HCA Holdings, the hospital operator being investigated for performing unnecessary heart procedures and billing Medicare for it, has issued a second statement in anticipation of a critical news story by the New York Times that examines the company's emergency room procedures. The notice, posted on the HCA website, says the newspaper has raised questions about the adoption of a set of guidelines for evaluating and managing patients at emergency rooms. HCA seems to be pre-emptively positioning itself amid such statistics when it claims that about half of its 163 hospitals have adopted systems to determine when patients seen at its ERs actually need emergency care.
How does Massachusetts healthcare reform and recently-passed cost containment legislation look from the perspective of an academic integrated delivery system like Partners Healthcare? There are still a few people in Massachusetts without healthcare insurance, but only a few. My colleagues like that—it's hard taking care of uninsured patients, and I don't know anyone who wants to turn back the clock. Massachusetts gets a bad rap for having high healthcare costs, but the fact is that we're relatively efficient compared to the rest of the U.S.
If any state is poised to be ready, it's Maryland. One of the first to pass a law establishing an exchange, back in April 2011, it's moved swiftly to begin building a $51 million computer system that citizens will use to shop for insurance online as they do for airline tickets on Expedia (EXPE). "We want to be the model," says Lieutenant Governor Anthony Brown, who oversees the state's healthcare reform efforts. Yet even with its early lead, Maryland faces big challenges as it tries to assemble all the pieces of the massive law. That computer system the state’s building? It will have to connect seamlessly with both Maryland’s Medicaid system and the federal government's computers.
A new information exchange will allow hospitals, doctors, long-term facilities and other medical personnel to exchange clinical data via a secure statewide network. The White House approved $16.9 million for the project. Massachusetts contracted with Orion Health to develop the statewide network. The project is designed to improve communication between these institutions and reduce redundancies.
Last month, The New York Times reported that President Obama's Affordable Care Act will worsen America's already steep shortage of doctors, particularly in the valuable field of primary care. With an estimated 30 million people set to gain insurance coverage under the law in 2014, there won't be enough physicians to serve all these new patients. Because it takes about ten years to train a new doctor, little can be done to reduce this deficit in the short term. But Congress can begin to address the problem in the coming decades if it alters its investment strategy in medical education.
No community hospital board easily votes to give up the hospital's independence and tie its fate to a larger health system. But that is what the boards in control of the 120-year-old Chester County Hospital did this month, after deciding that the $150 million to $275 million needed over the next decade to fulfill their vision for the institution was more than it could get on its own. What Michael J. Duncan, president and chief executive of the Chester County Hospital & Health System, and other Chester County Hospital leaders see in the future of the institution, one of the few remaining independent hospitals in the region, is more outpatient centers, an expanded physician network, and heavy investment in information technology to accommodate large-scale changes in health-care delivery.