, 62% of physicians).


• Given their use of and exposure to the security measures used to keep electronic medical records secure, physicians using EHRs have fewer concerns about the security of records.


• 47% of patients recall seeing their physicians or their nurse/assistants taking notes in a computer or other electronic device, whereas only 39% of patients recall seeing their physicians or their nurse/assistants taking notes directly into computers during treatment.


• Physicians and patients agreed on the benefits of using electronic devices to document patient care during an encounter.


• The most important benefits of EHR systems agreed on by the two groups: 1) Provides real-time doctor access to patient medical records and histories; 2) When appropriate, helps physicians securely and seamlessly share information with other doctors, pharmacies, and payers; 3) Helps doctors make good decisions about patient care, ultimately driving the quality of patient care.

Overall, most physicians and patients agreed that medical records stored electronically will help improve patient care. Also, physicians and other clinicians who participated in the study said that EHRs are tool to help them perform their work more efficiently.

According to the survey, patients, on the other hand, increasingly expect their doctors to offer them access to EHRs and patient e-tools, and as a result, are encouraging their physicians to adopt more connected technologies, Otter-Nickerson says.

“Patients who participated in the survey said they had greater confidence in providers who use electronic records,” she says. “This suggests that there’s an opportunity for doctors to learn directly from their patients how to improve their practices and their patient relationships.”

The Sage Healthcare Insights study was conducted online in December 2010. The survey was sent to 7,738 physicians or other clinical users of a Sage product or service. The patient survey was sent to 18,000 healthcare consumers. Statistically, the sample size is large enough that the findings are applicable to the population.

This article was originally posted at http://www.modernmedicine.com/modernmedicine/InfoTech+Bulletin/Patients-more-comfortable-with-doctors-who-use-EHR/ArticleStandard/Article/detail/724096?contextCategoryId=44687

 

Study: EMRs speed genetic health studies

Recruiting thousands of patients to collect health data for genetic clues to disease is expensive and time consuming. But that arduous process of collecting data for genetic studies could be faster and cheaper by instead mining patient data that already exists in electronic medical records, according to new Northwestern Medicine research.

In the study, researchers were able to cull patient information in electronic medical records from routine doctors' visits at five national sites that all used different brands of medical record software. The information allowed researchers to accurately identify patients with five kinds of diseases or health conditions – type 2 diabetes, dementia, peripheral arterial disease, cataracts and cardiac conduction.

"The hard part of doing genetic studies has been identifying enough people to get meaningful results," said lead investigator Abel Kho, MD, an assistant professor of medicine at Northwestern University Feinberg School of Medicine and a physician at Northwestern Memorial Hospital. "Now we've shown you can do it using data that's already been collected in electronic medical records and can rapidly generate large groups of patients."

The paper is published in Science Translational Medicine.

To identify the diseases, Kho and colleagues searched the records using a series of criteria such as medications, diagnoses and laboratory tests. They then tested their results against the gold standard – review by physicians. The physicians confirmed the results, Kho said. The electronic health records allowed researchers to identify patients' diseases with 73 to 98 percent accuracy.

The researchers also were able to reproduce previous genetic findings from prospective studies using the electronic medical records. The five institutions that participated in the study collected genetic samples for research. Patients agreed to the use of their records for studies.

Sequencing individuals' genomes is becoming faster and cheaper. It soon may be possible to include patients' genomes in their medical records, Kho noted. This would create a bountiful resource for genetic research.

"With permission from patients, you could search electronic health records at not just five sites but 25 or 100 different sites and identify 10,000 or 100,000 patients with diabetes, for example," Kho said.

The larger the group of patients for genetic studies, the better the ability to detect rarer affects of the genes and the more detailed genetic sequences that cause a person to develop a disease.

The study also showed across-the-board weaknesses in institutions' electronic medical records. The institutions didn't do a good job of capturing race and ethnicity, smoking status and family history, all which are important areas of study, Kho said. "It shows we need to focus our efforts to use electronic medical records more meaningfully," he added.

This article was originally posted at http://ping.fm/rcnib

CMS explains how to get paid EHR incentives

The Centers for Medicare and Medicaid Services will pay physicians four to eight weeks after they verify that they have satisfied conditions for meaningful use of electronic health records. That means that the soonest that CMS will issue incentives is in May.

