Medical liability expert says breakdowns in cognitive and process factors often aren't captured in adverse events reports, and only come to light for physicians when they're named in a lawsuit.
Misdiagnoses are the root cause of one-third of all medical liability claims and account for nearly half of all indemnity payments, according to a new report by Coverys.
The report from the medical liability insurer analyzed more than 10,500 closed medical liability claims from 2013-2017 and found that:
Diagnosis-related events are the single-largest root cause of liability claims. The 3,466 closed claims with diagnosis-related allegations from 2013-2017 account for 33% of all claims and 47% of indemnity payments.
35% of diagnostic errors occur in non-emergency department outpatient settings, such as physicians’ offices.
33% of diagnosis-related claims allege the decision-making breakdown happened as a result of a failure during the patient evaluation.
The four phases of testing -- ordering, performance, receipt/transmittal, and interpretation―account for 52% of diagnosis-related claims.
Among diagnostic failure claims, the largest number of cases involve a missed or delayed diagnosis of cancer, especially breast, lung, colorectal and prostate cancers.
Of the claims that cited an EHR issue, 58% had an injury severity considered high―a category that includes death.
Study author Robert Hanscom, vice president of business analytics at Coverys, spoke with HealthLeaders Media about the findings. The following is a lighted edited transcript.
HLM: What leapt out at you with your findings?
Hanscom: Clearly we don’t know enough about diagnostic error, which is often hidden from the view of physicians and other providers.
Generally, when we see them in malpractice they are missed and delayed cancer diagnoses that would miss any adverse event reporting system, which is often the way that providers learn about mistakes. These are non-events that actually take providers by surprise sometime later down the road.
There is not a lot of intelligence out there, in terms of helping physicians understand where their vulnerabilities are with respect to these errors.
HLM: So, the first time providers learn about these misdiagnoses is when they’re sued?
Hanscom: Absolutely! If it's a missed or delayed cancer diagnosis allegation, it may take them completely by surprise. It may happen that their patient may have gone elsewhere, for example, because the symptoms hadn't gone away, or they wanted to try a new physician. Ultimately, when the actual diagnosis was made, and sometimes it is not made until they are advanced in the progression of the cancer, the physician may get a notice of a suit for a situation that he or she may have very little recollection about. This happens quite frequently.
HLM: Is there a common theme with these missed diagnoses?
Hanscom: There are both process and cognitive factors that are in play here. Those first two steps are where a huge amount of our malpractice activity comes from.
First, we know that cognitive variability is a big problem. Some physicians are really good diagnosticians. They get their rule outs. They get their differentials. But, that has become an artifact of old time medicine when doctors had lots of time to do it. Much of today's world cheats the doctor on their ability to do what they were trained to do, so the cognitive ability is significant.
Second, getting that history and physical and fully evaluating the patient is a process issue, because there needs to be that full evaluation and the time taken to do that. If they are looking at the patient's clinical history, they are making sure that there is a full capture of what is going on with that patient on every visit, which can be done efficiently, that will cut into that cognitive variability.
HLM: Talk about the importance of documentation.
Hanscom: There are two facets. From the legal perspective, if we have to defend cases at a later point, documentation means everything. If it is not documented, it’s very difficult to convince all the people who adjudicate these cases that the care happened in the way the physician is remembering it and wants a jury or some other arbiter to believe it happened. Documentation should be a habit that needs to occur.
More importantly, documentation helps subsequent providers completely understand what was decided and what was done. That is critical to continuity of care, and making sure that there is not a lapse in the care and the decision-making that needs to continually be made, that of course the treatment plan.
HLM: You also encourage documenting coverage denials.
Hanscom: Document the denial. If we can show a jury later that you considered it, you tried to do it, but there was a denial and you had to take an alternate path, that is important to make sure that the full story is being told.
HLM: Does fear of malpractice lead to unnecessary testing?
Hanscom: Getting those differentials does not constitute unnecessary testing. That is how physicians were trained in medical school and they need to be allowed to do it. There needs to be a fine balance. We recognize that there is pressure on costs and doctors not to do more than they have to. That doesn't take away from the fact that doctors need to make differential diagnoses to ensure that the true diagnosis is not being missed.
We see that in many cases the patient will present with certain symptoms and the doctor will say 'I think I know what this is,' and start to run with it. But, if they don't get differentials, if they don't ask what else could it be, then not only does that doctor get anchored in a diagnosis that has a degree of uncertainty, but other providers behind him get anchored as well.
