Understanding that there is a lack of qualified technical workers, Health and Human Services said today it will make $80 million in grants available to develop the nation's healthcare information technology workforce. Community colleges will get $70 million of the grant money to develop training programs, and the remaining $10 million will be used to develop educational materials to support those programs, HHS said.
Earlier this year, the $787 billion American Recovery and Reinvestment Act created a $36.3 billion rebate program designed to broadly and rapidly expand the use of HIT in the nation's healthcare delivery system over the next decade. However, critics have noted a significant lack of qualified technical workers to install, operate, and maintain these complex inter-operative HIT systems. HHS has acknowledged the problem, and said it hopes the training grants will alleviate the shortage.
"Ensuring the adoption of electronic health records, information exchange among healthcare providers and public health authorities, and redesign of workflows within healthcare settings all depend on having a qualified pool of workers," said David Blumenthal, MD, HHS' national coordinator for health information technology, in a media release. "The expansion of a highly skilled workforce developed through these programs will help healthcare providers and hospitals implement and maintain EHRs and use them to strengthen delivery of care."
The $70 million community college program will establish intensive, non-degree training that can be completed in six months or less by people with some background in either healthcare or IT fields. Participating colleges will coordinate their efforts through five regional consortia across the nation. Graduates will assist healthcare practices during the critical process of deploying IT systems and support these practices once they are operational.
The $10 million curriculum development program will provide educational materials to community colleges so these training programs can be established quickly. Nonprofit institutions of higher learning now providing training in health IT that are interested in drafting curriculum or establishing a consortium may apply for the grants.
Hold on to your stethoscopes, the Senate Healthcare Reform Bill is expanding the RAC program.
Specifically, Section 6411 of the Patient Protection and Affordable Care Act (H.R.3590, p. 1777–1783) broadens the current RAC program to cover Medicare Part C and D as well as the Medicaid program—by December 31, 2010.
Similar to the current Medicare RAC program, the Medicaid RACs would be paid by contingency fee to identify under- and overpayments, and would recoup those overpayments. States would contract with one or more RACs to seek out payment errors, and each state must have "an adequate process for entities to appeal any adverse determination made by such contractors," according to the Healthcare Reform Bill.
"Certainly we will need some additional details on how this will work," says Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance for HCPro, Inc. "The complexity of the individual state Medicaid plans will make this difficult to coordinate at the federal level."
The Patient Protection and Affordable Care Act also provides several new requirements for contractors involved in the RAC program for Medicare Parts C and D. Per the Bill, RACs must:
Ensure each Medicare Advantage plan under Part C and each Part D prescription drug plan has an anti-fraud plan in effect, and review the effectiveness of that plan.
Examine claims for reinsurance payments under section 1860D–15(b) of the Social Security Act to determine whether prescription drug plans submitting the claims incurred costs greater than those allowable under paragraph 2 of the section.
Review estimates submitted by private insurers for their prescription drug plans regarding the enrollment of high-cost beneficiaries, and compare them with the numbers of such beneficiaries actually enrolled.
The expansion of the RAC program to Medicare Parts C and D doesn't surprise Hoy. "Providers have actually been asking whether RACs would audit Part C claims because they feel they are paid incorrectly a lot of the time."
But that doesn't mean the program is a no-brainer. For one thing, it is unclear how RACs, which are paid by contingency fee, would be paid for ensuring the presence of anti-fraud plans, says Hoy. "There's no dollar amount attached. So what would they get paid for, and how much would they receive?"
In addition, the Bill would require the secretary of HHS, through the CMS administrator, to submit an annual report to Congress on the effectiveness of the Medicare and Medicaid RAC program, along with recommendations to expand or improve the program.
While approaches to public insurance options and health exchanges have dominated the discussions of the House and Senate healthcare reform bills, issues addressing quality and value have been threaded through the bills, sometimes matching each other, sometimes showing some differences in the individual bills.
Here are some examples:
Medicare and Medicaid Payment Innovation Center. Both the House and Senate bills would require the Centers for Medicare and Medicaid Services (CMS) to develop and test innovative payment and care delivery models that emphasize coordination of care, quality improvement, and efficiency. These would include patient-centered medical homes, accountable care organizations, and bundled payments for hospital acute and post-acute care. The Senate bill also would implement a national, voluntary shared savings program for accountable care organizations.
Healthcare associated infections. Under the Senate proposal, hospitals with high rates of hospital acquired infections would have their Medicare reimbursement rates cut by 1%. In the House bill, hospitals and ambulatory surgical centers would be required to report public health information on healthcare associated infections to the Centers for Disease Control and Prevention.
