A physician in Iowa has devised a way to use electronic medical data to help control costs associated with operating room and anesthesia scheduling. The changes help OR managers better estimate how long a particular case will last, making it easier and more cost-efficient to schedule subsequent cases in the same room, says Franklin Dexter, MD, an University of Iowa physician and expert in operations research.
The federal stimulus bill allocates $19 billion to promote the use of IT to improve the efficiency of healthcare and lower its cost, and that infusion could benefit companies like the newly named HealthCare IT Inc. The company recently began offering services to help with the adoption of electronic medical records and the development of systems for managing healthcare data.
There are five areas the United States has to concentrate on in order to improve healthcare: coverage for all, payment incentive reform and realignment, wellness initiatives, quality improvement, and health information technology. That is what American Hospital Association President Richard Umbdenstock told key stakeholders last week during President Obama's White House healthcare summit.
If those are indeed areas we should be focusing on for healthcare reform, why aren't we hearing more talk about the patient centered medical home model? The very idea of the PCMH is founded upon reducing chronic diseases and improving quality care through preventive medicine and wellness initiatives, according to guidelines put forth by the National Committee for Quality Assurance.
The concept also represents a way of realigning financial incentives with healthcare delivery goals to provide coordinated, integrated, ongoing care, says Salvatore Volpe, MD, who runs a PCMH practice in Staten Island, NY.
Two things facilitate that integration and continuity of care: the primary care physician and health information technology, says Volpe. Primary care physicians, understandably, balk at spending the extra (uncompensated) time on attempting to arrange for follow-up care for each patient. But under the PCMH model, physicians are paid for services such as care management and care coordination, which are not reimbursed under the current fee-for-service system.
"The current system penalizes you for using HIT. If I spend the additional time to use my EHR to look up what's needed for my patient in terms of preventative, I'm being penalized because I'm spending additional time I could be spending seeing another patient," says Volpe. "We have to be reimbursed for that extra service and time. The only place I'm seeing that done is with the patient centered medical home," he says.
Volpe points to the oldest and largest PCMH model, North Carolina's Medicaid managed care program, Community Care of North Carolina, as proof that the idea works. CCNC is based on physician-led networks that use the PCMH model to provide care to the state's Medicaid recipients. It started 10 years ago with nine pilot projects covering 250,000 Medicaid enrollees, and has since expanded to 14 networks covering more than 750,000 Medicaid recipients across the state.
CCNC pays each network $2.50 a month for each Medicaid recipient and an additional fee of $2.50 to each physician for each Medicaid patient in the physician's practice. Over the course of the program, CCNC has saved North Carolina nearly half a billion dollars.
"By paying doctors a little more, they were able to invest in health information systems, like EHRs or e-prescribing software. Doctors had an incentive to stay open a little longer so instead of closing at 4 o'clock they might close at 5:30. They were able to offer more wellness programs or preventative care," says Volpe, who writes a blog on EHRs and the PCMH.
Sarah Corley, MD, chief medical officer for NextGen Healthcare and a practicing primary care physician, says she believes that President Obama's call for increased EHR adoption combined with the forthcoming stimulus money is leading the country toward greater use of the PCMH model.
"That's where the cost savings in our society are going to occur. Once you have a fairly good adoption of EHR, which I anticipate will occur over the next six years because otherwise the physician will be paying a penalty, I think that then you would say, okay, we paid the stimulus money to adopt EHR. Now what we're going to do is pay you to provide PCMH centers and care coordination services," she says.
As President Obama said last week during the summit, "No proposal for reform will be perfect. If that is the measure, we will never get anything done. But when it comes to addressing our healthcare challenge, we can no longer let the perfect be the enemy of the essential." By my calculations, the PCMH model addresses four of the five areas concentration called for by Umbdenstock: physician payment realignment, wellness initiatives, quality improvement, and health information technology. Not perfect, but maybe essential.
Kathryn Mackenzie is technology editor of HealthLeaders magazine. She can be reached at kmackenzie@healthleadersmedia.com.Note: You can sign up to receive HealthLeaders Media IT, a free weekly e-newsletter that features news, commentary and trends about healthcare technology.
Staff cutbacks, closings, trimming services—it seems every day the news is filled with another healthcare provider that is facing problems due to the state of the economy. But it isn't all doom and gloom. At least one area of the world continues to see a hospital building boom—$14 billion worth.
That much is being spent in Arabian Gulf countries on new hospital and healthcare facilities in various stages of construction, according to research findings presented by the Institute for International Research Middle East.
John Wallace, Group Marketing Manager for IIR Middle East, says the trend is simply a matter of supply and demand. A sustained growth in populations across the region, coupled with an accelerated rise in chronic disease, is forcing government leaders in this region to be focused and pragmatic when looking for health-related solutions.
"Governments are stepping up to the challenge of meeting this demand," Wallace said in an email interview last week. "I think the growth in healthcare is a strong indicator that this is the case, and governments understand the problems facing them."
Despite the extensive plans, Wallace admits it may be too early to tell if the healthcare facility construction trend will be deterred by the global economic crisis. But he is optimistic that it will not, given the necessity of quality healthcare as the Middle East region evolves.
The state of the economy, however, may force flexibility in the plans, Wallace says, and stakeholders will have to stay on top of market trends and any policy changes.