Providers will not receive the incentive payments within that time frame, however, if they have not yet met the threshold of $24,000 for allowed charges in claims for covered services to Medicare beneficiaries during 2011, CMS said in an announcement April 28.

[Related: HHS calls value-based pricing program 'historic change' in which Medicare pays for quality, not quantity of care.]

CMS launched meaningful use attestation on April 18. Once met, a qualifying physician will receive $18,000 in incentives for fulfilling the first stage of meaningful use.

The payments to physicians for the Medicare EHR Incentive Program are based on 75 percent of the estimated allowed charges for their covered during the entire payment year.

If a physician does not reach the threshold by the end of 2011, CMS said it expects to pay the incentive to the provider in March 2012, after allowing 60 days beyond the end of the 2011 calendar year for all pending claims to be processed.

CMS will use a payment file contractor to generate electronic payment of the inventives through the same bank account that providers receive payment for their Medicare claims, according to the announcement

[Editor's Desk: This Week in Government Health IT.]

To receive the maximum amount of $44,000 in incentives over the five years of the program, physicians must begin participating in 2011 or 2012. Providers who supply services in a "health professional shortage area" may receive additional incentives, CMS said.The bonus will be separate lump-sum payments within 120 days after the end of the year.

EHR incentives for hospitals and cirtical access hospitals start with a $2 million base payment. They will receive initial and final payments.

States manage the Medicaid EHR Incentive Program, in which physicians can receive up to $63,750 over six years. Medicaid hospitals also begin with a $2 million base payment. Timing of the states’ payment of incentives varies according to their program, CMS said.

This article was originally posted at http://ping.fm/Dj8kR

GAO says VA not transparent enough

The Veterans Administration’s new resource allocation process uses a standardized electronic model, but the transparency of networks' decisions for allocating resources to medical centers is limited, a new GAO report concludes.

[Editor's Desk: This Week in Government Health IT.]

In its April 29 report, GAO recommends that the VA require networks to provide rationales for all adjustments made to allocations proposed by VA's resource allocation model, and that it develop written policies to document practices for monitoring resources. The VA concurred with these recommendations.

The new process involves three steps:

• First, VA headquarters proposes medical center allocation amounts to networks using a standardized resource allocation model. The model includes a standardized measure of workload that recognizes the varying costs and levels of resource intensity associated with providing care for each patient at each medical center.


• Second, network officials review the proposed amounts and have the flexibility to adjust them if they believe that certain medical centers' resource needs are not appropriately accounted for in the model.


• Third, networks report final medical center allocation amounts to VA headquarters and any adjustments made to the allocation amounts proposed by the model.

VA headquarters did not ask networks to report reasons for each adjustment made to allocation amounts; networks reported reasons for some adjustments, but not for others.


VA officials said that the new network resource allocation process was not intended to be used to question networks' decision making, but to increase the transparency of networks' allocation decisions to VA headquarters while maintaining network flexibility.

However, absent rationales from networks on all adjustments made to medical center allocation amounts, transparency for decisions made through the allocation process is limited. Furthermore, understanding why networks make adjustments is key in determining if any modifications to the model are needed for subsequent years.

VA officials told GAO that they intend to conduct annual assessments of the new resource allocation process, including a review of adjustments to the model, to identify areas for improvement.

[See also: VA, DOD to incorporate open source in EHR.]

VA centrally monitors the resources networks have allocated to medical centers to ensure spending does not exceed allocations, but does not have written policies documenting these practices for monitoring resources. VA monitors resources through two primary practices – automated controls in its financial management system and regular reviews of network spending.

Specifically, VA's financial management system electronically tracks the amount of resources that networks and medical centers have available--the resources allocated, less the resources already spent--and prevents medical centers from spending more than what they have available by rejecting spending requests in excess of available resources.

In addition, each month VA headquarters officials compare each network's spending with what the network planned to spend and determine whether spending is on target, and whether any differences from the plan are significant.

However, VA headquarters does not have written policies documenting the agency's practices for monitoring resources, which is not consistent with federal internal control standards. These standards state that internal controls should be documented, and all documentation should be properly managed, maintained, and readily available for examination.

Without written policies, there is an increased risk of inconsistent monitoring of VA network and medical center resources.

