The Certification Commission for Healthcare Information Technology has developed a proposal that would create more certification options for health IT firms and healthcare providers, including open-source developers. CCHIT's proposal would create three certification paths: EHR Comprehensive (EHR-C), EHR Module (EHR-M) and EHR Site (EHR-S). The new options attempt to address concerns from open-source software developers about the costs and licensing issues involved with certification.
Wichita, KS-based Galichia Heart Hospital hopes to expand its medical tourism program through a contract with AWAC, a Georgia medical management company. Galichia has begun offering some procedures, such as heart bypasses or hip replacements, at a deeply discounted fee in an effort to lure business. The new contract will expose nearly 1 million potential customers to the hospital, said Galachia officials.
More National Health Service trusts in the United Kingdom admit they are failing to comply with child protection guidelines, the government'sCare Quality Commission reported. Although more than 94% of trusts say they are meeting the standard, the figure is down 3.1% on last year, according to the Commission's report. The decline in standards in key areas has has led the Commission to warn trusts that it may have to impose "strict conditions . . . on their license to operate."
Sri Lanka-based Asiri Hospitals is planning to raise fresh equity capital to help finance a new hospital and reduce debt, a senior official said. Currently the Asiri Hospitals Group has hospitals which include Asiri Hospital, Asiri Surgical Hospital, Asiri Central Hospital (formerly Asha Central), Asiri Hospital Matara and Asiri Diagnostics. The new hospital, called The Central, is just meters away from Colombo National Hospital, the island's main state-run hospital.
The International Finance Corp will provide $50 million loan to Apollo Hospitals for setting up hospitals in numerous smaller cities across India. Apollo is expected to set up 15 new hospitals in the next three years. "This project will help us fulfill Apollo's vision to deliver medical services where they are needed most," Apollo Hospitals founder and executive chairman Prathap Reddy told The Economic Times.
Physicians' overall compensation in primary and specialty care did not keep pace with inflation in 2008, reports the Medical Group Management Association's Physician Compensation and Production Survey: 2009Report Based on 2008 Data.
Primary care physicians saw generally flat compensation with a reported 2% increase–which was a 1.73% decrease when adjusted for inflation–for a median of $186,044. Specialists' compensation rose 2.19%–a 1.59% drop when adjusted for inflation–to a median of $339,738. Inflation in 2008 amounted to a 3.8% increase in the US Consumer Price Index.
"Physician practices endure tough economic challenges to stay solvent, especially these days. For physicians to have a chance to hold their incomes steady, it's vital that they pay close attention to their bottom line and benchmark their practices and compensation levels against their peers," says William F. Jessee, MD, MGMA president and CEO. "With physician payment rates lagging behind inflation, physician practices need as many tools as possible to maintain their incomes."
Internists fared worst among primary care physicians, with an increase of less than 1% in compensation in 2008–a 3.37% decrease with inflation is factored.
Among specialists, emergency medicine physicians, dermatologists, and general surgeons all reported flat salaries before inflation was factored in, with inflation-adjusted declines of up to 3.2%. Among the few specialties that posted nominal compensation gains in 2008 were gastroenterology, up 7.38%, and pulmonary medicine, up 6.65%. Psychiatry posted a 1.32% loss before inflation. With an increase of 7.16% from 2004 to 2008, psychiatry's five-year compensation increase was half that of other specialties.
MGMA observed that median collections for professional charges were flat in primary care and declined by 6.53% for specialties, which reflects on widespread reports that financially strapped patients are postponing care.
This year's 25th annual compensation report provides data on nearly 50,000 providers and includes physicians and non-physician providers in more than 110 specialties. MGMA has 22,500 members who lead 13,700 healthcare organizations nationwide representing 275,000 physicians.
A total of 1,061 foreigners visited Korean hospitals in May, a 41.3% increase from the same month last year, the country's Ministry for Health, Welfare and Family Affairs announced. On May 1, Korean law changed and allowed hospitals to aggressively attract overseas patients.