"The healthcare industry remains strong, and there is no question that the growth being witnessed will be sustained, but I think we should be aware that not all projects will necessarily encompass what they originally set out to do," Wallace said. "By this I mean you may see mission statements change with respect to what some individual projects' services will offer."
In addition, the support from governments across the region to develop their hospital infrastructure no doubt helps when it comes to acquiring and sustaining funding even in the face of a troubling economy.
"That's a massive draw for international companies looking to win contracts because they will come to the region with confidence knowing the project will proceed to completion and they will be paid for work done," Wallace says. Healthcare giants in the U.S. are noticing the trend as well—Cleveland Clinic has partnered with development firm Mubadala Healthcare on the Cleveland Clinic Al Suwwa Island development. The $1.9 billion first phase of the project is currently under way in Abu Dhabi. In many of these countries, as much as 80% of the population consists of expatriates, Wallace says, so it is logical that total funding would not come entirely from the public realm.
While some critics contend these tie-ins are simply marketing gimmicks, Wallace says there are innumerable benefits for both sides. By expanding their brand into the global market, these organizations can not only tap into patients that are in these regions, but also see some business from the medical tourism boom as well.
"I don't think Cleveland or Harvard would lend their name to anything that could have a negative impact on their reputation," Wallace says. "For the projects in this region, it offers fantastic opportunities for training and puts patients' minds at ease when they know a medical institution has the support of a reputable organization."
U.S.-based healthcare organizations may also be concerned that facilities such as those under construction in the UAE will soon be competitors. In the Gulf, the governments are careful that their healthcare facilities cater to medical travelers, and that all major projects have components built in to attract these types of visitors.
For example, several planned hospitals in the region have five-star amenities designed to specifically cater to medical tourists and their families, Wallace says.
"If the quality of healthcare is good, and the services on offer are cheaper than North America or Europe, then why shouldn't patients travel to the Middle East for treatment?" Wallace asks.
He says the hospital building boom is likely to continue in the future as well, especially as the region continues to develop and the population expands dramatically. With healthcare as an industry constantly evolving, a region such as the Middle East that is expanding just as quickly will continue to look for ways to grow quality healthcare for its people.
"This isn't simply a trend; it's a long term policy that will improve the quality of life of millions of people across the region," Wallace says. "Whether it's building a 600-bed hospital, a specialist centre of excellence or an R&D facility, the medical building boom in the Middle East is set to continue well into the future."
Ben Cole is an associate online editor with HealthLeaders Media. He can be reached at bcole@healthleadersmedia.com.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.
New York City hospitals are the least reliable in the state at reporting preventable mistakes and adverse incidents for patients like heart attacks, blood clots, hospital infections, and medication errors, according to a new report by the office of City Comptroller. Though New York City hospitals accounted for almost half the patients statewide in 2006, they reported about 39 adverse incidents per 10,000 patient discharges, compared with nearly 70 per 10,000 in the northern suburbs and upstate and nearly 64 per 10,000 on Long Island. The comptroller also expressed concern that the New York City data on medication errors appear to run counter to the national trend.
Atlanta-based Emory University announced that it is suspending its $1.5 billion medical expansion project, citing general uncertainty about the economy. Emory's plans included a new replacement hospital and large outpatient clinic on its main campus, plus a medical tower that would have hospital beds along with outpatient clinic space. It would add up to 300 combined beds to Emory University Hospital and the newly renamed Emory University Hospital Midtown.
Billions of stimulus dollars meant to spur doctors to switch to electronic record-keeping may not be enough to do the job, according to a study by Avalere Health, an information company serving government and the healthcare industry. The stimulus bill signed by President Barack Obama contained $19 billion for health information technology, including $17 billion for incentives and penalties to encourage doctors and hospitals to abandon paper record-keeping and go high-tech beginning in 2011. But particularly for doctors in small practices, the high cost of installing electronic records systems could outweigh the incentives and penalties for failing to comply, the analysis said.
The Western Pennsylvania Hospital-Forbes Regional Campus is the subject of investigations by two federal entities for "potentially erroneous evaluation and management claims," according to a financial document released by Forbes' parent, the West Penn Allegheny Health System. According to the document, the U.S. Attorney's Office for the Western District of Pennsylvania and the inspector general's office for the U.S. Department of Health and Human Services notified Forbes officials of the investigation in January. WPAHS spokeswoman Stephanie Waite told the Pittsburgh Post-Gazette that, "We are currently in the process of analyzing the data relative to this issue and the applicable regulations."
The United Auto Workers has ratified an agreement with Ford Motor Co, modifying its national agreement and the Voluntary Employee Beneficiary Association healthcare trust. The agreement allows Ford to end its legacy retiree healthcare obligation by funding a new VEBA with assets worth about $13.2 billion.
The 11th U.S. Circuit Court of Appeals has upheld most of the bribery and corruption charges against former Gov. Don Siegelman and all the charges against HealthSouth founder Richard Scrushy. A three-judge panel in Atlanta tossed out two fraud counts against Siegelman and ordered him resentenced—setting up a new battle between defense lawyers and prosecutors. The ruling was a major setback to Scrushy and Siegelman, who had argued their 2006 trial was riddled with errors.