This article was originally posted at http://ping.fm/UT5ro

 

Federal Grant Program Geared Toward Rural Health IT Adoption

The Health Resources and Services Administration at HHS has announced it will dole out $12 million in up to 40 grants to help rural hospitals and physicians meet meaningful use criteria, AHA News reports.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments (AHA News, 4/28).

Grant Details

The grants will be distributed through the Rural Health IT Network Program to rural health care providers who work in formal alliances, coalitions, networks or partnerships (Barr, Modern Healthcare, 4/28).

The grant funding can be put toward:

• Buying health IT equipment;


• Developing strategic plans; and


• EHR training (AHA News, 4/28).

The grant synopsis said that after finishing the grant program, "a network should have completed a thorough strategic planning process, business planning process and have a sound strategy in place for sustaining its operations."

This article was originally posted at http://ping.fm/xNcyw

Physical Security for Data Centers

Well-publicized health information breach incidents are serving as important reminders that paying attention to the physical security of data centers is a vital component of any information security strategy.

For example, in the largest breach reported so far under the HITECH Act breach notification rule, insurer Health Net says 1.9 million individuals may have been affected when server drives were discovered to be missing from a data center managed by IBM (see: Health Net Breach Tops Federal List). While details about the incident remain sketchy, the breach reinforces the need to pay attention to physical security details.

The HIPAA security rule spells out more than a dozen requirements for physical security, says Andrew Weidenhamer, audit and compliance manager at SecureState (See: Physical Security: Timely Tips). The National Institute of Standards and Technology offers HIPAA security rule compliance guides, he points out.

Key Physical Security Steps

The three most important physical security steps to take to protect data centers, Weidenhamer says, are:

• Make sure that all critical servers are housed behind locked doors using auditable access control measures;


• Limit data center access to only those individuals who have a legitimate need;


• Ensure that visitors, contractors and others are always escorted within the secure area.

Montgomery County Memorial Hospital, a 25-bed critical access facility in Red Oak, Iowa, takes all these steps at its new data center in a recently opened addition to the hospital, says Ron Kloewer, CIO.

All hospital employees use RFID proximity badges that enable them to open doors to restricted areas, based on their roles. Only about eight staff members have access to the data center, he notes.

A camera at the door to the data center ensures that "every coming and going from the data center is recorded," he adds. And directory maps of the hospital don't display the location of the data center.

PCI, HIPAA Compliance

An often overlooked physical security measure involves making sure that vendors hired to handle offsite storage of backup media have demonstrated their compliance with all relevant federal regulations, including HIPAA and the Payment Card Industry Data Security Standard, or PCI DSS, Weidenhamer says.

He also urges healthcare organizations to encrypt backup tapes, as well as all media and devices that store protected health information. "Encryption is the single best way to protect sensitive data," he notes. "Healthcare organizations are going to be in a much better position in the event they are breached if the data is encrypted."

A recent major health information breach incident illustrates the value of encrypting backup tapes. New York City Health and Hospitals Corp. notified 1.7 million individuals of a breach that occurred when unencrypted backup tapes were stolen from a truck that was transporting them for offsite storage (See: New York Breach Affects 1.7 Million).

Montgomery County Memorial Hospital will implement encryption of its backup tapes stored offsite in the coming weeks, Kloewer notes. Plus, it's developing a strategy for encrypting drives on servers in its data center.

"Healthcare organizations need to perform a data flow analysis to determine where all sensitive data is located, classify these assets and data and then implement security controls," Weidenhamer stresses.

Business Continuity

A good business continuity plan also can help ensure the integrity, availability and security of information, Kloewer notes.

The Iowa hospital has a fiberoptic link to an offsite backup data center for use in an emergency, he notes. To hold down costs, the hospital didn't use a suspended ceiling in its new data center, keeping it open instead so that heat would not be trapped near equipment if redundant cooling systems failed.

For more information on Montgomery County Memorial Hospital's security strategies, see: Security Spending Up at Rural Hospital.

This article was originally posted at http://ping.fm/j2hC1


 

 

CMS says more docs opting for evidence of effectiveness in treatments

More physicians are participating in “pay for reporting” programs that focus on using quality measures and electronic prescribing, according to the Centers for Medicare and Medicaid Services.

