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CMS Contracts with WorldVista to Train Vendors
on Vista-Office EHR Report:
Patients Like Coordinated Care, but It’s Expensive Survey: Health Care Leaders Say P4P Can Cut
Costs Group Seeks National Standards for EHR Lab
Interoperability within 6-9 Months Researchers Say HIPAA Hampers Quality Improvement
Work Online Poll Suggests More Public Education
on P4P Needed Study: Errors Persist Despite Electronic Prescribing System-wide Health Care Reform Could Save $125
Billion Annually More Work Needed on Patient Safety Says Five
Year Analysis of IOM Report NQF Endorses Updated Consensus Standards on
Diabetes Care Leavitt Establishes Medicaid Commission CMS:
New System to Coordinate Beneficiary Drug Coverage The Centers
for Medicare & Medicaid Services (CMS) has contracted
with the not-for-profit WorldVista organization to provide training to
vendors that will install and service the soon-to-be released Vista-Office
EHR software – a version of the Veterans Health Information Systems
and Technology Architecture ( Vista ) designed to meet the needs of small
physician offices. WorldVista will contract through the Iowa Foundation for Medical Care,
the Iowa QIO, which holds the contract with CMS to develop Vista-Office
EHR. The release of Vista-Office EHR is expected in August; vendor training
will begin in September. Initial testing of Vista-Office EHR has already begun in two physician
offices in Maryland and New Jersey and will expand to four community
health clinics in West Virginia later this summer. In Maryland , an interface
between Vista-Office EHR and a commercial lab is being tested. In West
Virginia , Vista-Office EHR will be tested using a method of distribution
that allows remote sites to access the software over the Internet. This
method could lower installation and maintenance costs, one of the primary
barriers to EHR adoption for small physician practices. The software
will be available on CDs and CMS officials say the agency is investigating
the possibility of distribution over the Internet as well. The report Coordinating Care for Medicare Beneficiaries: Early
Experiences of 15 Demonstration Programs, Their Patients, and Providers summarizes
findings from the first year of the Medicare Coordinated Care Demonstration
(MCCD), a congressionally mandated project run by the Centers for Medicare & Medicaid
Services. The MCCD involves 15 sites selected in January 2001 that serve chronically
ill Medicare beneficiaries but target different diseases. Interventions
and approaches vary but each site has two goals -- improving patient
health and reducing costs. Preliminary claims data and telephone survey data collected on 1,695
patients after the sites had been operating for nine to 14 months indicate
that patients were generally pleased with the use of care coordinators. In addition to noting the difficulty of achieving net savings for Medicare,
the study also said that, although those surveyed indicated they were
pleased with their programs, their enrollment did not result in a general
increase in the initial sample's rates of adherence to medication, diet,
and exercise regimens. “Treatment group patients were only slightly more likely than
control patients to report following a healthy diet or exercising regularly,
and they were equally likely to report not missing any doses of prescribed
medication during the past week,” according to the report produced
by Mathematica Policy Research Inc. Problems
with enrollment were noted for four out of the 15 sites. The report
attributes these problems to several factors, including “initial
overestimates of the number of eligible patients from their referral
sources, physicians’ failure to encourage their patients to enroll,
high patient refusal rates, and care coordinators whose time was too
limited to both recruit patients and serve those already enrolled.” In addition,
the report says that programs with low-cost enrollees are likely to
have difficulty achieving large enough savings to offset intervention
costs, “[A]
few programs may be unable to generate net savings even if they were
to reduce Medicare costs by 20 percent.” A second
report due in August will present program-specific estimates of impacts
on quality of care, service use, costs, adherence behavior, patients’ satisfaction
and disease-related limitations, and physician satisfaction. The report,
produced by Mathematica Policy Research Inc., is available at: http://www.mathematica-mpr.com/publications/PDFs/bestpraccongressional.pdf. Rewarding more efficient and high-quality providers ranked first among
effective ways to cut health care costs, according to a Commonwealth
Fund Health Care Opinion Leaders survey. The online survey included input
from 289 opinion leaders in health policy and innovators in health care
delivery and finance. Commenting
on the survey, Commonwealth Fund President Karen Davis said, “Health
care opinion leaders view pay for performance not just as a way to reward
quality, but as a strategy to raise efficiency in health care delivery.” When asked which methods would be most effective in reducing unnecessary