Patient Centered Outcomes Research Institute. The Senate bill calls for creation of an independent, nonprofit institute governed by public and private sector representatives to provide for research designed to "inform the decisions of patients and providers" regarding the clinical effectiveness of different medical treatments and services available for the same condition.
The Agency for Healthcare Research and Quality would disseminate research findings from the Institute and other government funded sources.
Value-based purchasing. In the Senate bill, Medicare payment policies would promote quality outcomes, including hospital and physician value based purchasing and incentives for quality reporting and improvement for all Medicare providers.
Quality improvement in private health plans. The Senate bill would require plans offered in a state health exchange to reward quality by including payment incentives related to quality reporting, case management, chronic disease management, prevention of avoidable hospital admissions, improvement in patient safety, and promotion of wellness initiatives. Health insurance plans in the exchange would be required to limit contracts with hospitals with more than 50 beds to those with patient safety evaluation systems and comprehensive discharge planning programs.
Two groups of Harvard researchers last week reported separate study results showing health information technology systems do not save money. The author of one of the reports said that any claim that it does is "baseless propaganda."
That inspired several health officials, who are trying to improve quality and patient safety, to weigh in with their views. Here is what four health leaders think about whether electronic medical records can actually save money:
Jim Lott
Executive Vice President
Hospital Council of Southern California
Los Angeles
"Looking for savings in hospitals that use EMRs is short-sighted. The real payday for use of EMRs will come with interoperability. Measurable savings will be realized as middleware is installed that will allow for the electronic transmission and translation of patient records across different proprietary systems between delivery networks.
"The savings for hospital-centric EMRs will balloon when integration of these confined systems with the rest of healthcare delivery system is realized. The ideal circumstance would be the use of EMR smart cards that would be updated with every patient encounter and that can be read electronically by every medical provider treating the patient, regardless of the providers' medical network or health plan affiliation.
"This virtual integration will facilitate more accurate and speedy patient assessments, diagnoses and treatment plans, and it will reduce duplicate and unnecessary imaging and laboratory tests, as medical providers will have immediate access to the most recent work done on patients both in and outside their own delivery networks."
Neil R. Powe, MD, MPH, MBA
Chief of Medical Services
San Francisco General Hospital
Constance B. Wofsy Distinguished Professor and
Vice-chair of Medicine
University of California San Francisco
"The paper as I see it tried to accomplish a lot. One limitation is that they used rather blunt measurement to assess the information systems.
"You can have all the components of the information system in place, but if they are not being used by physicians, one might not see an effect. In contrast, our study measured whether physicians are aware of the components and how physicians are using the components of the information system.
"Physician order entry and decision support I believe offer the most chance of improving healthcare delivery. There are a lot of information systems with bells and whistles that don't focus on physicians' real needs."
Robert M. Tennant, MA
Senior Policy Advisor
Medical Group Management Association
Washington, D.C.
"The government has clearly spoken. It says we want to spend billions to get the vast majority of physicians up and running on electronic medical records.
"The fact that they front-load the money means they want it to happen in a hurry. We agree with that too. We're excited about it. But if the program is developed in a way that it doesn't facilitate that, we're looking at potential failure. If they make it so difficult to participate in the program, it's going to fail."
Johnny Walker, MBA, CPA
Founder and past CEO of Patient Safety Institute
Plano, Texas
"EMRs don't save money in standalone situations. However, EMRs will absolutely save significant money (and improve care and safety) when connected and sharing clinical information.
"The reason VA and Kaiser see savings where other hospitals don't is because of the degree of connectivity and clinical information-sharing related to individual patients.
"The savings grow geometrically following the Law of Externalities. Currently we are still at the beginning of the information sharing curve and therefore the cost saving curve. We have taken our eye off the successful VISA example. Information connectivity and access drives [EMR] adoption; not the other way around."
Nearly 9% of nearly 8,000 surveyed members of the American College of Surgeons said they'd made a major medical error in the last three months, and one-third attributed the mistake to a "lapse in judgment," rather than a system failure.
Reporting those errors was strongly associated with burnout and depression manifested by emotional exhaustion, depersonalization, and decline in a sense of personal accomplishment.
Those are the results from the latest in a series of reports on the mental health of America's surgeons from Charles M. Balch, MD, colleagues at Johns Hopkins University, and others at the Mayo Clinic and the Winchester Surgical Clinic. It was published yesterday in the online version of the Annals of Surgery.