Its data also shows that physicians are increasingly turning to treatments that offer the best evidence of effectiveness.

In a report covering the results of the 2009 Physician Quality Reporting System and the ePrescribing Incentive Program, the agency’s most up-to-date data, CMS said that 119,804 physicians and 12,647 practices who reported data on quality measures to Medicare received a total $234 million compared with $36 million paid out in 2007, the first year of the program.

Under the e-prescribing program, CMS paid $148 million to 48,354 physicians in 2009, the first payment year for the program.

The quality reporting and e-prescribing programs are part of a broad effort to encourage providers to adopt practices that improve patient care.

Earlier this year, CMS launched the Medicare and Medicaid EHR Incentive Program, through which providers can quality for incentive payments for becoming meaningful users of certified electronic health records EHRs).

Physicians will also see data on how well they perform compared with their peers on quality measures as CMS’ Physician Compare Web site expands to include quality information by 2013.

Many of the participants in the quality reporting program practice in office settings, according Dr. Donald Berwick, CMS administrator.

“This is the care setting for which we have the least amount of data about quality of care,” he said in announcing the results April 19. The quality reporting and e-prescribing programs offer a means through which to assess the quality of care that patients receive in ambulatory settings, he added.

Information from the quality reporting program demonstrate growing rates in how often providers report that they are using evidence-based care practices. By collecting data about care practices, CMS can identify improvements in care for Medicare beneficiaries, and ultimately all Americans, Berwick said.

[See also: CMS to fine-tune technical guidelines for standards in stage 2.]

Providers have increased the frequency of using the recommended care by 10.6 percent based on 99 quality measures, according to the report.

Physicians most frequently reported measures that they had adopted and used EHRs to help manage patient care; worked with patients with diabetes to control blood sugar to lessen potential complications of the disease; and performed electrocardiograms in the emergency department to help diagnose patients with chest pain for a potential heart attack.

In 2009, physicians showed improvement over 2007 rates in stopping post-surgical antibiotics to prevent overmedication and the formation of potentially drug-resistant "superbugs," communicating with patients with diabetes about potentially damaging eye-related complications; and recommending beta-blocker drugs to patients with a specific form of heart failure.

This article was originally posted at http://ping.fm/87V49

 

AAFP Calls for 'Robust Investment' in Primary Care Physician Workforce

Federal investment in health careis necessary to "transform health care to achieve optimal, cost-efficient health for everyone," said the AAFP in recent written testimony (4-page PDF; About PDFs) to the House Appropriations Committee. That is why the Academy is urging the committee to make a robust investment in the nation's primary care physician workforce by financially supporting programs critical to building and strengthening the nation's primary care physician pipeline.

"We recognize the difficult decisions (that) our nation's budgetary pressures present," said the AAFP. However, the Academy urged the House Appropriations Subcommittee on Labor, Health and Human Services, and Education "to make a robust fiscal year 2012 investment in our nation's primary care physician workforce ... to ensure that it is adequate to provide efficient, effective health care delivery addressing access, quality and value."

Specifically, the Academy called on the committee to provide at least $449.5 million for training programs covered by Title VII of the Public Health Service Act and administered by the Health Resources and Services Administration, including at least

• $140 million for primary care training and enhancement as authorized by Title VII, Section 747 of the Public Health Service Act;


• $10 million for development grants for teaching health centers; and


• $4 million for rural physician training grants.

Failure to provide adequate funding for Title VII programs "would destabilize ongoing efforts to increase education and training support for family physicians, exacerbating primary care shortages and further straining the nation's health care system," said the AAFP."We urge the committee to increase the level of federal funding for primary care training to reinvigorate medical education (and) residency programs, as well as academic and faculty development in primary care to prepare physicians to support the patient-centered medical home."

The AAFP called for other funding increases, as well, including President Obama's requested funding of $418.5 million for the National Health Services Corps and at least $405 million for the Agency for Healthcare Research and Quality, or AHRQ.

"AHRQ's investment in patient-centered outcomes research will help Americans make the informed decisions we must make to focus on paying for quality rather than quantity," said the AAFP. "By determining what has limited efficacy or does not work, this important research can spare patients from tests and treatments of little value."

