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Project
To Test Payment For High
Quality Care
Many
Doctors Don’t Discuss
Useful, Uncovered Treatments
With Patients
Veterans
Affairs Will Allow
Patients Online Access
To Medical Records
Report
Says EMRs Are Easier
To Understand, Than
Paper Records
HHS
To Support Paperless
Medical Records System
NCQA
Issues New HEDIS Measures
With Clinical Care,
Customer Service
Public
Hospital Group Backs
Hospital Quality Initiative,
Urges Participation
JCR
Calls For Poster Presentations
For Ambulatory Care Conference
CMWF
Makes Business Case
For Quality Case Studies
Available
Project
To Test Payment For
High Quality Care
The
Centers for Medicare
and Medicaid Services
and the Premier hospital
purchasing alliance
have announced a groundbreaking
pilot program that
will reward top performing
hospitals with higher
Medicare payments.
At
a press conference
this week, CMS and
the Premier hospital
purchasing alliance
unveiled a three-year
demonstration that
will award bonuses
to hospitals based
on performance on 35
quality measures for
heart attack, heart
failure, pneumonia,
coronary artery bypass
graft, and hip and
knee replacements.
Medicare will pay bonuses
totaling $7 million
per year for a total
of $21 million during
the pilot.
Medicare
officials explained
that all participating
hospitals will receive
baseline measurements
for the first year.
As hospitals improve
performance on the
indicators over the
next three years, they
will receive an additional
payment of 2% for being
in, or moving into
the top 10% of participating
hospitals and 1% for
the next 10%.
However,
CMS Administrator Thomas
Scully said hospitals
still in the bottom
20% of performers in
the third year of the
project will face reduced
payments—a 2% reduction
for the lowest 10%
and a 1% reduction
for the next lowest
10%. Scully explained
that if every hospital
improves on the indicators
and moves into the
top 20% of performers,
all will get bonuses.
In addition, if all
hospitals improve to
rates higher than the
lowest 20%, based on
the baseline measurement,
none will receive reductions
in the third year of
the demonstration.
Hospitals
in the top 50% of performers,
but not in the top
20%, will receive recognition
but no additional funds.
"The
costs of this demonstration
will be partly offset
by reductions in medical
costs, especially in
reductions of unnecessary
hospital readmissions
because of better care
in the initial inpatient
stay," said Scully,
who called the demonstration
"budget neutral."
Scully
added that the current
Medicare law only allows
CMS to pay more for
higher performance
under a demonstration
project, but he expressed
hope that Congress
would consider changing
the law to allow for
expansion of the initiative
to all hospitals.
CMS
will rank the hospitals
by their performance
in as many as eight
high-volume clinical
areas and all rankings
will be posted on Medicare.gov
in 2004. As many as
300 of Premier’s 1,500
member hospitals are
expected to participate,
CMS said.
For
more info, www.hhs.gov/news.
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Many
Doctors Don’t Discuss
Useful, Uncovered Treatments
With Patients
Nearly
one in three doctors
withholds information
from patients about
useful medical services
that aren’t covered
by their health insurance
companies, according
to a new study.
Study
authors say their work
offers the first empirical
evidence for what many
have long suspected:
that coverage limitations
imposed by managed
care are inhibiting
communications between
doctors and patients.
Researchers
surveyed 700 physicians
and asked how often
they had decided not
to offer a "useful
service to a patient
because of health plan
rules." Forty-two
percent said never,
and 27% said rarely.
But 23% said "sometimes,"
and 8% said "often"
or "very often."
Most
medical codes of ethics
strongly discourage
physicians from holding
back information on
useful care from their
patients because of
coverage rules. However,
significant numbers
of physicians are withholding
information from some
patients as a way of
dealing with restrictive
coverage rules, said
lead study author Matthew
Wynia, director of
the Institute for Ethics
at the American Medical
Association in Chicago.
·
Wynia
said that failing to
address uncovered services
also denies patients
the opportunity to
argue to change coverage
restrictions, and can
lead to distrust of
physicians.
Physicians
who cared for larger
volumes of Medicaid
patients were more
likely to sometimes
withhold information
on useful but uncovered
treatments, the report
said. Researchers said
that this attitude
may contribute to racial
disparities in health
care, since African
Americans are much
more likely than whites
to be covered by Medicaid.
