On April 27, HIMSS published its definitions of "meaningful use of certified EHR technologies" as outlined in the American Recovery and Reinvestment Act of 2009. HIMSS sent a cover letter, plus two definitions: 1) meaningful users of certified EHR technologies and 2) meaningful use for hospitals, to the National Coordinator of Health IT and the Acting CMS Commissioner, within the Department of Health and Human Services, according to a HIMSS release.
A new regulation will require health insurers to think about climate change and how it could affect their companies, investments, and members.
Though property insurance companies have been preparing for possible climate change, health insurers have not been focused on the issue. Property insurance has tackled the issue of climate change because of possible catastrophic events, such as rising seas wiping out oceanfront property. On the surface, climate change may not appear to have as much of a direct impact, but health insurers face their own climate change issues.
In hopes of getting health insurance companies focused on the issue, The National Association of Insurance Commissioners recently adopted a regulation that requires insurance companies complete an annual eight-question survey about the companies' financial risks associated with climate change and what actions the companies are taking to respond to those risks. The survey will both assess insurers' risk assessment and management efforts and allow regulators to follow up with questions if necessary, according to NAIC.
The policy will require all insurance companies with annual premiums of $500 million or more to complete the Insurer Climate Risk Disclosure Survey and submit them to the state insurance commissioner where the company is domesticated. The first reporting deadline is May 1, 2010.
The survey includes questions about what insurers are doing to reduce greenhouse gas emissions, whether they have a climate change statement of policy, whether they consider climate change as they choose investments, what they have done to encourage policyholders to reduce losses caused by climate-influenced events, how they are engaging their members on the topic of climate change, and how climate change could impact the insurer's investment portfolio.
"Climate change will have huge impacts on the insurance industry and we need better information on how insurers are responding to the challenge," said Pennsylvania Insurance Commissioner Joel Ario, who chairs the NAIC Climate Change and Global Warming Task Force, in announcing the requirement recently. The task force released a white paper, The Potential Impact of Climate Change on Insurance Regulation, last year.
Insurance commissioners point to a number of potential issues for health insurers, such as compounding current health issues, such as asthma; people exposed to hurricanes and floods; heat-wave related health issues; and more airborne allergens, rising temperatures, greater humidity, wildfires, and dust and particulate pollution may "considerably exacerbate" upper respiratory disease and cardiovascular disease, according to NAIC.
"At a very basic level, human health will be impacted by climate change in ways that are not yet fully understood nor anticipated," wrote NAIC in its white paper.
Michael Gresty, president of Kinetix Business Ecology, a New York City-based sustainability consultancy, says health insurers have not seen climate change as an issue that affects them.
"I would argue from anecdotal information that they are all behind the curve on this. None of them is really ready to respond," Gresty says about health plans.
With its new regulation, NAIC is forcing insurers to take action, he says.
"[Health insurers] don't want to look any less aware or smart than they appear and they certainly want to do the due diligence on thinking through what these implications are as much as they possibly can. I think it's a call to action," says Gresty.
On the surface, the eight-question survey may seem simple enough, but Gresty suggests health insurers could face problems finding out more about their investments. For example, a health insurer probably won't have a problem asking a major manufacturer about a climate risk plan. However, getting a "meaningful response" from a municipality, on the other hand, could take years, he says.
Gresty says property and casualty insurers have been ahead of health insurers on the issue, but climate change could strain the healthcare system. It's not that no one has been speaking out about health insurers and climate change. Six years ago, Paul R. Epstein, MD, MPH, associate director of the Center for Health and the Global Environment at Harvard Medical School, spoke before Congress about how global warming could affect health insurers.
"All of this is going to make a huge impact on the ability of healthcare systems to provide services to effected populations. They are going to be overwhelmed in some cases by pandemics that they are not able to manage or control," says Gresty.
In addition to completing the NAIC survey, Gresty says health plans should do the following immediately:
Revise catastrophic models of future events and their effect on populations, such as disease patterns and potential disease outbreaks
Review their financial profile risk model to see what investments in companies may be affected by climate change, such as businesses that face carbon taxes
Create a disaster recovery plan for its headquarters and branch offices, particularly if the offices are based in a possible at-risk area
NAIC says the survey is the first of its kind and the regulators hope it will serve as a model for financial institutions to discover how climate change is affecting industries.
Infection prevention and control issues continue to weigh heavily on hospitals.
National Patient Safety Goals focus on healthcare-acquired infections in 2009, providing consistent challenges in identification and prevention for hospitals preparing for Joint Commission surveys. Some states have targeted specific infections for education and prevention.