Among other programs that are critical to the primary care physician pipeline, according to the AAFP, is the teaching health center program, which provides resources to qualified, community-based, ambulatory care settings that operate as primary care residency programs. These settings include federally qualified health centers, rural health clinics, community mental health centers, health centers operated by the Indian Health Service and centers that receive Title X grants.

In addition, the Academy continues to call for reforms to graduate medical education programs that encourage training of primary care residents in nonhospital settings, which is where most primary care is delivered.

"We were pleased that the Patient Protection and Affordable Care Act authorized a mandatory appropriations trust fund of $230 million over five years to fund the operations of teaching health centers," the AAFP said. "However, if this program is to be effective, there must be funds for the planning grants to establish newly accredited or expanded primary care residency programs."

The Academy also addressed rural health needs in its testimony. For example, the Rural Physician Training Grants Program helps medical schools recruit students who are more likely to practice medicine in rural communities. "This modest program ... will help provide rural-focused training and experience and increase the number of recent medical school graduates who practice in underserved rural communities," the AAFP said.

This article was originally posted at http://ping.fm/1dcv1

Care for the Underserved, Interprofessional Learning Focus of Student-run Clinic

For more than two months, medical and nursing students from Case Western Reserve University, or CWRU, in Cleveland have been training together as they provide primary care at a student-run clinic for the city's underserved. Supervised primarily by family physicians, the interprofessional teams participating in this pilot manage all aspects of patient care, from preliminary intake and assessment of vitals to clinical evaluation and plan of care.


The CWRU Student-run Free Clinic, which is scheduled to open officially in October, is one component of an interprofessional learning initiative aimed at bringing together students from the CWRU School of Medicine and Frances Payne Bolton School of Nursing to learn to work as health care partners for patients. These future physicians and nurses have the opportunity to collaborate not only in clinical care but also in the daily management and administration of a community clinic.

Organized as part of a vision to increase access to care for the underserved in Cleveland, the clinic represents a collaboration with The Free Medical Clinic of Greater Cleveland, which has a nearly 40-year history of serving as a critical health safety net for patients in Cleveland. The clinic is designed to be self-sustaining, and participating students raise money themselves for operating expenses.

"There's a lot of energy among the students," said George Kikano, M.D., chairman of the family medicine department. "The idea is that the medical and nursing students learn together."

Collaboration Right From the Beginning

Tammy Wang, a third-year medical student and one of the four founders of the clinic, told AAFP News Now that the clinic's founders -- two medical students and two nursing students -- received encouragement from both the medical school and the nursing school. Working together for more than a year, the student founders set up the clinic's organizational structure.

For patient care, a medical student and a nursing student are paired as a team. The team performs patient histories and physical exams, presents findings to attending preceptors, usually family physicians, and discusses appropriate plans of care, including medications and connections to community resources.

The collaboration continues outside of the clinic sessions, with medical and nursing students working together to plan all logistics for the clinic. The clinic's board of directors, in fact, is made up of seven medical students and four nursing students.

It is anticipated that both CWRU medical and nursing students will acquire team-building skills as they voluntarily participate in the student-run free clinic, according to Wanda Cruz-Knight, M.D., who is an assistant professor in the medical school's family medicine department, director of the school's predoctoral program and faculty adviser to students in the clinic.

And, she added, the fact that the clinic is being managed by the medical and nursing students allows them to incorporate aspects of business, office practice and clinical models they've identified as being effective.

Mutual Respect and Effective Communication

"Working with nursing students has absolutely been a valuable experience," Wang said. "Though we have differences in our training, our skills can still complement one another to provide more comprehensive patient care.

"Working together at this point in our education builds mutual respect and effective communication skills for two disciplines that traditionally may have held some biases toward one another," Wang added.

Nicholas Kucher, a first-year medical student, leader of the campus family medicine interest group and volunteer coordinator of the clinic, agreed. "We're all learning as we go, but working with each other is key, because there is so much to coordinate and new issues are popping up," said.

"The key point that we want participants to take away is that medicine is no longer centered around someone with an M.D. It is centered around the patient, and different perspectives and training, such as with nurse practitioners, are important in providing the best possible treatment," Kucher added.

Alyssa Wagner, a first-year nursing student and a clinic director, told AAFP News Now that nursing students also gain special knowledge from the collaboration.

