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Top 12 Healthcare Quality Concerns in 2012

Cheryl Clark, for HealthLeaders Media, January 4, 2012

5. Meaningful Use

With the impending release of the Stage 2 Meaningful Use final rule, physicians and others have no more excuses to delay learning and installing software and computerized physician order entry systems.

If you listen closely, you will hear their cries, that they have been turned from being doctors to being typists. That they hardly ever get to see their patients because their heads are blocked by a computer monitor.  Quality wonks will want to see evidence that these systems are time-efficient and not intimidating.

Look for applications that use hand-held tablets that are not just patient and doctor friendly, but actually fun to use and may make documentation seem more like a game.

6.  Release of the Medicare claims database

Without much fanfare, CMS on Dec. 5 released its final rule governing how it would release, and who might obtain, access to its enormous claims database. This is a goldmine for any public or private entity that wants to "datadive" into numbers to evaluate cost as well as performance.

CMS' final rule specifies that those selected to receive this information – and CMS will pick which ones – are expected to "increase the transparency of provider and supplier performance, while ensuring beneficiary privacy." It is to be used to evaluate performance of providers and suppliers on quality, efficiency, effectiveness measures as well as use of resources.

The only catch is that the data may not be used by itself, but must be combined with health plan or other provider claims and quality information for performance measurement.

Medicare officials acknowledged in a statement that the final rule governing access to this treasure trove ends a situation that has been "frustrating" to providers and employers, consumers, and health care quality advocates.

7. Drug shortages and grey market vendors

Quality leaders are looking nervously at all the drugs that they can't get or can't afford to get because of price gouging – as much as 4500% – by grey-market vendors, and what drugs can be safely substituted. The problem involves the word "safety."

According to a survey from the purchasing and quality group Premier Healthcare Alliance, the number of drugs with exceptionally high markups because of scarcity numbered only about 50 five years ago. But now the number is approaching 400.

"When these drugs are bought and sold across state lines, moved in whole or partial lots, repackaged and relabeled, resulting in a complex web of transactions involving dozens of trading partners, (it makes) it almost impossible to determine the supply source or authenticity," said Premier's COO Mike Alkire during a news conference in mid-August.

In a commentary for HealthLeaders Media online April 15, Alkire wrote:
"Drug shortages present a danger to public health. In hospitals, a shortage may delay necessary medical procedures. Substitution of similar medications, if available, may lead to errors and adverse events, especially if prescribers are unfamiliar with the alternative products' dosing and potential interactions with other drugs."

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