Despite a recession and continued crowding, a new study shows that the average wait time in the nation's emergency departments fell by two minutes in 2008 to 4:03. Even with the long waits, Press Ganey's Emergency Department Pulse Report 2009 finds that patient satisfaction rose in 2008, continuing a five-year improvement trend.
Leigh Vinocur, MD, on the emergency physician faculty at the University of Maryland School of Medicine, says she's not surprised that patients leave the ED satisfied.
"First of all, they probably can't get in to see a primary care doctor," says Vinocur, who is also a national spokesperson for the American College of Emergency Physicians. "And when you go to a doctor's office, he decides you could need a CT scan or a neurologist and you're waiting another few weeks for a referral.
"So, even though people are waiting four and five hours in the ER, they have an idea they are going to have a diagnosis when they leave. That doesn't always happen. But we can do a lot of procedures and things while you are there to get closer to the diagnosis," she says.
Vinocur laughed when told that two minutes had been trimmed from a four-hour wait, but she noted that it at least reverses a trend that Press Ganey says has added 27 minutes to the nationwide average ED time since 2002.
The ACEP has long maintained that ED care is actually efficient and cost effective, especially because of the dearth of primary care physicians and a lack of alternatives. Press Ganey President and CEO Richard Siegrist, Jr. does not disagree.
"Emergency department care for certain situations can be cost effective," he says. "Things that could be better treated in a primary care setting if there were greater access would be preferable. But I agree with the emergency physicians that the emergency department can be the appropriate place for many treatments. As a company, we don't have a stance on that issue. There are obviously two sides to that discussion."
The Pulse Report analyzed the experiences of nearly 1.4 million patients treated at 1,725 emergency departments nationwide in 2008.
Among the findings:
South Dakota has the lowest total time spent in the emergency department (2:52); Utah had the highest total time (6:48).
Virginia patients spent 23 fewer minutes in the ED in 2008 than they had in 2007, while patients in Maryland spent 14 fewer minutes in the ED last year.
The metro areas with the highest patient satisfaction in the ED for 2008 were, in order, Miami, Detroit, Philadelphia, Pittsburgh, Boston, Chicago, Baltimore, Houston, Dallas/Ft. Worth, and New York/Long Island. Miami moved up from third on last year's list, while Detroit moved up from fourth. Philadelphia was a new entry in the Top 10.
Patients who arrive in the ED between 7 a.m. and 3 p.m. report higher satisfaction than those who arrive in the evening or overnight hours. Lowest satisfaction was reported among those who are in the emergency department between 3 p.m. and 11 p.m.
While average total times have increased since data was first collected in 2002, patient satisfaction is improving as many hospitals are communicating better with patients about delays.
The economy is having a significant impact as the proportion of emergency department patients without insurance is increasing. Fewer patients are seeking inpatient and elective services.
Christina Dempsey, senior vice president of clinical operations for patient flow at Press Ganey, says a growing number of hospitals are re-examining scheduling for elective surgeries and coordinating those schedules with the ED.
"The elective schedules coming in to the OR actually have more peaks and valleys than the ED arrivals do," she says. "By looking at that elected volume and smoothing that out over the week, getting rid of those peaks and valleys, improves patient placement, improves boarding in the ED, and opens capacity in the downstream units. You can do the same thing in the cath lab with the same methodology."
Deirdre Mylod, vice president of acute services at Press Ganey, says there is some indication that hospitals that have embraced technology are seeing higher levels of patient satisfaction. "It's not the case that simply applying technology to bad practices will solve the problems, but that in the face of improving processes, technology can make it that much more efficient," she says.
When patients' test results are abnormal, their doctors failed to tell them the bad news more than 7% of the time, and in practices that used a combination of paper and electronic medical records, the failure rate was as high as 26%, according to a new report.