"People have talked about fatigue and long working hours, but our results indicate that the dominant contributors to self-reported medical errors are burnout and depression," said Balch, a professor of surgery. "All of us need to take this into account to a greater degree than in the past. Frankly burnout and depression hadn't been on everybody's radar screen."
The study found that 40% of the surgeons who responded to the survey said they were burned out.
The authors said the findings are important because, while surgeons don't make more errors than physicians in other disciplines, "errors made by surgeons may have more severe consequences for patients due to the interventional nature of surgical practice."
"For example, reporting a major medical error in the last three months was associated with a 7-point increase ... in emotional exhaustion on the MBI (Maslach Burnout Inventory questionnaire) and roughly a doubling in the risk of screening positive for depression," the authors wrote.
The mean age of those reporting medical errors was three years younger than those who did not report errors (49 versus 52). Surgeons who worked an average of 4.6 more hours a week were more likely to report a recent medical error (63.5 hours versus 58.9) and spent an additional hour per week in the operating room. They also had slightly more nights on call per week.
General surgeons were more likely to report errors than obstetrician gynecologists, plastic surgeons, and otolaryngologists.
The report said the rate of reporting perceived mistakes seemed linked to career satisfaction. "Surgeons reporting recent errors were less likely to report they would become a physician or a surgeon again and were also less likely to recommend their children pursue a career as a physician or surgeon."
Surgeons reporting a medical error were also associated with higher levels of burnout. "Each 1-point increase in depersonalization was associated with an 11% increase in the likelihood of reporting an error while each 1-point increase in emotional exhaustion was associated with a 5% increase," according to the report.
"The most important thing for those of us who work with other surgeons who do not appear well is to address it with them so that they can get the help they need," said Julie A. Freischlag, MD, chair of the Department of Surgery at Johns Hopkins and one of the study's authors.
In August, the same group of researchers led by Balch reported in Annals of Surgery that burnout is common among American surgeons and is the single greatest predictor of surgeons' satisfaction with career and specialty choice.
With Los Angeles County supervisors expected to sign off next week on plans to partner with the University of California to reopen the Martin Luther King Jr. medical facility, the hard work—creating a new hospital from the ashes of the old by 2013—begins. In many respects, the partnership with UC would wipe the slate clean, creating a nonprofit company overseen by a seven-member board of directors who would decide how to run the facility and whom to hire—a key issue to critics who cite the county's poor history of dealing with problematic employees at the Willowbrook hospital. County supervisors closed King to all but outpatient care after the facility failed a make-or-break inspection that meant the loss of $200 million in federal funds. The final failure came after repeated findings that inadequate care had led to patient injuries and deaths.
At least one-fourth of all U.S. adults are obese. About one in five smokes. Fewer than half get the recommended amount of physical activity. Despite Americans' poor lifestyle choices and the chronic problems they spawn, healthcare reform legislation that Congress is considering would do little to encourage people to live healthy lives, according to health experts. Advocates say Congress is missing an opportunity to expand medicine's focus beyond the diagnosis and treatment of illness. They say lawmakers should do more to boost efforts to prevent the onset of diseases by improving the mental and physical well-being of Americans.
Health experts say it would be great if national health reform legislation would render San Francisco's groundbreaking health program unnecessary—but they don't see that happening anytime soon. None of the bills under consideration in Congress promises to cover everyone living in the United States, leaving some people without coverage. Those include new immigrants who can't afford coverage but are not yet eligible for public programs, low-income people who wouldn't qualify for subsidies, and illegal immigrants. These are among the groups of people who have health coverage under Healthy San Francisco.
It has been a tough 10 years for corporate America, but you wouldn't know it by looking at the nation's biggest healthcare firms. Examine the Standard & Poor's 500 Index and you'll find, on average, those companies will end the decade with slightly lower profits. But the healthcare companies in the index have been anything but the norm. Data compiled by MarketWatch show that the 52 healthcare companies in the index are about to close out the decade with average profits that nearly tripled. That level of money-making seems unlikely to change soon, even if lawmakers pass the legislation that's working its way through Congress. Experts say there aren't many reform proposals that would take a significant bite out of healthcare profits.
Abortion-rights groups, acknowledging they were caught off guard by a last-minute amendment toughening abortion restrictions in the House healthcare bill, are mobilizing to ensure that doesn't happen in the Senate. Activists hope to flood Washington to rally and lobby on Dec. 2, during the week that Senate floor debate begins. The Center for Reproductive Rights has aired television ads criticizing the restrictions. On Tuesday, activists will announce the creation of the Coalition to Pass Health Care Reform and Stop Stupak, a network of more than 30 groups.
