It is not often that President Barack Obama and former Speaker Newt Gingrich publicly agree, but both have made similar arguments recently pointing to shipping company FedEx as evidence that electronic health record interconnectivity is possible. If FedEx can digitally track a package sent anywhere in the world, the argument goes, then why can't the U.S. healthcare system collect and track basic patient health information?
But comparing a single company to an entire industry isn't exactly apples to apples. FedEx is a massive corporation that has the economies of scale and capital to invest in state-of-the-art technologies. What about the rest of the shipping industry? A much smaller company that offers similar services—let's say an independent courier that delivers packages in New York City—has a more limited budget and runs a very different operation.
It's not a perfect analogy, but the point is most healthcare isn't provided by big businesses that have the resources of a FedEx. In fact, small medical practices provide about 75%-80% of ambulatory care in the United States. While implementing an EHR system can be complicated and expensive (even with federal incentives) in any practice, it is particularly challenging for small and solo practices that can't spread the cost burden among a large group.
That's why only about 13% of small and solo practices have implemented EHRs, compared to 57% of physicians in practices with more than 50 doctors.
Federal officials charged with working out the details of the Health Information Technology for Economic and Clinical Health (HITECH) Act must account for this landscape and the unique challenges that small and solo practices face. Will $44,000 over several years even be enough to offset the costs of implementation for a single physician? Will an ambitious meaningful use definition set the bar too high for small physician groups?
A report released yesterday by the National Committee for Quality Assurance suggests that, while small practices are often willing to change in order to improve quality, they lack the resources and need special attention and assistance.
Congress, to its credit, is looking for ways to help. Yesterday, the House Committee on Small Business held hearings about the specific challenges solo and small practices face in health IT adoption. Kathy Dahlkemper (D-PA), chairwoman of the Subcommittee on Regulations and Healthcare, oversaw the hearings and introduced the Small Business Health Information Technology Financing Act, which would establish a new program at the Small Business Administration to guarantee loans made to physicians seeking to invest in Health IT.
"Ultimately small and solo health practitioners are small businesses. Similar to small businesses everywhere, one of their biggest challenges is accessing affordable capital," Dahlkember said.
In the last few months, I've heard from several physicians that the lag between the initial investment in an EHR system and when physicians actually will start receiving incentive payments is one of the biggest remaining obstacles to EHR adoption. A few thousand dollars in extra reimbursements in 2011 or 2012 does little good if a practice can't afford the upfront costs of implementation today.
This legislation is a good first step. But the focus on small practices needs to persist throughout the process—when meaningful use is defined, when certified EHR systems are selected, and when reimbursements are potentially cut in 2015.
The bigger physician groups already have EHRs, and if they don't, implementation is at least manageable. It's the smaller practices that will determine whether or not this ambitious shot at digitizing healthcare succeeds or fails.
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Americans are growing older, fatter, and more depressed, but we’re also choosing good health behaviors, such as eating fruits and vegetables, getting flu shots and cancer screenings, and wearing seatbelts, according to a new national health report card.
As expected, the clearest and most alarming trend is the growing number of Americans who are overweight or obese. Currently, 67.4% of adults nationwide are overweight (with a body mass index of 25 or higher). In 1995, it was 50%. The prevalence of obese Americans (29% of Americans have a BMI value of 30 or higher) has nearly doubled since it was first measured in 1995 (14.7%). At-risk groups include lower-income adults, African-Americans, and adults aged 40 to 64.
A big contributor to the obesity crisis is sedentary lifestyles. In 2008, nearly 29% of Americans reported no leisure-time physical activities in the month before the interview, the highest proportion recorded since this survey question was first asked in 1995.
The study also found that the percentage of Americans who are limited in activities because of a physical, mental, or emotional problem has increased from 14.5% in 2001 to 21.8% in 2008. Limitations are most often attributed to musculoskeletal issues.
More than 24% of Americans currently suffer from arthritis or rheumatism (more than 50% among seniors aged 65 and older). More than 22% suffer from sciatica or chronic back pain, something that has trended upward considerably over the past several years (14.3% in 1995). Nearly 8% require the use of special equipment, such as a wheelchair, cane, special bed, or special telephone (including 26% of those reporting an activity limitation).
While age is a key factor, the report also noted that more than 44% of Americans living below the federal poverty level have health-related activity limitations.