Financial
pressures also appear
to play a role, it
said. Physicians whose
incomes depended to
a large extent on risk-sharing
arrangements with managed
care plans for patient
care costs tended to
say they did not offer
some patients useful
but uncovered services.
For
more info, www.healthaffairs.org.
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Veterans
ffairs Will Allow Patients
Online Access To Medical
Records
The
Department of Veterans
Affairs will offer
veterans who seek treatment
at its facilities access
to their records over
the Internet starting
next spring.
Although
patients will not be
able to view complete
records, they will
get access to copies
containing data that
VA clinicians consider
most relevant, the
report said. Data will
include progress notes,
discharge summaries,
medications, ECGs and
most laboratory results.
To
view their information
online, patients will
have to sign up for
the offering, called
MyHealtheVet.
They also will be able
to authorize relatives,
friends and any physician
treating them to access
their records, the
report said.
Patients
also will be able to
request corrections
or amendments to their
records by contacting
the VA medical center
where their records
are maintained. The
VA said it eventually
plans to electronically
exchange data with
non-VA physicians and
facilities. However,
physician use of electronic
medical records will
have to become more
pervasive, and the
health care industry
will have to adopt
uniform clinical data
standards, the article
said.
The
report said VA believes
that making records
accessible online to
patients will improve
care and communication
between patients and
physicians.
Given
the size and national
reach of the VA, some
observers think the
VA could help boost
industry adoption of
online personal health
records.
For
more info, www.va.gov.
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Report
Says EMRs Are Easier
To Understand, Than
Paper Records
Electronic
medical records are
easier to understand
and contain more complete
patient information
than paper records,
according to a British
study.
The
study focused on whether
paperless records contained
less information than
paper records, and
whether that information
was harder to receive.
The
study included 53 general
practitioners—25 using
EMRs and 28 using paper
records—who each recorded
10 patient consultations.
Eighty-nine percent
of the electronic records
were fully understandable,
compared with 70% of
the paper ones. All
of the EMRs were legible,
compared with 64% of
paper records, the
study said.
In
cases where a physician
prescribed drugs, 87%
of EMRs and 66% of
paper records specified
the proper dose. Neither
set of doctors could
recall a greater proportion
of specific patients
or consultations, but
39% of physicians who
used electronic records
could recall advice
they gave to patients,
compared to 27% of
doctors using paper
records.
The
researchers said they
could not conclude
that high quality electronic
records lead to better
clinical care or outcomes,
but that good records
are essential patient
protection and a first
step to good clinical
decision making.
For
more info, www.bjm.com.
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HHS
To Support Paperless
Medical Records System
HHS
has announced two new
steps in building an
electronic health care
system that will allow
patients and their
doctors to access their
complete medical records
as needed, leading
to reduced medical
errors, improved patient
care, and reduced health
care costs.
HHS
Secretary Thompson
said HHS has signed
an agreement with the
College of American
Pathologists (CAP)
to license the College’s
standardized medical
vocabulary system and
make it available without
charge throughout the
country. HHS said this
action opens the door
to establishing a common
medical language as
a key element in building
a unified electronic
medical records system.
Secondly,
HHS has commissioned
the Institute of Medicine
to design a standardized
model of an electronic
health record. The
health care standards
development organization,
known as HL7, has been
asked to evaluate the
model once it has been
designed. HHS will
share the standardized
model record at no
cost with all components
of the U.S. health
care system, and expects
to have a model record
ready in 2004, HHS
said.
The
announcements were
part of the ongoing
effort to develop the
National Health Information
Infrastructure by encouraging
and facilitating the
widespread use of modern
information technology
to improve the country’s
health care system.
HHS
estimates that the
free system will reduce
medical errors and
reduce health care
costs by about $100
billion per year. However,
many health care institutions
will need to invest
in computers and train
staff.
With
terms for more than
340,000 medical concepts,
the College’s standardized
system has been recognized
as the world’s most
comprehensive clinical
terminology database
available, the agency
said. The licensing
agreement with the
CAP will make it possible
for health care providers,
hospitals, insurance
companies, public health
departments, medical
research facilities
and others to incorporate
this uniform terminology
system into their information
systems.