utilization of health care services, a majority (56%) rated disease management
for patients with high-cost conditions and enhanced primary care case
management highest. Use of evidence-based medicine was ranked a close
second, with about half (52%) rating this as extremely or very effective. Other key findings from the survey: The survey
was conducted by Harris Interactive between April 7, 2005 and April
21, 2005 . Questions focused on potential ways to lower health care
costs; respondents were given five possible options to choose from
in each of three areas: methods of reducing the price of health care,
methods of reducing unnecessary utilization of health care services,
and methods of reducing health insurance overhead. A summary of the results
is available at: www.cmwf.org. A new initiative launched by the California HealthCare Foundation seeks
to facilitate electronic delivery of laboratory results to clinicians
using Electronic Health Records (EHRs) in the office setting. The EHR-Lab
Interoperability and Connectivity Standards (ELINCS) project is developing
a national standard for the real-time reporting of lab data to EHRs. Members of the ELINCS steering committee anticipate having a new national
standard within six to nine months. They hope that after an additional
nine months ELINCS will be adopted by electronic health record vendors
and laboratories across the nation. “The ability to access lab results in real time means that physicians
should be able to make medically appropriate decisions earlier in the
course of patient care than with the current lab notification process,” said
ELINCS steering committee member John Tooker, M.D., M.B.A., F.A.C.P.,
who also serves as executive vice president and CEO of the American College
of Physicians. “The ELINCS national standard may also spur adoption
of electronic health record technology as physicians realize the tangible
benefits of timely access to laboratory results and reduced installation
and configuration costs.” Tooker participated in an AHQA news conference yesterday. He explained
to reporters how the use of technology such as ELINCS can help communities
get connected for better health. Other ELINCS steering committee members include senior executives from
the Healthcare Information and Management Systems Society (HIMSS); the
American Clinical Laboratory Association (ACLA); the American Health
Information Management Association (AHIMA); the EHR Vendor Association
(EHRVA); the National Alliance for Health Information Technology (NAHIT);
and Health Level Seven (HL7). ELINCS will work closely with other national and international programs
developing clinical data standards for EHRs to ensure widespread adoption
of its standard. These include the Certification Commission for Health
Information Technology (CCHIT); Connecting for Health (Markle Foundation);
eHealth Initiative (eHI); DOQ-IT (Centers for Medicare and Medicaid Services);
Integrating the Healthcare Enterprise (IHE); Public Health Information
Network (CDC/PHIN); and Health Level Seven (HL7). ELINCS
is funded and convened by the California HealthCare Foundation (CHCF).
For more information, visit: http://www.chcf.org/topics/chronicdisease/index.cfm?subtopic=CL505 A paper
published in the Archives of Internal Medicine uncovers an apparent
conflict between protecting individual patients’ privacy and
improving the quality, safety and cost of medical care for all patients. In the paper, Potential Impact of the HIPAA Privacy Rule on Data
Collection in a Registry of Patients with Acute Coronary Syndrome,
University of Michigan Cardiovascular Center researchers report how
their work on heart attack care has been hampered by the national medical
privacy regulations under the law known as HIPAA, which took effect
two years ago last month. In all,
they write, the changes needed to comply with HIPAA have hindered quality
research efforts. One problem the authors encountered is HIPAA’s
requirement of prior consent for patients to participate in post-care
surveys. Researchers noted a drastic drop — from 96 percent in
previous surveys to 34 percent post-HIPAA — in the proportion of
heart attack survivors and chest pain patients who take part in follow-up
surveys after they leave the hospital. In addition, findings generated
from these respondents are skewed because patients who returned the HIPAA-compliant
written consents were far more likely to be older, married, and white
than those for whom consent could not be secured. HIPAA changes have also dramatically boosted the cost of performing
the surveys, with increases noted in computing time, staff hours, office
supplies, and postage. “We won’t solve safety, quality and cost issues in health
care unless we do quality research, and our findings show that HIPAA,
as currently written, has the potential to hinder that effort,” says
senior author Kim Eagle, M.D., clinical director of the U-M CVC. “Privacy
is crucial. But quality improvement research aims to generate public
benefit, and as a society we have to be careful that we don’t find
ourselves on such a far extreme on one side of privacy protection that