The report also found that Americans are facing higher barriers to accessing healthcare services. In 2008, 42.4% of all adults reported difficulty or delay in receiving healthcare, up from the 36% five years earlier. Groups most adversely impacted included the poor, African-Americans, Hispanics, young adults, and women.
The biggest barriers were:
The cost of prescriptions
The cost of doctor visits
Difficulty getting appointments
Inconvenient office hours
All of these are growing trends. For example, nearly 20% of adults say they went without a needed prescription within the last year because they couldn’t afford it, more than twice the percentage (9.5%) first reported in 1999.
The survey also found that one in 10 American adults used a hospital emergency room more than once in the past year, another sign that emergency rooms are being used for primary healthcare needs. This proportion has increased significantly from the 5.6% first recorded in 1999, and runs concurrent with the growing numbers of uninsured Americans, and access difficulties for primary care. Nearly 18% of American adults report that they do not have a regular physician and they rely on a hospital emergency room for most of their medical care.
The survey also found that:
Fruit and vegetable consumption is improving as 43.5% of adults report eating five or more servings of fruits and vegetables per day. This is a considerable increase from the 31.4% first recorded in 2001.
Roughly 30% of American adults have experienced symptoms of chronic depression, stating that they have had two or more years in their lives when they felt sad or depressed on most days. This proportion is at its highest since this indicator was first tested in 1995. Chronic depression appears to impact a majority of Americans who live below the federal poverty level; women, blacks, and Hispanics are also more likely to report symptoms of chronic depression.
More than 35% of Americans have been told that their blood pressure was high, and this proportion has trended upward over the past decade (findings were around 25%-26% prior to 2003).
Diabetes now affects 11% of adults–the highest prevalence recorded since first measured in 1995. Nearly 10% of Americans report suffering from chronic lung disease, including bronchitis or emphysema. This prevalence is the highest recorded since this question was first asked in 1995.
A growing percentage of seniors age 65 and older are receiving annual influenza vaccinations. In 2008, 73.2% of seniors were vaccinated.
Colorectal cancer screenings have increased significantly over the past decade, and nearly 65% of Americans aged 50 and older are screened at some point in their lives.
Nearly 18% of Americans aged 18 to 64 years don’t have health insurance, either through private insurance or through the government. Uninsured rates increased considerably between 1997 and 2005. Not surprisingly, people without coverage are much less likely to receive routine medical care, such as checkups, and age- and gender-appropriate cancer screenings.
Since the late 1990s, self-reported seat belt use has continued to improve, with 83.5% of Americans now reporting they "always" wear a seat belt when driving or riding in a vehicle (up from 70.4% in 1997).
Health insurers have forced consumers to pay billions of dollars in medical bills that the insurers themselves should have paid, according to a report released by the staff of the Senate Commerce Committee. At a committee hearing, three healthcare specialists testified that insurers go to great lengths to avoid responsibility for sick people, use deliberately incomprehensible documents to mislead consumers about their benefits, and sell "junk" policies that do not cover needed care.
Almost half of young adults–a group some would argue are the most insurable–went without health coverage for more than one month in 2006 and almost one-fourth, or 3.5 million Americans, were uninsured for the entire year, according to a new federal report.
Authors of the Agency for Healthcare Research and Quality report said this population, ages 19-23, were almost twice as likely to be uninsured all year as adults ages 45–64. The agency compiled the report based on most recent data from the ongoing Medical Expenditure Panel Survey.
Most significantly, nearly one-third of those who had no insurance for an entire year felt health insurance was not worth the cost.
It was not clear from the report how much money the illnesses and injuries in this group of uninsured cost the healthcare system through uncompensated care and how much the patients paid out-of-pocket.
The group is largely healthy, with only 6.5% reporting they'd been diagnosed with any form of chronic condition by a health provider.
But, the authors said, the fact that a disproportionately larger numbers of people in this age bracket are uninsured relative to older groups of adults is cause for concern.
The report, entitled "Characteristics of Uninsured Young Adults: Estimates for the U.S. Civilian Noninstitutionalized Population, 19-23 Years of Age, 2006," was written by Karen Beauregard and Kelly Carper.
Among its other findings:
Those who were uninsured for the entire year were more than twice as likely to have been unable to obtain necessary healthcare as their insured counterparts.