In Kentucky, a collaborative has targeted methicillin-resistant Staphylococcus aureus (MRSA) as a focus point for improvement.
Initially, the plan was to focus on rural hospitals, using funding through a rural grant, explains Elizabeth Cobb, MPH, vice president of health policy with the Kentucky Hospital Association. As discussions continued, however, the University of Louisville School of Public Health and Information Sciences was brought into the loop, and funding from emergency preparedness grants came into play.
"The timing was right in that we were able to leverage work done as part of emergency preparedness training grants and submit for some additional funding that was targeted toward emerging infections and healthcare worker training," says Ruth Carrico, PhD, RN, CIC, assistant professor and health promotion and behavioral sciences director with the school.
The organizations decided to pool their resources and target MRSA across the state.
"We decided from the beginning that this needed to be bigger than just hospitals or healthcare," says Cobb. "It's a community problem, not just a hospital or healthcare problem."
"I once worked with a state epidemiologist who would say, 'There's no such thing as a leak on your side of the canoe,'" says Carrico. "We're all impacted by the actions of others."
This concept drove the collaborative to not only target MRSA in hospitals, but build in a range of components to the program, particularly providing resources to nursing homes, home health, first responders, correctional institutions, schools, and athletics groups.
"We are really reaching out to all types of organizations where these infections are of concern," says Cobb.
Among the key targets: Hot topic (and NPSG) hand hygiene.
"We're encouraging everyone to educate visitors to your facilities about hand hygiene, and how that is so key to stopping the spread of MRSA and infections in general," says Cobb. "While we've built a MRSA toolkit, [MRSA prevention] really goes across borders."
Legislation requiring the reporting of infection rates was introduced at the state level in Kentucky in 2008. This legislation arrived early on in the development of the toolkit, prompting the collaborative to take a different approach demonstrating whether the program was making progress.
"How can we approach this at a statewide level and not be led by the drumbeat of mandatory reporting?" says Carrico. "We really wanted to lead instead of be led. We wanted to be very transparent, look at our issues, bring in concepts like standardization and social networking where improvements begin at the ground level."
The data collected will be applied directly as a method tracking process improvement.
"We wanted to do some data collection so we could share successes of the collaborative's efforts, but also if we find some components are not working, this will allow us to go back and modify the toolkit to get better results," says Cobb. "It will also help identify hospitals that are really excelling so that we can share those processes."
This will also provide an opportunity to improve through example.
"We will be able to identify facilities [that] are high performers, and also enable those who are not doing as well to make appropriate changes and figure out what is different about those facilities," says Carrico. "You can't do that if you're mired in mandatory regulations."
With healthcare reform among the top issues facing the U.S., there has been much talk about increasing transparency and quality in the effort to reduce healthcare costs.
Now more large insurers are beginning to, or at least considering, covering medical tourism. Industry insiders say the medical travel industry's growth can ultimately improve healthcare quality for Americans by encouraging U.S. providers to be more transparent with their outcomes.
"Along with driving down costs, I think the other thing it will do is force that transparency of quality data from U.S. providers, and that to me is a huge benefit," says Wouter Hoeberechts, CEO of California-based WorldMed Assist, which works with employers to coordinate medical travel options for employees.
Before traveling for medical reasons, Americans will likely research and compare costs, outcomes, and quality-related statistics to determine whether the trip is worth it. If more Americans see that the quality of cardiovascular care is just as good as, say India, and they can get the same procedure at a significant cost saving, they will be more likely to go.
If medical tourism grows in popularity, the increased competition could encourage U.S. providers to improve their services and reevaluate costs, as well as make this information readily available to consumers.
"The American consumer and the American patient have not been trained to ask for outcomes data when they go to see their local physician, they just don't," Hoeberechts says. "Even if they are asking, they aren't going to get an answer—medical tourism will really change that."
As Hoeberechts said in a recent interview with HealthLeaders Media, medical travel is attractive for three reasons: Cost savings, access to some of the highest quality surgeons in the world, and decreased wait times.
The healthcare climate in the United States contributes to the medical travel industry as well.
"The uninsured people go because the cost savings are there—more companies are starting to implement high deductibles or in general do more cost shifting to their employees," Hoeberechts says. "It's just a matter of time before the employees will go in pretty large numbers."
He is quick to point out, however, that medical travel is only an additional option, not a replacement to receiving care in the United States.