The
National Library of
Medicine (NLM), at
the National Institutes
of Health will administer
the CAP agreement,
under a 5-year, $32.4
million contract to
the College for a permanent
license for their terminology,
known as SNOMED (Systematized
Nomenclature of Medicine)
Clinical Terms. The
contract includes a
one-time payment-shared
by the Departments
of Veterans Affairs,
Defense, and several
HHS agencies—with annual
update fees paid by
the NLM.
NLM
will distribute SNOMED
through its Unified
Medical Language System,
which incorporates,
links, and distributes
in a common format
100 different biomedical
and health vocabularies
and classifications.
For
more info, www.nlm.nih.gov/research/umls/Snomed/snomed_announcement.html.
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NCQA
Issues New HEDIS Measures
With Clinical Care,
Customer Service
The
National Committee
for Quality Assurance
has unveiled its new
edition of measures
for how health plans
evaluate their own
clinical care and customer
service.
New
measures in the Health
Plan Employer Data
and Information Set
(HEDIS) include those
that focus on appropriate
antibiotic use (two
new measures), colorectal
cancer screening for
adults age 50-80, chemical
dependency (two measures),
and customer service,
NCQA said.
The
accreditation group
said it has added 10
new measures. Seven
of them address public
health issues: the
two for antibiotics,
two for chemical dependency,
colorectal cancer,
management of urinary
incontinence, and osteoporosis
management. Three new
measures (claims timeliness,
call answer timeliness,
and call abandonment)
address performance
of customer service.
NCQA
said that this is the
first edition of HEDIS
to look at the problem
of overuse of medical
care and the waste
it represents.
A
draft measure on cardiac
care—outpatient management
of heart failure—was
dropped from the final
version of HEDIS 2004.
NCQA said it dropped
the measure due to
data collection and
validity issues.
There
are now 60 total HEDIS
measures. The new measures
will be phased in over
the next few years.
For
more info, www.ncqa.org/publications.
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Public
Hospital Group Backs
Hospital Quality Initiative,
Urges Participation
The
board of the National
Association of Public
Hospitals and Health
Systems (NAPH) formally
endorsed The Quality
Initiative: A Public
Resource on Hospital
Performance at its
recent meeting, according
to the American Hospital
Association. Hospitals
in the initiative will
report performance
on quality measures
that will be posted
on the Internet later
this year.
The
NAPH, which represents
more than 100 public
hospitals and health
systems, plans to send
its members a letter
encouraging their participation
in the voluntary initiative,
along with a pledge
form and a packet of
information, AHA said.
NAHP
joins 30 state associations
endorsing the hospital-led
effort, according to
AHA.
For
more info, www.aha.org.
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JCR
Calls For Poster Presentations
For Ambulatory Care
Conference
Joint
Commission Resources
is seeking proposals
for good practice poster
presentations at the
8th Annual Ambulatory
Care Conference Oct.
9-10.
The
theme for 2003 is "Patients
First: Enhancing Safety
and Minimizing Risk."
Those interested in
submitting an abstract
to the conference planning
committee should think
broadly on topics such
as:
- Credentialing
and Privileging.
- Implemented
Systems to Improve
Patient Safety.
- National
Patient Safety Goals.
- Failure
Mode and Effects
Analysis.
- Infection
Control.
- Performance
Improvement.
The
abstract should include
a poster objective,
methods, results and
conclusions.
Applications
must be received by
Aug. 15.
One
presenter from a selected
organization will be
given a complementary
registration to the
8th Annual
Ambulatory Care Conference.
For
more info, Alma Harrell,
(630) 792-5409; aharrell@jcaho.org.
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CMWF
Makes Business Case
For Quality Case Studies
Available
The
Commonwealth Fund has
made available six
case studies that address
the theory of the "business
case for quality improvement."
