A physician in Iowa has devised a way to use electronic medical data to help control costs associated with operating room and anesthesia scheduling. The changes help OR managers better estimate how long a particular case will last, making it easier and more cost-efficient to schedule subsequent cases in the same room, says Franklin Dexter, MD, an University of Iowa physician and expert in operations research.
The federal stimulus bill allocates $19 billion to promote the use of IT to improve the efficiency of healthcare and lower its cost, and that infusion could benefit companies like the newly named HealthCare IT Inc. The company recently began offering services to help with the adoption of electronic medical records and the development of systems for managing healthcare data.
There are five areas the United States has to concentrate on in order to improve healthcare: coverage for all, payment incentive reform and realignment, wellness initiatives, quality improvement, and health information technology. That is what American Hospital Association President Richard Umbdenstock told key stakeholders last week during President Obama's White House healthcare summit.
If those are indeed areas we should be focusing on for healthcare reform, why aren't we hearing more talk about the patient centered medical home model? The very idea of the PCMH is founded upon reducing chronic diseases and improving quality care through preventive medicine and wellness initiatives, according to guidelines put forth by the National Committee for Quality Assurance.
The concept also represents a way of realigning financial incentives with healthcare delivery goals to provide coordinated, integrated, ongoing care, says Salvatore Volpe, MD, who runs a PCMH practice in Staten Island, NY.
Two things facilitate that integration and continuity of care: the primary care physician and health information technology, says Volpe. Primary care physicians, understandably, balk at spending the extra (uncompensated) time on attempting to arrange for follow-up care for each patient. But under the PCMH model, physicians are paid for services such as care management and care coordination, which are not reimbursed under the current fee-for-service system.
"The current system penalizes you for using HIT. If I spend the additional time to use my EHR to look up what's needed for my patient in terms of preventative, I'm being penalized because I'm spending additional time I could be spending seeing another patient," says Volpe. "We have to be reimbursed for that extra service and time. The only place I'm seeing that done is with the patient centered medical home," he says.
Volpe points to the oldest and largest PCMH model, North Carolina's Medicaid managed care program, Community Care of North Carolina, as proof that the idea works. CCNC is based on physician-led networks that use the PCMH model to provide care to the state's Medicaid recipients. It started 10 years ago with nine pilot projects covering 250,000 Medicaid enrollees, and has since expanded to 14 networks covering more than 750,000 Medicaid recipients across the state.
CCNC pays each network $2.50 a month for each Medicaid recipient and an additional fee of $2.50 to each physician for each Medicaid patient in the physician's practice. Over the course of the program, CCNC has saved North Carolina nearly half a billion dollars.
"By paying doctors a little more, they were able to invest in health information systems, like EHRs or e-prescribing software. Doctors had an incentive to stay open a little longer so instead of closing at 4 o'clock they might close at 5:30. They were able to offer more wellness programs or preventative care," says Volpe, who writes a blog on EHRs and the PCMH.
Sarah Corley, MD, chief medical officer for NextGen Healthcare and a practicing primary care physician, says she believes that President Obama's call for increased EHR adoption combined with the forthcoming stimulus money is leading the country toward greater use of the PCMH model.
"That's where the cost savings in our society are going to occur. Once you have a fairly good adoption of EHR, which I anticipate will occur over the next six years because otherwise the physician will be paying a penalty, I think that then you would say, okay, we paid the stimulus money to adopt EHR. Now what we're going to do is pay you to provide PCMH centers and care coordination services," she says.
As President Obama said last week during the summit, "No proposal for reform will be perfect. If that is the measure, we will never get anything done. But when it comes to addressing our healthcare challenge, we can no longer let the perfect be the enemy of the essential." By my calculations, the PCMH model addresses four of the five areas concentration called for by Umbdenstock: physician payment realignment, wellness initiatives, quality improvement, and health information technology. Not perfect, but maybe essential.
Kathryn Mackenzie is technology editor of HealthLeaders magazine. She can be reached at kmackenzie@healthleadersmedia.com.Note: You can sign up to receive HealthLeaders Media IT, a free weekly e-newsletter that features news, commentary and trends about healthcare technology.
Billions of stimulus dollars meant to spur doctors to switch to electronic record-keeping may not be enough to do the job, according to a study by Avalere Health, an information company serving government and the healthcare industry. The stimulus bill signed by President Barack Obama contained $19 billion for health information technology, including $17 billion for incentives and penalties to encourage doctors and hospitals to abandon paper record-keeping and go high-tech beginning in 2011. But particularly for doctors in small practices, the high cost of installing electronic records systems could outweigh the incentives and penalties for failing to comply, the analysis said.
Some new low-cost services have popped up on the Internet with the aim of providing basic healthcare consultations more cheaply and easily. The services are the next step in "telehealth," or the delivery of healthcare through the telephone, Web, or other telecommunications technologies. The new services offer the convenience of online consultations, but they still have their drawbacks.
At a time when the new administration is striving to digitize the entire nation’s hospitals, a new analysis from HIMSS Analytics estimates only 0.5% of hospitals have reached the organization’s Stage 6 level of adoption.
According to the association’s Electronic Medical Records Adoption Model, just 42 of the more than 5,000 U.S. hospitals tracked by HIMSS Analytics have achieved Stage 6 capability, meaning they have made significant investments in healthcare IT and are almost completely automated utilizing paperless medical records.
HIMSS Analytics developed the EMRAM in 2005 as a methodology for evaluating the progress and impact of electronic medical record systems for acute care delivery hospitals. With an almost paperless environment, Stage 6 hospitals are ready to address many of the upcoming and current industry requirements, such as HIPAA Claims Attachment, pay for performance, and government quality reporting programs, according to HIMSS Analytics.
There are a total of 8 stages (0-7) on the EMRAM with the goal of reaching Stage 7 - operating in an environment where paper charts are not used to manage the delivery of patient care, and clinical data is used for performance improvement and analytics of care delivery.
"Only 0.5% of hospitals (tracked through the HIMSS Analytics Database) have achieved Stage 6 capabilities," said Mike Davis, executive vice president, HIMSS Analytics in a release. "The hospitals we rank as Stage 6 have implemented advanced clinical applications that improve patient safety and care delivery outcomes."
A link to the complete list of Stage 6 hospitals appears on the HIMSS Analytics Web site.