As hospitals shift their security efforts, healthcare data security is in transition. External hackers are less of a concern these days than insiders snooping on electronic medical and financial records. Hospitals are exchanging more data with small physician practices that may not have adequate safeguards in place, while mobile devices are extending networks far beyond institutional walls. Plus, federal privacy and security standards are getting stronger, as are the penalties for violating those rules. "Your biggest [threats] are internal," Terrell Herzig, information security officer for the University of Alabama at Birmingham Health System, said at a health IT conference in Atlanta. Employees have been known to take unauthorized peeks at the records of VIPs such as local celebrities or prominent citizens, and with more than 50 million uninsured. Americans, there is a thriving black market for stolen and fraudulent health plan identification numbers.
A collective of large providers that have been early adopters of electronic health records has established a joint effort to securely share electronic health information among their systems starting next year. Combined, the healthcare organizations treat patients from all 50 states. The Care Connectivity Consortium will deploy health IT tools over the next year to electronically share data about their patients, who will be able to choose whether they want their information be shared among the organizations. The providers will use electronic tools that are consistent with national health IT standards to foster interoperability among the group's systems, according to an announcement April 6.
Four large nonprofit health plans will return excess profits from public health care contracts to the state under a yearlong deal announced Tuesday by Gov. Mark Dayton. Blue Cross Blue Shield of Minnesota, HealthPartners, Medica and UCare -- the biggest of the health plans that contract to cover more than 500,000 subsidized patients -- agreed to limit their 2011 profits from state business to 1%. Any earnings above that will come back to the state next year, flowing into the general fund and a special fund tied to the MinnesotaCare health plan for the working poor. The profit cap is the latest development in the Democratic governor's push to curb HMO earnings from public contracts. It comes a day after the state Human Services Department launched a website displaying financial details about health plans. In recent weeks,
MidState Medical Center announced this week that an employee who wanted to work at home improperly transferred information on 93,500 patients to a personal hard drive. The information transferred outside the hospital?s secure computer system included patients? names, addresses, dates of birth, Social Security numbers and medical record numbers. A spokesman for the hospital, which is affiliated with Hartford Healthcare, said that the person who took the hard drive was a Hartford Hospital employee and was dismissed following an investigation by a private security firm. The hard drive has not been located, according to MidState, but the hospital has no evidence that any of the personal information has been misused. The hospital is sending letters to the 93,500 patients, advising them of the possible compromise of their information and offering them two years of an identity protection service.
After nearly five years of construction, the most expensive building project in Baltimore history is heading into the final stretch. The Johns Hopkins Hospital has set April 12, 2012, as the dedication date for its new home—a $1 billion clinical building on Orleans Street between Wolfe Street and Broadway. Under construction since June 2006, the building will provide new in-patient facilities for adults and children and serve as the new main entrance to Hopkins' East Baltimore medical campus. The expansion also includes new emergency departments and other facilities.
After 25 years of capitation, one Texas physician practice has found that it can be the key to financial success, but only when structured just right.
The Kelsey-Seybold physician practice was started in 1985 as a subspecialty-oriented, multispecialty group practice in Houston. It was oriented toward the higher-end socioeconomic strata, with many patients coming from Mexico and South America, says Patrick Carter, MD, MBA, FAAFP, medical director of care coordination and quality improvement and chief of family medicine at the Kelsey-Seybold Clinic.
In the mid-1980s, the oil industry in Texas hit hard times, and the economic downturn greatly affected the physician practice. One health plan was pushing the idea of capitation, and Kelsey-Seybold decided to try the idea of a guaranteed fee per patient. Unfortunately, the practice learned the hard way how important it is to do your homework before signing the agreement.
"We got a capitation rate, but we didn't really know how much we needed to make it work," Carter says. "We kind of let the health plan tell us what would be fair. We took it, and it turned out not to be an economically feasible capitation rate. We didn't have enough revenue to cover expenses, which of course is death to a medical group."
The practice went back to the health plan and, through a tough negotiation that included taking the plan to court, succeeded in getting a higher capitation rate. "During that time, we also had to work on our physicians to change from a fee-for-service [FFS] culture that emphasized doing more because you made more money to a culture of practicing in a cost-effective, evidence-based manner," Carter says. "Part of that was investing heavily in primary care. Up to that point, primary care was not a big part of our practice, but now 50%-60% of our doctors are primary care."
With a more realistic capitation rate, the physicians began to see capitation as the best move the practice ever made, Carter says. The practice's capitation peaked in 2000 when about two-thirds of patients came to the practice under capitation, but then health plans in Houston started backing away from the concept.
Currently, about one-third of Kelsey-Seybold's patients are seen under capitation, and the practice is actively working with CIGNA to promote the idea with local employers.
"We want to regrow our capitation population because it gives you the money to do infrastructure improvements to your practice, like electronic medical records," Carter says. "It allows you to have an evidence-based style of practice without shooting yourself in the foot financially."
Under FFS, it can be difficult to dissuade physicians from performing unnecessary tests and procedures because that would mean making less money, Carter says. With capitation, physicians strive to provide quality care at the lowest cost because the capitation is the same no matter what is ordered for the patient.
"It has helped move us toward the kind of quality care we always wanted to provide," Carter says.