Some patients were given a false sense of security in that they were told if they didn't hear anything, the test result was fine. Some patients were told, "No news is good news."
"Failures to inform patients of clinically significant abnormal test results or to document that they have been informed appear to be relatively common, occurring in 1 of every 14 tests," the researchers wrote.
The study, by Lawrence Casalino, MD, of the Weill Cornell Medical College in New York, and colleagues in Chicago and Los Angeles, was published in the Archives of Internal Medicine yesterday. The researchers said theirs is the first to document a failure rate for a broad set of tests for a large and varied group of physician practices.
Medical records from 5,434 patients between the ages of 50 to 69 were examined from the files of nearly 200 volunteering primary care physicians in PPOs in the West and Midwest. The researchers discovered 1,889 abnormal results, but 135 of those findings were never conveyed to the patients.
The project selected only patients who had undergone any of 11 blood tests, such as cholesterol or hemoglobin, or three screening tests, such as mammography, Pap smear, or fecal occult blood. A failure to notify the patient was counted when the abnormal result was deemed clinically significant, in that the outcome could have indicated a lethal disease process.
For example, patients were not informed of results of total cholesterol levels as high as 318 mg/dL, a hemoglobin A1c as high as 18.9%, a potassium level as low as 2.6 mEq/L, or a hematocrit level as low as 28.6%.
The patient was said to not have been informed if there was no record of the patient being told, no follow-up referral, or any other documentation indicating disclosure within 90 days of the date the physician received the test result. In the case of high or low sodium or potassium level tests, the interval was 21 days.
Perhaps a surprising result from the study was that when an electronic medical record system was used in combination with a paper record system, it made the process worse. In the four practices that used both, the failure rate was 5.4%, 8.7%, 21.5%, and 26.2% (the last two were the worst scores in the study). Practices that used only paper records were almost as good as practices that had transitioned completely to an electronic medical record system.
"Diagnostic errors are the most frequent cause of malpractice claims in the United States," the authors wrote, adding that, "Failures to inform patients of abnormal results and failures to document that patients have been informed are common, and legally indefensible factors in malpractice claims."
One finding from this report that was astonishing is the high number of practices that the researchers said had no explicit rules for managing test results. "In most cases each physician devised his or her own method. In 8 practices, patients were told that 'no news is good news.' i.e. they should assume their results were normal."
The report said there are no generally agreed-upon guidelines to delineate practices to manage test results so that patients are always told. But, they said, these five rules might be used:
All results are routed to the responsible physician
The physician signs off on all results
The practice informs patients of all results, normal and abnormal
The practice documents that the patient has been informed
Patients are told to call after a certain time interval if they have not been notified of their results.
The patient was counted as having been informed based on 13 types of evidence, such as a referral for a follow-up test. Additionally, the patient was informed if the physician responded to a subsequent questionnaire indicating the patient had been informed.
One might suggest that in some cases, such as patients who are too old and sick and perhaps unable to comprehend their results, the physician may have no need to tell the patient of a particular finding when more serious medical issues are present. However, the researchers got around that by including younger people below age 70 without existing known chronic diseases.
The researchers noted that while it is possible their report failed to recognize documentation that patients were informed, they added that this group of physicians volunteered for the study. A more random sample might find even greater failure rates.
The researchers also noted the lack of any incentive for physicians to notify patients about test results. "Failures to inform could be approached as a systems problem—a problem of organization and incentives—rather than as a failing of individual physicians," they wrote. In some practices the only way to see a test result is to search through every patient's records. In others, an electronic medical record routes test results to the responsible physician, and the system records the fact that the physician clicked on the results.
The authors summed up: "One approach to reducing failure rates would be to rely on the efforts of individual physicians and to exhort them to try harder to notify patients."
The report was funded by the California Healthcare Foundation.
Health insurers have spent millions on improving member outreach on the Web, but most people still don't visit their health plans' Web sites or believe their insurers support their health, according to The Microsoft Health Engagement Survey 2009, conducted by Kelton Research.