"The nursing students get to learn more about differential diagnoses, we both (medical and nursing students) get to work on our assessment skills, and the medical students get to participate in patient education. We get to use the strengths from each of our fields to provide the best care we can for our patients," she said.

After each of the clinic sessions during the recently completed pilot, the medical and nursing students met to discuss what went well, what didn't and what could be improved. They're using the results of this exercise to design a patient satisfaction and well-being survey that will set measures for future quality assessment and improvement activities.

Medical Education Benefits

CWRU's collaborative learning initiative offers a real-world model of recommendations in the Joint Principles for the Medical Education of Physicians as Preparation for Practice in the Patient-Centered Medical Home (12-page PDF; About PDFs) issued by the AAFP and other primary care groups last December.

Promulgated as a guide to the education of physicians in the context of a reformed health care environment that will rely heavily on primary care, the principles say, for example, that medical students should learn to work effectively with others as a member or leader of a health care team. Students also should be able to articulate the roles, functions and working relationships of all members of the team and apply knowledge of leadership development, quality improvement, change management and conflict management.

AAFP Vice President for Education Perry Pugno, M.D., M.P.H., who helped develop the joint principles, praised the CWRU initiative as embodying many of the concepts on which those principles were founded.

"This program is a prime example of what we hoped to accomplish in the creation of the new joint principles -- namely, an immersion experience for health professions students in actually delivering patient care in a highly functional interdisciplinary setting," Pugno told AAFP News Now. "This isn't just book learning; it's pragmatic hands-on learning."

And the learning continues.

Wang said the students presently are analyzing data from the four pilot clinic sessions, which provided care to more than 50 patients, and considering strategies to improve clinical care. Possible future directions include the incorporation of additional professional schools to provide patients with even more resources, she said. 

The latest challenge: adopting electronic medical records

For those of you who do not know me personally, I am an internist and have been in private practice in central Florida for more than 30 years. Like so many of you, I have had to make changes -- expensive changes -- over the years to keep my office up to date, my practice competitive, and to provide better service to my patients.

Right now, one of the biggest challenges small offices like mine are facing is the requirement to adopt health information technology -- health car IT -- such as electronic medical records and electronic prescribing systems. Both are good ideas. Both ultimately will improve efficiency and should allow physicians to do more of what we are trained to do, and that is spend time with our patients.

Many physicians, however, are seeing a very rough passage between the here and now and full adoption of electronic medical records.

As a voice for America's physicians, the AMA is involved both in Washington and on the ground to ease the transition.

In December, the AMA was one of several dozen professional associations that co-signed a letter to Health and Human Services Secretary Kathleen Sebelius about the inconsistencies in requirements between the federal e-prescribing and EMR incentive programs. We petitioned for relief until those inconsistencies are rectified. The most troubling thing about the inconsistencies is a policy in the electronic prescribing program that will penalize physicians in 2012 if they do not e-prescribe in the first six months of 2011.

The AMA believes the penalty policy is unreasonable in that it will force physicians to purchase stand-alone e-prescribing software just to avoid penalties -- software most of them will end up discarding when they transition to a complete EMR system.

Under law, physicians cannot receive incentives from both programs simultaneously, yet they will face a penalty if they decide to participate in one over the other.

A subsequent report by the Government Accountability Office echoed the AMA's concerns about inconsistencies within the two federal health IT incentive programs.

As AMA Secretary Steven J. Stack, MD, has stated, "We continue to urge immediate action by CMS to harmonize the conflicting e-prescribing and [electronic health record] incentive programs in order to support effective health IT adoption."

Since the inception of requirements for the federal EMR incentive program, the AMA has strongly advocated for greater flexibility in adopting the meaningful use requirements for EMRs so more physicians can successfully participate.

We submitted comments to HHS during the creation of the first stage of meaningful use criteria and more recently responded to the proposed stage 2 criteria to help ensure physicians are not overly burdened with requirements that would prevent them from successful participation in the incentive program.

A survey by the Markle Foundation in February showed that nearly half of physicians indicate they are "not too" or "not at all" familiar with meaningful use requirements.

Not surprisingly, a recent Black Book Rankings user survey found that fewer than 10% of EMR purchasers are on track to meet meaningful use requirements.