"The domestic options stay in place, an international option is just added to that," Hoeberechts says. "You cannot have any hard rules around 'this type of procedure has to go abroad' because every case is just different."
Hoeberechts says that the medical travel business will grow exponentially in the next decade or so, but it will always remain a niche industry.
"This is not for everybody, not for every person in terms of their readiness to adopt it, but also from a medical point of view," Hoeberechts says. "Not everybody can get on the plane and fly depending on what is going on with their healthcare situation."
But for those U.S. patients who do decide on the medical travel route, the ability to compare quality and cost will continue to be a huge factor as they decide whether to get on a plane to travel to a foreign country for any medical procedure.
Hoeberechts says people may soon realize that in some areas of the world, quality information is readily available that shows the outcomes for certain procedures very comparable, or even better, than in the U.S., and at a significantly lesser cost. This could lead people who were on the fence about medical travel to be more likely to take the plunge, he says.
And as medical facilities face increased competition from abroad, they in turn would face pressure to be more transparent with their quality statistics, and reduce costs, to remain competitive.
"As we continue to broadcast that message, I think people will get smarter and ask more and more questions, and that will lead to improvement of quality," Hoeberechts says.
Note: You can sign up to receiveHealthLeaders Media Global, a free weekly e-newsletter that provides strategic information on the business of healthcare management from around the globe.
A project to link up African Union countries with Indian hospitals and universities via satellite will accelerate after a pilot project in Ethiopia proved successful. Ethiopia was the first country to participate in the Indian taxpayer-funded project, called the Pan-African e-Network, and Nigeria is scheduled to go online in June.
The project, costing more than $100 million, aims to connect universities and hospitals of all 53 countries of the African Union with Indian counterparts for telemedicine and tele-education activities.
Thousands of patients' details have been discovered on "lost" waiting lists at hospitals in London as they struggle with a new computer system installed as part of the government's overhaul of National Health System IT, according to an investigation by The Guardian. The discovery has led many healthcare facilities into a crisis which has already cost tens of millions of pounds in lost revenues and mounting bills for remedial work.
South Korea's hospitals will be allowed directly to seek foreign patients beginning May 1 as part of the country's efforts to promote medical tourism. Lee Young Ho, a marketing director of the Global Healthcare Business Centre, said he expects the medical industry to grow fast due to aggressive overseas marketing. South Korean hospitals are currently barred from directly advertising for patients or accepting them through dedicated referral services. But the Centre, which is controlled by the health ministry, is forming a network of hospitals and travel agencies which will be officially allowed to seek patients abroad under a law which takes effect on May 1.
A widespread practice in which physicians and healthcare institutions receive money, services, drug samples, fees, and gifts from biotech, medical device, and drug industries is a practice that threatens patient care and research integrity and erodes the public trust, says an exhaustive report issued today by the Institute of Medicine.
The 353-page document, titled Conflict of Interest in Medical Research, Education, and Practice gives numerous examples in which research findings may be compromised by a multitude of "disturbing" traditions.
Those traditions include pharmaceutical companies giving physicians drug samples in an effort to influence their prescribing patterns, medical industry representatives funding research and ghost writing study findings, and physicians and researchers receiving consulting fees or other payments from the medical companies, toward which those investigators are supposed to remain objective.
Research suggests "that physicians who have access to [drug] samples may change their prescribing habits, for example, by not prescribing the drugs that they would prefer for their patients to use or by prescribing drugs in ways that are not consistent with evidence based recommendations," the report said.
"It's time to end a number of long-accepted practices that create unacceptable conflicts of interest, threaten the integrity of the medical profession, and erode public trust while providing no meaningful benefits to patients or society," Bernard Lo, chair of the commission that wrote the report, said in a statement. The director of the medical ethics program at the University of California, San Francisco, acknowledges that there are productive relationships between the medical community and industry, but there are also too many worrisome problems with it.
In a press briefing today, Lo acknowledged that not all relationships between researchers and health providers are problematic. "Patients and the public benefit from constructive relationships [with the medical industry] particularly from moving discoveries from bench to clinical care," he said.
However he says, conflict of interest is such a pervasive issue, "it really goes to the heart of patients' trust, that they're receiving the best advice and medical care."
The 17-member panel of physician and research ethicists recommends 16 policy changes to end or limit these influential relationships, which have the potential to bias how and what kind of patients receive, either overtly, or unconsciously or unintentionally.
"Such conflicts of interest threaten the integrity of scientific investigations, the objectivity of medical education and the quality of patient care," said the report. "They may also jeopardize public trust in medicine."