The
case studies examine
diabetes management
programs, group medical
appointments, tobacco
cessation programs,
wellness programs in
the workplace, pharmaceutical
management, and care
based on clinical pathways
and outcomes-management
programs. All six reports
are available from
the Health Care Quality
page on www.cmwf.org:
"Clinical
Pathways and Outcomes
Management: Children’s
Hospital and Health
Center of San Diego"
The
Children’s Hospital
and Health Center of
San Diego (CHSD) has
significantly lowered
the cost of providing
care and slashed the
length of hospitalization
through measurably
increasing its quality
outcomes.
Yet,
under the current business
model of per diem payment,
those savings have
accrued mostly to insurers
and other payers, and
the hospital has actually
forfeited millions
of dollars in annual
revenue. The per diem
payment structure typical
for children’s hospitals
(where Medicaid typically
becomes the primary
payer for chronic conditions)
contrasts with the
per discharge basis
for Medicare; reducing
length of stay thereby
gives adult hospitals
a financial gain, but
gives children’s hospitals
a financial loss.
For
more info, www.cmwf.org/programs/quality/march_physicianorderentry_609.pdf.
"A
Corporate Wellness
Program: A Case Study
Of General Motors And
The United Auto Workers
Union"
In
1996, General Motors
and United Auto Workers
launched a corporate
wellness program, called
LifeSteps, to hold
down rising health
care costs and improve
the health status of
workers and their dependents.
There
is some evidence that
the LifeSteps program
has succeeded in slowing
the rate of increase
in health care costs—by
about $42 per person.
For
more info, www.cmwf.org/programs/quality/mcglynn_corporatewellness_612.pdf.
"Diabetes
Disease Management
At Two Managed Care
Organizations"
Analysis
of two health plans
with established diabetes
programs shows that
the business case for
diabetes disease management
is weak. The initial
costs for such programs
are substantial, and
plans may not be able
to reap the potential
savings until 10 years
after a health plan
member is enrolled
in the program.
The
authors estimated that
net savings under the
HealthPartners diabetes
management program
would be only about
$75 per patient. At
Independent Health,
researchers found that
diabetes testing rates
and some results improved
after the initiation
of the plan’s disease
management program,
but they failed to
find proof of substantial
short-term medical
cost savings attributable
to the program.
For
more info, www.cmwf.org/programs/quality/beaulieu_diabetesdiseasemanagement_610.pdf.
"Drop-In
Group Medical Appointments:
A Case Study Of Luther
Midlefort Mayo System"
While
group medical appointments
can increase access
to physicians, improve
patient satisfaction,
and increase physician
productivity, a review
of the experience of
one Wisconsin health
system found the model
is unprofitable and
unpopular with most
patients.
For
more info, www.cmwf.org/programs/quality/christianson_drop-ingroup_611.pdf.
"Pharmaceutical
Management: A Case
Study Of Henry Ford
Health System"
The
Henry Ford Health System
experimented with the
use of an expensive
new drug for treating
deep vein thrombosis.
Its goal was to prevent
or shorten hospitalization
for the condition.
The
study found that the
use of this drug—low
molecular weight heparin—can
reduce hospitalizations,
shorten lengths of
stay, and lower overall
costs by $800 per patient.
In effect, there was
a compelling business
case for the use of
the drug, especially
for an integrated health
system operating with
capitated payments.
The
second section examines
a lipid clinic created
to maximize the benefit
of powerful new cholesterol-lowering
drugs. The clinic proved
effective in helping
patients achieve desired
level of blood lipids,
which may avert a heart
attack in the future.
But
potential financial
savings generated by
the clinic probably
will not accrue to
the Henry Ford system.
The report said the
clinic was investing
to reduce cholesterol
levels in patients
who probably will not
be enrolled in its
health plan by the
time any averted heart
attack would have occurred.
For
more info, www.cmwf.org/programs/quality/smits_pharmaceuticalmanagement_613.pdf.
"Tobacco
Cessation Programs:
A Case Study Of Group
Health Cooperative
In Seattle"
The
report said calculating
the cost benefit of
smoking cessation programs
is a "murky undertaking."
If health providers,
insurers, and other
payers invest in tobacco
programs, they do not
reap immediate financial
savings for delaying
the onset of smoking-generated
health conditions,
the report said.
For
more info, www.cmwf.org/programs/quality/march_tobaccocessation_614.pdf.
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