More than 90% said they lack substantive support from EMR vendors, and 89% have delayed implementation because of the cost of additional support from EMR vendors and/or consultants. Significant numbers of others said they lacked trained staff (or available staff) to properly implement an EMR system or are unprepared and underfunded to rectify the difficult system interfaces.

It's a difficult situation all the way around for many physicians, made worse by the feeling by many practices that they must move quickly to adopt a complete health IT solution.

Make no mistake: The AMA is committed to widespread health IT adoption that can help streamline the clinical and business functions of a practice, but this takes time. We are working hard to help physicians understand the requirements of the federal incentive programs and how they can qualify for them. Even more important, we want to advise physicians to take the time to find the right solution for their practice.

While federal incentives for demonstrated meaningful use of electronic medical records begin this year, physicians don't have to rush into adopting a system today. If a practice reports on just the last 90 days of the year, that will qualify for meaningful use incentives, and practices even can wait to adopt a solution until 2012 and be eligible for full payment under the meaningful use program. Physicians should take the time to explore their practice needs, assess their practice's readiness to adopt health IT and select the right system for the practice -- and its patients.

Recognize that there are alternatives to implementing more complex systems, such as adopting a certified patient registry and certified e-prescribing application that also can qualify a doctor for stage 1 of meaningful use incentives and may be sufficient alone, or in conjunction with other modules, to qualify for subsequent stages as well. Such an approach can cost less, be easier to implement and be far less disruptive to work flow. But no matter the decision, it should be made with care and deliberation. In the Black Book Rankings survey, 82% of those who adopted health IT programs reported that a hurried selection of an EMR vendor produced negative consequences.

Dr. Thomas Fuller, a 17th-century British physician, noted, "All things are difficult before they are easy." That is certainly the case with EMRs.

In addition to advocating on behalf of physicians in Washington, the AMA is on the ground with support for physicians' offices that are moving forward in adopting health IT.

To this end, the AMA has many free resources available to help physicians with successful selection, purchase and implementation of health IT. We have information and tools to help physicians better understand the federal incentive program requirements and a wealth of additional health IT resources. You will find it all online (www.ama-assn.org/go/hit).

Today and always, the AMA is committed to supporting the physician community as we try to find a way through these murky waters.

This article was originally posted at http://www.ama-assn.org/amednews/2011/04/04/edca0404.htm

Obama deficit plan includes strengthened Medicare pay board

President Obama on April 13 rebutted a House Republican plan to trim $4 trillion worth of federal deficits over a decade with his own proposal that he said would protect guaranteed benefits in Medicare and Medicaid.

Obama also proposed that the Medicare Independent Payment Advisory Board be directed to enact even deeper reductions than outlined. The 15-member board was created by the health system reform law to improve Medicare quality and cut costs when the program's per capita growth rate exceeds specific targets. The IPAB, which is set to begin its work Jan. 15, 2014, could call for pay cuts to physicians and others that could be overridden only by substantial majorities in both houses.

GOP leaders have vowed to repeal the IPAB and the rest of the health reform law. A bill by Rep. Phil Roe, MD (R, Tenn.), that would accomplish the former had 83 co-sponsors, including four Democrats, at this article's deadline.

The American Medical Association also opposes the IPAB as structured, noting that physicians already are subject to deep pay cuts under Medicare's sustainable growth rate formula that lawmakers have had to override.

"We have strong concerns about the potential for automatic, across-the-board Medicare spending cuts because they are not consistent with meeting the medical needs of patients, which is our primary focus," said Ardis Dee Hoven, MD, chair of the AMA Board of Trustees.

Obama, however, proposed using the strengthened authority for the IPAB and other health care savings in his proposal to pay for a reform of the SGR formula, estimated to cost $300 billion over a decade.

The other health care proposals in the Obama deficit plan include limiting states' ability to draw higher Medicaid payments through funding loopholes and establishing tighter limits on prescription drug spending in Medicare and Medicaid. The president also proposed establishing a single rate for federal Medicaid payments that would increase automatically during recessions.

Obama said he would oppose any reform that fundamentally alters the commitments the nation has made -- in the form of Medicare and Medicaid -- to health care for seniors, the poor and the disabled. The GOP's budget plan would limit federal health spending by changing Medicare into a voucher program that would help seniors buy private coverage. It also would reduce federal Medicaid payments to states and allow states more flexibility on how they run their Medicaid programs.