we actually paralyze our ongoing efforts to monitor and improve care.” Read the
full article at: http://archinte.ama-assn.org/cgi/content/full/165/10/1125 Results
of an online poll conclude that Americans are only “modestly
supportive” of health insurance plans paying physicians more for
quality care. The poll, conducted by The Wall Street Journal and Harris
Interactive, also found that most adults would be more interested in
pay for performance if it meant they could spend less on health care. Forty-four
percent of the survey respondents, 2,129 adults aged 18 and over, said
they were neither for nor against, or “not sure” about
pay for performance initiatives – an indication that more education
on the issue is needed, said Katherine Binns, senior vice president at
Harris Interactive. The Wall
Street Journal reports that “On the whole, the public
is somewhat supportive of measures associated with prevention and promoting
patient compliance. This includes doctors’ use of preventive
tests, such as cancer screening, and patient reminders. On the other
hand, doctors’ use of electronic patient medical records was seen
by fewer than one in five U.S. adults as a good measure of doctor quality
of care.” Findings released in an Archives of Internal Medicine study indicate
that hospital adoption of computerized medication systems alone does
not come close to eliminating potentially harmful medication errors.
Patients still face an approximately 50-50 chance of experiencing an
error in prescribing. Several broad-based studies during the past 15 years have demonstrated
that injuries resulting from the inappropriate use of medications, called
adverse drug events (ADEs), account for up to 41 percent of all hospital
admissions and more than two billion dollars annually in inpatient costs.
Many of these studies have also suggested that as much as a quarter of
inpatient adverse drug events might be prevented through the use of computerized
physician order entry (CPOE) and related computerized medication ordering
and administrative systems. This study found that the computer system was successful in eliminating
problems reading physicians' orders, but did not resolve the other problems
associated with administering medication, drug selection, dosage and
monitoring. The Findings Among 937 hospital admissions, 483 ADEs were identified, accounting
for 52 adverse drug events per 100 admissions. Nine percent of the adverse
drug events resulted in serious harm, the other 91 percent were classified
as moderate, requiring monitoring, interventions or discontinuation or
adjustment of the dose of the problematic drug. The most common errors were failure to provide for expected adverse
drug reactions, for example, prescribing potassium with diuretics to
avoid a low potassium level (36 percent); failure to start or complete
adequate monitoring for common adverse drug reactions (33 percent); and
prescription of improper doses (33 percent) or inappropriate medications
(seven percent). The researchers found errors occurred at the following stages of care,
61 percent ordering, 25 percent monitoring, 13 percent administration,
one percent dispensing and 0 percent transcription, indicating that IT
adoption does not resolve problems associated with administering medication,
drug selection, dosage and monitoring. The authors
conclude, “our
findings do imply that purchasers of CPOE systems should not rely on
generic CPOE and bar code medication administration systems alone to
dramatically reduce ADE rates. Rather, health care organization desirous
of preventing ADEs should consider whether candidate computerized medication
systems offer decision support functions that address the most troublesome
aspects of the medication administration process.” According
to the National Coalition on Health Care (NCHC), system-wide health
care reform would save money – in excess of $125 billion
annually after 10 years of implementation. Health care economist Kenneth Thorpe reached this conclusion after analyzing
four scenarios for health care reform put forth by the NCHC last year
in its report, Building a Better Health Care System. That report
called for comprehensive reform based on universal health care coverage,
quality improvement and cost management. The four scenarios include: Thorpe used conservative assumptions and Congressional Budget Office
methodology to conclude that employers who provide health coverage now
would save at least $195 billion annually by year 10 of implementation,
while employees would collectively save at least $40 billion in the same
time period. Cost savings would continue to grow annually after year
10. Thorpe estimated that instituting universal coverage would require an
initial investment of $75 billion per year under the first three scenarios,
but when combined with cost management and quality improvement measures
recommended by NCHC, the cost would be more than offset by savings. Dr. Henry
E. Simmons, president of NCHC says, “What this economic
modeling shows unambiguously is that done right, health care reform will
save Americans a great deal of money – while at the same time assuring