That sobering news is balanced, however, with some positive findings. Survey respondents are interested in their health plans connecting with them via e-mail and phone for electronic coaching, but they want those services integrated into their lives.
Dennis Schmuland, MD, U.S. health insurance industry solutions director at Microsoft in Redmond, WA, says healthcare must control runaway medical cost growth. One way to do that is to improve chronic disease care, which would decrease health costs. Two examples are to help members self-manage their conditions and create preventive programs for those who are healthy.
He adds the results show that health insurers cannot wait for consumers to self-manage their chronic conditions through standalone Web tools. Instead, patients want providers and insurers to come together to help them improve their health habits and self-manage their conditions.
This will require insurers to implement a "new generation of technology designed to proactively improve health and coordinate care at the individual and community levels," Schmuland adds.
Survey respondents were not exactly positive about the current healthcare system. A majority of those surveyed see the healthcare system as fragmented and believe it doesn't help them proactively manage their health. Those who share that view are more likely to search general health Web sites for information rather than seeking health information from doctors or insurers.
Schmuland says those who feel the system is fragmented tend to believe they are on their own when it comes to their health and healthcare.
Consumerism is driving online investments
The consumerism movement with insurers and employers pushing more out-of-pocket costs onto members has led insurers to invest in online components in hopes of creating more educated consumers. However, nearly half of those surveyed thinks health plans only support them when they need a doctor.
This disconnect is creating barriers. Consumers are simply not visiting their health insurers' Web sites. Though 82% of insurers provide Web sites with health and wellness information, nearly three-quarters of respondents visited their insurers' Web sites fewer than six times a year. That includes 16% who never visited their insurers' sites and another 16% who only went on the sites one or two times in the past year.
Schmuland says people usually trust their doctors, but insurers, advisory hotlines, and association Web sites don't enjoy the same level of trust.
"[Consumers] perceive the health plan cares about them only when they are sick," says Schmuland.
Those who are actually going onto the sites are not using the breadth of information either. Nearly half of those surveyed go to find provider lists or coverage information. Only one-third check out information on health and wellness.
For those who actually search for health information, the survey found that many of those people do so only after a diagnosis. In other words, patients are conducting reactive health information searches rather than proactive wellness searches, according to the survey.
They are also not going to insurers' Web sites, but instead visit popular health sites, such as WebMD, or conduct searches on Google.
Positives for health plans
The way health plans are implementing technology might not be working, but there are two positives from Microsoft's survey:
The vast majority of people surveyed said healthcare technological solutions are inviting
Most respondents were interested in communicating with their insurer through e-mail
More than half of the respondents are interested in using e-mails to ask questions about benefits and coverage; receive feedback about their health; and get encouragement, reminders, and advice on diet and exercise.
"They are saying 'technology is inviting. I'm not afraid of it. I want to use technology,'" says Schmuland, which includes Web-based products and text messaging. Microsoft officials say the survey shows that consumers want coaching through technology. This might be a cost-effective tool for health plans, which could reach more members through an online coaching program. Not only could health plans benefit from more technology in the area of coaching, but disease management, wellness, and population health companies could also see great savings.
"This could change the ROI to their advantage," says Schmuland.
Opportunities for health insurers
Though the survey showed that health insurers are not maximizing member communication on its Web sites, the findings provide a glimpse into what consumers want and how health plans can implement those solutions.
Hector M. Rodriguez, industry chief technology officer/technology strategies for Microsoft's health plan industry group in Irvine, CA, says the first step for health plans is figuring out how to get into members' digital lifestyles and then concentrate on content. The survey shows that people want to integrate health information into technology, which they can seamlessly connect into their daily lives.
Schmuland says health plans need to re-invest their technology and self-service portal money. Insurers have added personal health records, communications, and videos, but they are not being integrated into members' lives.
