There are still huge barriers to the meaningful use of health IT relating to security, health information exchange, decision support, and the secondary use of data collected in electronic health records. The government doesn't know how to surmount these obstacles, which is why Department of Health and Human Services announced it's providing $60 million in grants funded through the HITECH Act for Strategic Health IT Advanced Research Projects.
"This program will fund projects in areas of research where breakthrough advances are needed to address barriers in health IT adoption. Addressing these breakthrough areas will require the most advanced thinking the nation can bring to bear," David Blumenthal, MD, national coordinator for health information technology wrote in the HIT Buzz blog.
Not surprisingly, one of the targeted areas is related to health information exchanges, specifically to help develop applications and network platform architectures to electronically exchange clinical data and use health information in a secure, private, and accurate manner.
"By 2015 we are still going to have many of the same problems," says Chris Giancola, a principal consultant with CSC Healthcare Group, a Falls Church, VA-based global technology consultancy that has been the program manager for the New England Health Exchange Network.
"Data liquidity will have improved, which is wonderful because we are at least saying that we will be investing in things to move data," he says. "But the costs of healthcare and rate at which costs are increasing aren't going to change because I don't see the legislation impacting cost containment in a meaningful way."
The report outlines three core principles that are necessary to establish a financially viable HIE based on CSC's work with the New England Health Exchange Network. NEHEN, which was formed 11 years ago to help address the mandates outlined in the HIPAA legislation, is a member-owned and privately funded HIE with about 50 participating members in New England area. The initial participants were motivated by the idea of exchanging a standard set of administrative actions so that they could rid themselves of clearing house transactions fees, says Giancola. "We started off with the administrative actions—claims files, checking patient eligibility, doing electronic referrals. Doing those transactions first show real dollars to the participants so that they can get behind it."
The report says healthcare organizations should target key payer and provider organizations to secure private funding, create a core value proposition that clearly demonstrates what the benefits are to all participants, and determine how costs will be fairly allocated between participants.
"You really need to start with looking at private funding and obtaining that rather than securing a grant first. Look at grant money as the gravy," says Giancola, adding that "forming a nexus around the large players is huge because once you have critical mass around the right payer and provider organizations everyone else will want to get involved."
Participants in NEHEN pay according to size. The smallest organizations don't pay the same as the largest, because the larger organizations stand to gain the most so they share more of the costs, explains Giancola. Organizations can also pay for additional services like exchanging a continuity-of-care document between two members.
Today, one of the challenges NEHEN is facing, says Giancola, is restructuring the funding formula based on the requirements of ARRA and HITECH. "Payers were at the table and interested in participating because it saved them a great deal of money," he says.
Now that administrative data is a solved problem—for the most part—and payers are only involved in two of the nine different meaningful use recommendations for health information exchange, payers don't want to fund the exchange at the same rate, he says. "They don't think that they should bear as much of the burden any more and provider organizations have to pick up the slack."
There will need to be more of a fundamental shift in the financing model, says Giancola, explaining that it's going from administrative to doing more clinical transactions. "The providers will have to take on more of the financial burden for next few years," he says.
Therein lies the challenge—most providers are hard pressed to come up with the extra capital to add the technologies required by the HITECH Act. And while the incentive payments are nice and a great benefit, they don't cover all of the costs associated with installing and meaningfully using EHRs. Then again, providers can't afford being hit with penalties in 2015 and beyond, either. So if you have any solutions on how to make health information exchange financially viable, please pass it on.
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Genesys Health System in Grand Blanc, MI, will pay the federal government $669,413 to settle allegations that it overbilled Medicare, the U.S. Justice Department said.
The government claims that between 2001 and 2007, Genesys violated the False Claims Act by billing Medicare for higher levels of service than were actually given to patients, specifically for evaluation and management services for cardiology patients.
The settlement resolves allegations brought forward in a whistleblower lawsuit by Wendy Buterakos, a contracted auditor who will receive a $133,882 share of the settlement.
"With the rising cost of healthcare and the related pressure on the Medicare Trust Fund, the last thing our nation can afford are providers who are profiteering at the expense of patients. (Buterakos) can be proud that she brought these serious allegations of Medicare fraud to our attention and paved the way for the government to uncover the false claims," said Terrence Berg, U.S. Attorney for Eastern Michigan. "It is important that anyone who has information about alleged fraud on the federal government come forward so we can investigate."
Genesys Health System, a member of Ascension Health, is anchored by Genesys Regional Medical Center at Health Park. The system has operating revenues of more than $410 million, and serves eight counties in central Michigan.
Genesys issued the following statement regarding the matter:
"As part of our stringent Corporate Responsibility Program, Genesys fully cooperated and followed due diligence with the Department of Justice regarding resolution of inadvertent documentation and billing errors related to certain physician claims. This issue did not relate to the quality of care provided to patients. Consequently, the settlement was attained without an admission of liability on the part of Genesys, resulting in the conclusion of this matter."
Health-related spending represents the fastest growing component in state government budgets throughout the United States. And, while Medicaid will remain the largest health-related expenditure component among state governments for now and the near future, spending on state and local government retirees' health benefits is projected to more than double as a share of total operating revenues to 2.1% by 2050, according to a new report from the Government Accountability Office (GAO).
GAO said that according to its model, by 2050 the number of state and local government retirees is likely to grow by about 70%—from the current level of 3 million to 5.1 million retirees. However, the cost of retiree health benefits is projected to grow more quickly, at an annual rate of 6.7% over that same period. Retiree health benefit liabilities of state and local governments currently amount to more than $530 billion, GAO estimated, with liabilities heavily dependent on projections of healthcare costs.