Obama criticized the House Republican plan -- known as the Path to Prosperity -- for including $1 trillion in tax cuts to wealthier Americans while asking middle- and lower-income people to pay more for health care and college.

"In the last decade, the average income of the bottom 90% of all working Americans actually declined," Obama said. "Meanwhile, the top 1% saw their income rise by an average of more than a quarter of a million dollars each. That's who needs to pay less taxes?" Obama also said he would not approve further extension of the Bush tax cuts to wealthier people.

The House adopted the GOP's fiscal 2012 budget plan by a vote of 235-193 on April 15, with no Democratic support and only four Republicans voting against it. The budget resolution would set fiscal 2012 spending limits for Congress, but it faces strong opposition from Democratic leaders in the Senate.

2011 cuts affect reform

Congress and Obama avoided a partial government shutdown on April 8 by agreeing to about $38 billion in reductions over the previous year in a fiscal year 2011 spending measure that will fund the federal government until Oct. 1. In doing so, Obama and congressional Democrats agreed to cut or repeal three programs in the health reform law, including:

• Ending the Consumer Operated and Oriented Plan, created to foster the development of nonprofit health plans in individual and small group markets.


• Ending the Free Choice Voucher program to allow certain workers in 2014 to use their employers' contribution on health coverage to pay premiums for a health insurance exchange plan or a private health plan.


• Reducing the State Health Access Grants program, which awards money to states to help them expand affordable health care coverage to the uninsured.

In addition, the deal repeals $3.5 billion in performance bonus payments to states that meet certain enrollment goals in Medicaid and the Children's Health Insurance Program. The 2009 CHIP reauthorization created the program.

House Republican support for the 2011 spending bill wavered before the House adopted the package on April 14 on a 260-167 vote. In part, GOP reluctance came from the fact that the Congressional Budget Office concluded that only $352 million of the cuts actually would affect spending in fiscal 2011, which ends on Oct. 1. The CBO also said the measure would cut spending by up to only $25 billion between 2012 and 2016, with the rest of the cuts only reducing dollars Congress is authorized to spend, not dollars Congress is likely to spend.

Fifty-nine House Republicans joined the majority of Democrats to vote against the 2011 spending package on April 14, but 81 Democrats crossed the aisle to help adopt it. The Senate approved the measure 81-19, and Obama signed it into law on April 15.

The CBO did not detail which cuts it deemed part of the $25 billion of real cuts. However, a House Appropriations Committee summary of the $38 billion package outlined about $1.5 billion in cuts to health programs, including $600 million in reduced funding to community health centers.

"This cut is especially perplexing at a time when our nation and the Congress are focused on reducing health care costs," said Tom Van Coverden, president and CEO of the National Assn. of Community Health Centers.

This article was originally posted at http://www.ama-assn.org/amednews/2011/04/25/gvsa0425.htm

 

 

Homeland Security plans EHR for detainees

The Homeland Security Department plans to acquire an electronic health record system to improve the quality and efficiency of its health care for illegal aliens and other foreign fugitives detained by the Immigration and Customs Enforcement agency.

DHS clinicians and staff at 22 locations will use the electronic health record (EHR) to replace the current manual and stand-alone automated systems.

[See also: VA, citing taxpayer savings, seeks open source EHR.]

DHS is gauging vendor expertise to deploy a comprehensive system for patient operations, reporting and statistical analysis within a correctional environment, according to a request for information announcement in Federal Business Opportunities.

The agency anticipates awarding a contract in September to deploy the EHR system in fiscal 2012 as part of a five-year contract.

The potential vendor’s system must be certified by an organization authorized by the Office of the National Coordinator for Health IT as meeting the functions for meaningful use requirements. Those features include being able to exchange patient records using standard summary care and message formats when detainees move between facilities.

[Related: ONC's draft Federal Health IT Plan: Realistic in a reasonable timeframe?]

The system should also be able to perform detainee intake screening, scheduling, master medication list management and clinical decision support, according to the notice.

Last year, DHS published an announcement for such a system but ran into delays in the solicitation process, so it released another request for information, April 6 with responses due April 25.

This article was originally posted at http://ping.fm/RJLFY