For Democrats, the stimulus bill working its way through Congress is a tool for rewriting the social contract with the poor, the uninsured, and the unemployed, in ways they have long yearned to do. With little notice and no public hearings, House Democrats would create a temporary new entitlement allowing workers getting unemployment checks to qualify for Medicaid. Spouses and children could also receive benefits, no matter how much money the family had. In addition, the stimulus package would offer a subsidy to help laid-off workers retain the same health plans they had from their former employers.
Doctors from the United States who rushed to the Gaza Strip to help the war wounded quickly found themselves operating on patients who had fallen victim to the 20-month-border closure that had crippled Gaza's healthcare system even before Israel's offensive against Hamas. Even before the war, Gaza's hospitals had run out of 250 of the basic 1,000 healthcare items, and were short on 105 of 480 essential drugs, said Mahmoud Daher, a representative of the World Health Organization.
The top-rated U.S. hospitals have a 27% lower death rate than other hospitals, according to a study released by HealthGrades, an independent healthcare ratings organization. Researchers analyzed the records of about 41 million Medicare patients treated at the nation's almost 5,000 non-federal hospitals. The study of data from fiscal years 2005, 2006, and 2007 focused on 26 common diagnoses and procedures. Patients treated at hospitals ranked in the top 5% nationally had a 27% lower risk of in-hospital death, the report found.
Randall S. Moore, MD, chairman and CEO of American TeleCare, talks about why he thinks offering government subsidies to telehealth providers would be a mistake. +
Home Depot announced it was cutting 7,000 positions and closing its Expo Design stores nationwide. It was the first cut of a very bad Monday that saw almost 50,000 job cuts, bringing the total for the new year to 185,00 and on pace to match 2008's loss of 2.6 million if the slide continues. +
I thought of that phrase after seeing details on how the $825 billion Obama stimulus bill would be divvied up. There's a lot of healthcare in the bill, but there's precious little healthcare reform. +
Patients today seek healthcare information and treatment from a variety of sources, and HealthLeaders contributor John Morrow offers five strategies that healthcare executives can use to better demonstrate their organization's value to these newly empowered consumers. +
Mike Allen, chief financial officer of Winona Health in Minnesota, had plenty to say about Finance Editor Philip Betbeze's take on the issue of community benefit as outlined in a column he wrote last November entitled, Just Not Good Enough. +
I thought of that phrase after seeing details on how the $825 billion Obama stimulus bill would be divvied up. There's a lot of healthcare in the bill, but there's precious little healthcare reform. +
As minimally invasive procedures consume a larger portion of spinal care, provider organizations have many opportunities—and challenges—in an increasingly outpatient service line. +
Joe Paduda, principal at Health Strategy Associates, talks about healthcare reform, the top healthcare issue for the government to tackle, and what he expects will happen to Medicare Advantage this year. +
The way medical care is delivered has to change quickly to adapt both to a shortage of physicians and an aging and chronically sicker demographic. This is particularly true in rural America. +
Even as healthcare organizations expand across the globe, recent speculation about the rate and reach of medical travel is running up against today's uncertain economic conditions. +
More hospitals and health systems are partnering with individual communities to provide preventive care and patient education in an attempt to alter disease-causing behaviors and, in turn, reduce health costs. But does it make much business sense for a provider organization to spend millions of dollars on what could be a futile attempt to change behaviors? +
Patsy Metheny, an independent community benefit consultant, talks about the role of hospital and health system marketers in reporting community benefit activities. +
Since launching in 2004, the Certification Commission for Health Information Technology has become the de facto stamp of approval for EHRs, helping providers judge EHR product suitability, quality, interoperability, and security. For about $28,000, a vendor who meets the Commission's criteria can be certified, automatically proving to providers that their EHR is worth the money, say CCHIT proponents. Now, CCHIT is expanding its scope of certification, and not everyone is happy about CCHIT's increasing influence in the market.
The expansion includes two areas already named in previous years—behavioral health and long-term care—that will be developed as planned. In addition, four new program areas are proposed, all of which are optional add-on certifications for ambulatory EHRs: clinical research, dermatology, advanced interoperability, and advanced quality.