HLM: What other actions could reduce liability?
Hanscom: Pay attention to the process categories. That is where resources need to be invested to make sure that good diagnosticians are not defeated. And, there needs to be attention paid to decision support that helps providers make sure that they’re considering everything that might be possible.
We have often seen that good diagnosticians get defeated by bad processes. More often we see both; physicians who are not as good with diagnoses and bad processes as well. That is the perfect storm.
It is also true with managing referrals. We see many cases where patients will refer to a specialist but the patient kind of drifted away from the primary care provider. There wasn’t a real process in place to make sure that the patient was looping back to the primary care provider.
Obviously, test result management is big. If test results are getting lost and the ordering provider is not getting the information they need to make that diagnosis, which is another major process issue.
HLM: Anything else?
Hanscom: I’ve looked at this data for 20 years and these data points have not moved very much. We really have to start a fire here with people thinking creatively and innovatively about how to put some very serious prevention to these tragic cases. These are high-severity injury outcomes. The time for innovation is really now. We need to think differently about how to help providers work their way through these complex scenarios.
Older patients are more vulnerable to postoperative delirium and cognitive dysfunction, but a few simple techniques could help to ease the transition.
The American Society of Anesthesiologists has developed a list of pre- and post-surgery tips to limit confusion for older patients.
"The aging brain is more vulnerable to anesthesia, but there is research that provides guidance to decrease these risks," said ASA President James Grant, MD.
"Older patients should talk with their physician anesthesiologist prior to surgery about their entire medical history and any memory problems they’ve had in the past, so an anesthesia plan can be developed," he said.
In particular, older patients are more susceptible to two anesthesia-related surgery risks, Grant said.
Postoperative delirium is temporary and causes the patient to be confused, disoriented, unaware of their surroundings, and have problems with memory and paying attention. It may not start until a few days after surgery, may come and go, and usually disappears after about a week.
Postoperative cognitive dysfunction is a more serious condition that can lead to long-term memory loss and make it difficult to learn, concentrate and think. Because some of these problems are already common in elderly people, the only way to determine if a patient actually has POCD is to conduct a mental test before surgery, Grant said.
Conditions such as congestive heart failure, lung disease, Alzheimer’s disease, Parkinson’s disease and having had a previous stroke, increase the risk for POCD.
ASA has put forward six tips that older patients and clinicians can take to reduce post-surgery confusion:
The physician should conduct a pre-surgery cognitive test of the patient and use the results as a baseline for comparison after surgery.
A caregiver or family member should stay with patients as they recover to observe physical and mental activity after surgery and report problems to the physician.
Physicians should know beforehand which medications a patient is taking after surgery, especially those medications that can affect the nervous system.
If the patient wears hearing aids or glasses, they should be made available as soon as possible after the procedure.
When possible, the patient should be in a recovery room with a window so they can tell whether it's day or night.
If the patient stays overnight in the hospital, they should pack a family photo, a clock and a calendar, or other familiar objects from home to help readjust.
The novel approach found a nearly 64% reduction in high blood pressure levels after barbers promoted follow-up with pharmacists in the barbershops.
African-American men lowered their high blood pressure to healthy levels when aided by a pharmacist and their local barber, according to a new study in The New England Journal of Medicine.
"When we provide convenient and rigorous medical care to African-American men by coming to them—in this case having pharmacists deliver that care in barbershops—blood pressure can be controlled and lives can be saved," said study lead author Ronald G. Victor, MD, associate director of the Smidt Heart Institute.
"High blood pressure disproportionately affects the African-American community, and we must find new ways to reach out so we can prevent strokes, heart attacks, heart failure and early deaths," Victor said.
The study included 319 African-American men recruited from 52 barbershops in the Los Angeles area. Participants had a systolic blood pressure reading of more than 140 mmHg, placing them at high risk of heart attack and stroke. The men received intervention aimed at lowering blood pressure below 130/80 mm Hg.
The men were randomly assigned to two groups. The first group's barbers encouraged patrons to meet with specially trained pharmacists who met the men monthly in the barbershop—where they prescribed blood pressure medication, monitored blood tests and then sent progress notes to each patron's primary care provider.
In the second group, barbers encouraged their patrons to follow up with a primary care provider for treatment and make lifestyle changes, such as increasing exercise and decreasing salt consumption.
For the patrons working with their barbers and pharmacist, systolic blood pressure dropped from 153 mmHg at the start of the study to 126 mmHg after six months, along with a decrease in diastolic blood pressure of 18 mmHg.