health coverage for all Americans and dramatically improving health care.” The National Coalition on Health Care is a non-partisan alliance of
more than 90 major organizations including: health care leaders and innovators,
legislators, major medical and professional societies, health care providers,
corporations, religious organizations, and educational institutions. For more
information on the NCHC report: www.nchc.org. An analysis
in the Journal of the American Medical Association, Five
Years After To Err Is Human, reviews changes in the state of health
care since the Institute of Medicine’s landmark report was published
in 2000. According to the JAMA article, the IOM report found that up
to 98,000 Americans die each year from medical errors. The JAMA article by Lucian Leape, MD, and Don Berwick, MD finds that
hospitals have made significant advances in patient safety, but that
the pace of change is far too slow. They call for the Agency for Health
Care Research to bring together all stakeholders, including payers to
make a commitment to achieve a set of explicit, ambitious patient safety
goals by 2010. The authors point out a number of barriers to improvement, including
lack of consistent measurement of patient safety incidents, the complexity
of health care systems, a lack of leadership, reluctance of doctors to
admit errors and an insurance reimbursement system that rewards errors.
For instance, when patients are injured by medical error, insurance companies
will reimburse hospitals for the additional services needed to take care
of that patient, but payment for practices that reduce those errors in
the first place often do not exist. However,
the authors note that the IOM report has had important impact on the
health care system, including: changing the view of error prevention
from personal responsibility to system-wide accountability, garnering
stakeholder support for patient safety initiatives, and accelerating
changes in practice necessary to make health care safer – from
residency training to hospital requirements. The report
notes that “Dramatic advances are likely within the
next 5 years in at least 4 important areas: implementation of electronic
health records; wide diffusion of proven and safe practices, such as
those approved by the NQF; spread of training on teamwork and safety;
and full disclosure to patients following injury. “ The authors
stress that to reduce medical errors, “We really need
to rethink how we pay for health care. What we do now is pay for services,
but what we should do is pay for care and outcomes.” An abstract
of the report is available at: http://jama.ama-assn.org/cgi/content/abstract/293/19/2384 The National Quality Forum (NQF) endorsed an initial set of measures
to update its voluntary standards for the care of adults with diabetes.
The standards, which are derived from a larger set of measures approved
by The National Diabetes Quality Improvement Alliance and developed and
maintained by the National Committee for Quality Assurance, represent
the consensus of more than 260 health care providers, consumer groups,
professional associations, purchasers, federal agencies, and research
and quality improvement organizations. These standards are designed to drive quality improvement primarily
through external accountability at the health plan and provider level
for ambulatory care, including public reporting of results. They are
intended for use by consumers, purchasers, health care professionals,
providers, health plans, accrediting organizations, quality improvement
organizations, researchers, community and public health groups, and other
relevant stakeholders to enable performance-based decisions about provider
and health plan selection. On May
12, the NQF Board of Directors approved nine measures for public reporting,
which fully replaces a set endorsed by the NQF in 2002. The consensus
standards were vetted through NQF’s formal Consensus
Development Process, with multiple stakeholder input, review, and voting,
to achieve special legal standing as voluntary consensus standards. The nine endorsed measures fall into the following categories: A1c management
, lipid management, urine protein screening, eye examination, food examination,
and blood pressure management. One proposed measure for public reporting,
related to smoking use, was not endorsed and instead deferred for re-consideration
at a later time. NQF Members are expected to soon consider 32 additional diabetes performance
measures intended for internal provider, health plan, and community quality
improvement activities. “Having better, standardized public information about care for
diabetes will help improve the care of persons having this condition,” said
Kenneth W. Kizer, MD, MPH, President and CEO of the NQF. For more
details, visit www.qualityforum.org. The National
Quality Forum (NQF) formally endorsed the Hospital CAHPS or HCAHPS
survey, a standardized accounting of patients’ perception
of their experience of hospital care. HCAHPS® is a 27-item survey designed and developed over a three
year period by the Centers for Medicare & Medicaid Services and the