According to its model, GAO said this means that current spending of $15.8 billion on retiree health benefits will grow to $237.3 billion by 2050, in current dollars. However, much of this is will remain an unfunded liability for many of those states and local governments. Many of these governments have not set money aside to pay for these benefits.
But some state and local governments have taken actions to address liabilities associated with retiree health benefits by setting aside assets to prefund the liabilities—before employees retire—and by reducing these liabilities by changing the structure of retiree health benefits. Approximately 35% of the 89 governments that GAO reviewed reported having set aside some assets for retiree health, but the percentage varied.
Among the 10 selected governments that GAO reviewed in more detail, officials from the governments that were prefunding at least a portion of their retiree health liability reported using irrevocable trusts. However, these governments varied with regard to the source of the money used to prefund their retiree health liabilities and how they determined the level or amount to commit to prefunding each year.
To address their retiree health liabilities, the governments GAO selected made three key types of changes to their retiree health benefits: changes to the type of retiree health benefit plan, to the level of government contribution, and to the eligibility requirements employees need to meet to qualify for retiree health benefits.
Changing the level of government contribution, such as reducing the amount or proportion of health insurance premiums paid for by the government, was the most common benefit change reported. Some of the selected governments made more than one change to their retiree health benefit structure. The changes were most often applied to the retiree health benefits of newly hired employees or currently active employees.
"This report clearly demonstrates the effect that rising healthcare costs are having on state and local governments," said Sen. Herb Kohl (D-WI), chairman of the Senate Special Committee on Aging, who requested the study.
Separate bills passed by the Senate and the House would squeeze nearly a half-trillion dollars from projected spending on Medicare over the next 10 years, and these savings would help offset the cost of providing coverage to people who are uninsured. At the same time, federal accountants say the money would shore up the Medicare trust fund, so the program could continue paying hospitals to treat older Americans in the future, the New York Times reports.
While it may be less as well-known than MRSA, drug-resistant strains of the potentially dangerous bacteria, Acinetobacter, are beginning to become increasingly common in American hospitals, according to a new study.
In reviewing data from 300 hospitals nationwide, the researchers, part of the Washington, DC-based Extending the Cure project, looked at imipenem, an antibiotic often used as a last-line treatment against the bacteria. Between 1999 and 2006, more than a 300% increase occurred in the proportion of Acinetobacter cases resistant to the drug, they report in the most recent issue of Infection Control and Hospital Epidemiology. The national resistance rate, as determined by the study, was estimated at 18%.
Acinetobacter infections have recently been linked to infections impacting soldiers returning home from the war in Iraq. Many infections often have affected patients in hospital intensive care units (ICUs): Using one of the largest sample sizes to date, 47,000-plus Acinetobacter isolate samples were tested against imipenem that were collected between 1999 and 2006. Those recovered from patients in intensive care units (ICUs) accounted for 33% of all isolates.
These infections often can appear as severe pneumonias or bloodstream infections, and will require strong drugs for treatment. The most common sources of isolates were found in the respiratory tract (52%), urine (11%), wounds (22%), and blood (12%). However, they noted that identifying the presence of Acinetobacter did not indicate that an infection occurred.
Most of the cases originated in the South Atlantic states (22%), followed by Middle Atlantic (21%), Pacific (16%), North Central (13%), West South Central (8%), East South Central and West South Central (5%), and New England (2%).
"The findings are troubling because they suggest this bacteria is becoming resistant to nearly everything in our arsenal," said Ramanan Laxminarayan, PhD, a principal investigator with Extending the Cure. "There is a lot of attention on MRSA, but less on infections caused by bacteria like Acinetobacter for which there are fewer drugs in the development pipeline. While all drug resistance is of concern, it is particularly worrying in the case of bugs for which we have few treatment options."
Heart specialists have filed suit against Secretary of Health and Human Services Kathleen Sebelius in an effort to stave off steep Medicare fee cuts for routine office-based procedures. The lawsuit, filed in U.S. District Court for the Southern District of Florida, charges that the government's planned cutbacks will deal a major blow to medical care and force thousands of cardiologists to shutter their offices, sell diagnostic equipment and work for hospitals, which charge more for the same procedures.
Several states are debating a proposed amendment to their constitution that would try to block, at least symbolically, much of the proposed federal healthcare overhaul, the New York Times reports. Backers of the state measures say they want to send a message to Congress and also lay groundwork for fights about elements of the healthcare package that are expected to be left up to the states. Advocates of a overhaul by the federal government say the magnitude of the healthcare industry's contributions shows the dangers of leaving such a question up to individual states, the Times reports.
House Democrats are signaling that a final healthcare bill will drop the government-run public health insurance option. Supporters of a public option say it would provide nonprofit competition to private insurers that would bring down costs, but opponents contend that it is the first step toward a government takeover of the healthcare system. President Obama has expressed general support for a public option but stops short of insisting on the provision.
Hospital system UMass Memorial Health Care Inc. posted a $91.6 million surplus during the recently completed fiscal year by cutting its costs, deferring some purchases, treating more patients, and reversing investment losses. Hospital executives said the surplus for the fiscal year that ended Sept. 30 was up 65%, compared with the previous year. Chief Executive John O'Brien said the system boosted hospital admissions by about 2,000 from the previous year as UMass Memorial sought to capture patients and procedures that otherwise probably would have gone to Boston hospitals.
A $1 million cash donation to Community Health Network Foundation is the Indianapolis-based philanthropy's largest ever. John W. Heiney, a retired president and CEO of Indiana Gas Company who has worked on numerous boards for the foundation for nearly 40 years, gave the gift as a tribute to his late spouse. His unrestricted donation will support Community's greatest needs and will provide funding to improve community health through outreach, wellness, and prevention programs and to lead patient-centered healthcare reform, according to a news release.