Although some insurance companies allow young adults who are students to be covered on their parents' health insurance policy until they are 23, only 18.5% were enrolled and eligible under this provision. However, of those young adults who were uninsured for the whole year, 18.6% were full-time students in contrast to 42.2% of those who had health insurance for some portion of the year, indicating that some students were able to take advantage of their parents' policies.
Hispanics were more than twice as likely to have no health insurance for the entire year (43.9%) than black non-Hispanics (21.1%) and whites (19%).
The lower the level of education attained, the more likely a young adult was to have no health coverage through the year, with 30.6% who had not graduated from high school, compared to 15.5% of those who had at least some college.
Males were more likely to be uninsured for the entire year (29.8%) than females (17.9%).
Joel Cohen, director of the division of Social and Economic Research for the AHRQ, suggested that females tend to not lack health coverage as much as males because in many cases, they are eligible for programs like Medicaid.
He added that in many cases, individuals within this age bracket work in settings that offer health coverage, but "it may not be considered affordable by the workers, so they may not sign up."
A spokesman for America's Health Insurance Plans, Robert Zirkelbach, says many health plans have devised policies to meet specific pricing and insurance needs of young adults. However, he says, "Certainly, there's a recognition that many young adults simply don't choose to participate."
As policymakers design comprehensive healthcare reform legislation in Washington, Zierkelbach says they need to require that all people participate in the healthcare system. This would mean that all Americans, including individuals between the ages of 19 and 23, would have to sign up, though the federal government could provide subsidies through tax breaks to help with the cost of premiums.
The insurance industry will do its part, he says, by guaranteeing coverage for pre-existing conditions and no longer performing health status ratings for its applicants. "But for that to work, there needs to be a personal coverage requirement to get everybody into the system."
He adds that price differentials would still exist based on an applicant's age, geographic residence, family size, and the design of the benefit plan.
Senators are struggling with the possibility that in offering subsidized health insurance to millions of individuals and families, they could speed the erosion of employer-provided coverage that they want to preserve. Senator Max Baucus, the chairman of the Finance Committee, said senators were investigating "the ramifications and implications" of requiring employers to provide or pay for coverage. Baucus said he and other senators wanted to minimize the chance that employees "may be enticed to leave their firms in order to get health insurance in the exchange."
A bipartisan group of governors told President Obama that they share his desire to restructure the nation's healthcare system but warned that any changes should not place more burdens on strained state budgets or eliminate innovative programs they already have in place. With many state budgets burdened by ballooning Medicare and Medicaid costs, the five governors who met with Obama at the White House voiced concern about how to achieve reform.
Washington, DC-area hospitals are bracing for what could be a budget crisis in coming months resulting from funding cutbacks by Virginia and Maryland. Hospitals throughout the region are experiencing soaring demand from uninsured patients who cannot pay for their care and plummeting revenue from reductions in investment income, charitable giving, and elective surgery. If the economy doesn't improve, there could be "ugly scenarios that would require wrenching changes and scaling back of services," said Chris Bailey, senior vice president of the Virginia Hospital and Healthcare Association.
The past year has been brutal for South Florida hospitals, and this year is likely to be worse. The Baptist Health system suffered a $71.7 million loss in its 2008 fiscal year. Miami Children's lost $72 million. Holy Cross lost $25 million, and Mercy $34.8 million. All four of these suffered serious losses in their investment portfolios, but others are beginning to feel the effects of the recession as their number of uninsured patients grows.
As the recession continues and unemployment climbs, surveys suggest many Americans are cutting costs by delaying or forgoing preventive healthcare. And although the details of President Obama's healthcare plan are not yet known, much of the discussion has centered on preventive care. A survey of family doctors released last month by the American Academy of Family Physicians found six out of 10 respondents said they were seeing more health problems as a result of skipped preventive care, such as screenings or unfilled prescriptions.
A new Gallup Poll finds a substantial proportion of Americans willing to consider traveling outside the United Sttes to obtain major medical treatments and procedures, notes Sg2 Director Michael Warren. One hospital providing the kind of high-quality, lower-cost care with growing appeal to medical tourists is Bangkok's Bumrungrad International Hospital, he says. Sg2 thought leaders and selected members of Sg2's Design Forum have visited Bumrungrad to experience the organization's innovation and quality first hand.