Agency for Healthcare Research and Quality. The primary purpose of the
survey is to provide standardized information across institutions and
over time about how patients experience hospital care. Results from the
survey are intended for public reporting. The survey includes 22 questions addressing seven domains of hospital
care: communication with doctors, communication with nurses, responsiveness
of hospital staff, pain control, communication about medicines, cleanliness
and quiet of the environment, and discharge information. It also includes
five demographic questions used for patient-mix adjustment and other
analytic purposes. The NQF
Board of Directors approved the survey as the final step of vetting
through the NQF’s formal Consensus Development Process,
with multiple stakeholder input, review, and voting, to achieve special
legal standing as a voluntary consensus standard. The NQF endorsement
represents the consensus of more than 240 health care providers, consumer
groups, professional associations, purchasers, federal agencies, and
research and quality improvement organizations. “To improve the quality of American health care, it is critically
important that the patient be given a strong and active role,” said
Kenneth W. Kizer, MD, MPH, President and CEO of the NQF. “Having
a standardized measure of patient perception of care will enhance that
role and give the consumer a stronger voice in the process.” For more
information, visit: www.qualityforum.org Department of Health and Human Services Secretary, Mike Leavitt, created
an advisory commission to identify reforms necessary to stabilize and
strengthen Medicaid. The Medicaid commission must submit two reports to Secretary Leavitt.
The first, due September 1, will outline recommendations for Medicaid
to achieve $10 billion in savings during the next five years as well
as ways to begin meaningful long-term enhancements that can better serve
beneficiaries. In its first report, the Commission also will consider
potential performance goals for Medicaid. The second report, due December 31, 2006 , will provide recommendations
to help ensure the long-term sustainability of Medicaid. The proposals
will address key issues such as: The second report will also consider how to address the major issues
affecting Medicaid under three different scenarios: an assumption that
federal and state spending continues at current paces, an assumption
that Congress chooses to lower the rate of growth in the program, and
an assumption that Congress may increase spending for coverage. The report
will assume that the basic federal-state match for Medicaid will continue. Leavitt will appoint up to 15 voting members to serve on the commission,
including at least three representatives of public policy organizations
involved in health care policy for families, individuals with disabilities,
individuals with limited incomes, and the elderly. In addition to the
voting members, the commission will have up to 23 non-voting members
including advisors with specific health care expertise or interest in
Medicaid, and as many as eight policy experts designated by various Congressional
leaders. A full copy of the commission's charter is available at http://www.cms.hhs.gov/faca/mc/default.asp. The Centers
for Medicare & Medicaid Services (CMS) created a Coordination
of Benefits program that integrates new technology with pharmacists’ existing
computer systems to calculate a beneficiary’s true out-of-pocket
expenses for prescription drugs. CMS Administrator Mark B. McClellan,
M.D., Ph.D. says the new system “simplifies life for the beneficiary.” Under contract to CMS, NDCHealth, based in Atlanta , GA , will develop
an electronic system similar to systems pharmacies already use to bill
insurance plans for prescription drug claims. The system will route claims
for benefits paid by entities other than Medicare back to the prescription
drug plans to ensure that what seniors pay at pharmacy counters takes
into account the proper level of their Medicare coverage. The new process
will also include coordination of other programs beneficiaries may enroll
in. Medicare
beneficiaries will begin to receive prescription drugs under the new
Part D benefit starting January 1, 2006 . Whether a beneficiary has
limited means and receives comprehensive benefits or gets additional
assistance for drug costs from a former employer, state, charity, or
private insurance, CMS says the new Coordination of Benefits system will
provide a straightforward way to combine these multiple sources of coverage
and make it easier for beneficiaries to maximize the Medicare prescription
drug benefit while ensuring they do not pay more than needed.  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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A
majority of the online survey respondents rated pay for performance as
an extremely or very effective way to reduce health care costs. Only
a third rated requiring patients to pay a substantially higher share
of health care costs as an effective measure.|
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American Health Quality Association. All Rights Reserved. |