One of the main components being added to CCHIT's lineup will be increased flexibility and opening up the option of certifying advanced levels of technology for products that go "beyond the basics" in any domain, says Mark Leavitt, MD, chair of CCHIT.
"There is now a degree of sophistication with the technology and a readiness on the part of the end users that we need to have different levels of certification. You will still have the certification for ambulatory EHR, but those with advanced decision support, for example, would get additional certification that says this product also offers advanced decision support so if that's something you are ready for and looking for, this has it," says Leavitt.
He says the group chose the expansion areas based on a model that quantified the benefit of certification by looking at how many patients are affected by the specialty, how many dollars are spent in the specialty, the readiness of the specialty (for example, have providers gotten together and formed committees to define what they need or would CCHIT have to start from scratch) and then, "we balanced those out. We ultimately came out with a prioritization, and published that January 14 open for comment. We are accepting comment through February 5," says Leavitt. CCHIT also is considering eventual certification programs for software to support eye care, oncology, obstetrics/gynecology, advanced security, and advanced clinical decision support.
Just how much CCHIT certification should influence the decision about which EHR system to buy has become a point of contention for detractors who say smaller vendors are getting pushed out by the cost of getting certified ($23,200 for the initial review and $4,800 in annual maintenance fees over the three-year certification), giving vendors with capital to spare an unfair advantage. In addition, critics maintain that CCHIT certification will lead to higher prices for EHRs because vendors will be forced to pass the cost of certification on to providers and competition will be limited by narrowing the number of competitive software vendors.
"The people who are subsidizing EMRs or reimbursing providers are looking to drive them toward automation in their offices, and therefore financial incentives or the requirements that those organizations put on physicians are increasingly going to favor CCHIT-certified EMRs because it's easier to take a quick swipe at the market and lop off anything that isn't CCHIT certified," says Don Fornes, CEO of Software Advice, a consulting firm that offers advice to organizations looking to buy new software. "If you know that a CCHIT-certified EMR is absolutely going to give you a certain set of functionality and interoperability that you need, that's extremely useful."
For me, the whole "controversy" seems pretty cut and dry. At a time when very few people have money to spare, deciding to make an investment of this magnitude cannot be taken lightly. And I, as a tried and true consumer, would most certainly be looking for system that has all the stamps of approval. CCHIT is a private, nonprofit initiative whose stated mission is to "accelerate the adoption of robust, interoperable health information technology by creating a credible, efficient certification process." It's not as if the group is looking to make millions by fleecing small vendors through the certification process. Not only that, but all of the new EHR legislation being drafted at the federal level includes money to help stimulate the adoption of EHRs and all of that legislation requires that the EHRs be CCHIT certified, according to Leavitt.
As Gregory Spencer, MD, an internist and CMIO at Crystal Run Healthcare in Wallkill, NY, told me, "It's unbelievably helpful to have third party out there kicking the tires for you. People in the market need a product that they know matches what vendor tells them the capabilities are. We have that assurance. We know we are going to get a certain amount of capability if the vendor has been certified," he says. With three-quarters of the EHR market represented by vendors who have CCHIT certified products, it's looking like those vendors who don't want to or can't pay to get certified are going to have two choices: take a major hit in sales or be swallowed up by a bigger, CCHIT certified company.
Kathryn Mackenzie is technology editor of HealthLeaders magazine. She can be reached at kmackenzie@healthleadersmedia.com.
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Randall S. Moore, MD, chairman and CEO of American TeleCare, talks about why he thinks offering government subsidies to telehealth providers would be a mistake.
Hospitals with automated notes and records, order entry, and clinical decision support had fewer complications, lower mortality rates, and lower costs, according to a study published in the Archives of Internal Medicine. Researchers conducted a cross-sectional study of urban hospitals in Texas using the Clinical Information Technology Assessment Tool, which measures a hospital's level of automation based on physician interactions with the information system. After adjustment for potential confounders, they examined whether greater automation of hospital information was associated with reduced rates of inpatient mortality, complications, costs, and length of stay.