The panel devoted considerable attention to the relationships between the common practice by which drug companies give physicians free product samples, gifts, and meals.
"Although one argument for the use of drug samples is that they help low-income patients, research suggests that these individuals are not the primary recipients of such samples," the report said. And, free samples are often timed with new brand name drugs "when they are not recommended by evidence based practice guidelines" and when less expensive drugs are available for the same indication, the ethicists wrote.
In the briefing, Lo said, "We call on physicians–no matter where they practice–not to accept gifts from pharmaceutical companies and limit use of samples and interactions with drug representatives."
Although gifts may seem inconsequential, some research suggests they can contribute to unconscious bias in decisions and advice physicians give, the report said.
"It seems unlikely that companies would give such gifts to physicians if they did not believe that they would benefit the company in some way."
Another focus of the report is the fact that medical institutions have great variation in their conflict of interest policies.
"Relationships and practices that are forbidden by one institution may be allowed and even encouraged by others," the report stated, adding that there have been shortcomings in oversight by federal agencies and medical institutions.
Drug company sponsorship of research also came under attack. When pharmaceutical companies sponsor research, the results "are more likely than other reviews to present conclusions favorable to the company, even when the actual findings are not favorable," the report said.
The 18-member panel of research and physician ethicists advocated the following:
Medical institutions should adopt and strengthen conflict of interest policies in a way that can be standardized.
The U.S. Congress should require pharmaceutical, medical device and biotech companies, and their foundations to publicly report all payments to physicians, researchers, healthcare institutions, professional societies, patient advocacy and disease specific groups, providers of continuing medical education, and their foundations.
Research centers should preclude any investigator with any financial or other interest in the outcome from being involved in studies that include human subjects.
Academic medical centers should prohibit faculty, students, residents, and fellows from accepting gifts, including meals, making industry-controlled presentations, or claiming authorship for ghostwritten publications. Physicians likewise should decline any such arrangements.
Those who write evidence-based practice guidelines should be required to disclose all funding from industry and all financial interests.
The National Institutes of Health should require certain public health institutions to adopt institutional conflict of interest policies.
Academic medical centers and teaching hospitals should provide education on how to avoid conflicts of interest and manage relationships with pharmaceutical and medical device industry representatives.
Accreditation organizations, public and private health insurers, and associations of medical journal editors should develop incentives to make institutions more accountable for preventing, identifying, and managing conflicts of interest.
The report enumerated several ethical lapses in recent years that potentially altered or influenced patient outcomes.
For example, it described investigations into the 1999 death of Jesse Gelsinger, a patient in a gene therapy trial at a University of Pennsylvania research institute, which raised questions about whether the institute had properly managed the experiment. Both the university and several officials were found to have significant financial interests in the company that developed the therapy. The company also had contributed $25 million to the institute's annual budget and had exclusive rights to develop products that emerged from the trial, the report said.
Amgen, the manufacturer of epoetin, a drug that increases hemoglobin levels, was the founding and primary sponsor of the Kidney and Dialysis Outcomes Quality Initiative carried out by the National Kidney Foundation. This project issued practice guidelines recommending an increase in the target hemoglobin level for patients with chronic kidney disease, which would entail the use of higher doses of epoetin and increased sales of the sponsor's product, according to the report.
It's not enough to simply disclose conflicts of interest to the public or to patients, the authors wrote. It also must be properly curtailed.
"When a relationship or conflict of interest is disclosed to individual patients, students or research participants, they often lack the knowledge and perspective to assess . . . and may have no satisfactory options if they have concerns about it."
The report summed, "Society has traditionally granted the medical profession considerable autonomy to regulate itself," the authors summarized. "But concern is growing in the U.S. Congress, state legislatures, federal agencies and elsewhere that stronger measures are needed."
The Senate is set to approve President Barack Obama's nominee for health and human services secretary Tuesday, giving the agency a leader in the midst of the swine flu outbreak. Morning debate and an afternoon vote were scheduled to confirm Kathleen Sebelius, the two-term Democratic governor of Kansas. She was expected to get the 60 votes needed in the Democratic-led Senate.
California Assemblyman Dave Jones, D-Sacramento, wants to curb the practice of unregulated rate increases through legislation that would require the state's two health insurance regulators to approve health plan increases in premium, co-payment, deductible or other charges. Not surprisingly, the California Association of Health Plans opposes the bill. The trade group for the state's health insurers argues that such legislation would hinder plans from offering new products or changing existing policies, adding a "burdensome new regulatory scheme."