After six months, almost two-thirds of participants in the group working with pharmacists brought their blood pressure into the healthy range, the study found.
Men who met only with their barber saw their systolic blood pressure drop from 155 mmHg at the start of the study to 145 mmHg after six months. Diastolic blood pressured dropped by 4 mmHg in this group. At the six-month mark, 11.7% of the group brought their blood pressure into the healthy range, the study found.
"It's the silent killer, and it has cost the lives and health of a lot of good men," said study co-author Eric Muhammad, whose Inglewood shop, A New You Barbershop, participated in the study. "It's a no-brainer that black men are at the highest risk of high blood pressure. What's different about this study is it looks at ways to effectively bring it down with the help of your friends, family and support group."
Muhammad recruited his own customers for the study and helped recruit 50 other barbershops to participate. He said the program can make a significant difference in the health of African-American men.
"A big takeaway from this study is to release the fears," Muhammad said. "We cannot fear what the doctor will tell us. Dr. Victor has a very sincere desire to bring down blood pressure in people in general, and in black men in particular. Since I could see his heart in this, it was easy for me to offer assistance."
C. Adair Blyler, a pharmacist who treated patrons while they were in the barbershops, said the location was key.
"There is a different level of trust and respect that's earned when you meet people where they are, instead of in a hospital or clinic," Blyler said. "The rapport I've been able to establish with this group of patients has been unlike any other I've had in my professional career."
Researchers have started a second phase of the study to determine if the benefits can be sustained for another six months. Victor wants to expand the program to other parts of the country.
CMS Administrator Seema Verma gives Idaho 30 days to correct the deficiencies identified in a notice this week or face a federal intervention.
The federal government has slapped down an attempt by the state of Idaho to bypass health insurance market requirements in the Affordable Care Act.
In a letter this week to Idaho Republican Gov. C.L. "Butch" Otter, Centers for Medicare & Medicaid Services Administrator Seema Verma said she was sympathetic to the state's efforts "to address the damage caused by the Patient Protection and Affordable Care Act," but warned that the Gem State's health insurance offerings violate Part A of the Public Health Services Act.
"PPACA remains the law and we have a duty to enforce and uphold the law," Verma said in the letter.
The letter identified several noncompliance areas around pre-existing conditions, age-related premium rates, annual coverage limits, essential benefits and out-of-pocket expenses.
Verma said Idaho has 30 days to address compliance issues identified in her eight-page letter. If not, CMS could assume enforcement of the PHS Act in Idaho and impose fines or shut down noncompliant insurers.
The warning comes as the Trump administration puts forward a proposed rule to expand the availability of short-term health insurance plans, with lower premiums and stripped-down benefits.
In her letter to Otter, Verma said Idaho's market requirements could be legal under the PHS Act exception for short-term, limited-duration plans "with certain modifications."
"I encourage you to continue to engage in a dialogue with my staff regarding this and other potential options," Verma said.
Researchers say the use of Interleukin-7 is a departure from traditional treatments that have relied on antibiotics and inflammatory medications that tamp down the immune system.
A small clinical trial shows that a drug used to rev up the immune system could effectively treat sepsis.
Researchers at Washington University School of Medicine in St. Louis said their findings are a potential breakthrough in the fight against sepsis, which claims about 250,000 lives each year.
The use of immune system boosting drugs is a marked departure from standard treatments for sepsis that involve high doses of antibiotics that fight the infection, but which fail to boost the body’s immune defenses.
The results were published Thursday in JCI Insight.
The trial involved 27 sepsis patients, ages 33 to 82, who were treated at Barnes-Jewish Hospital in St. Louis, Vanderbilt University Medical Center in Nashville or two medical centers in France — Dupuytren University Hospital in Limoges and Edouard Herriot Hospital in Lyon.
The study authors concede that the trial was too small to see a statistical benefit in mortality. However, senior investigator Richard S. Hotchkiss, MD, said there was an improved immune response in patients who were given a drug to beef up their immunity.
"Mortality rates from sepsis have remained essentially the same over the last 50 years. Hundreds of drugs have been tried and have failed," said Hotchkiss, a professor of anesthesiology, of medicine and of surgery.
"It may sound counterintuitive when inflammation is such a problem early in sepsis, but our approach is to stimulate certain immune cells to help the patient's system take control of the infection," he said.
The patients were treated with a drug made of interleukin-7 (IL-7).
"IL-7 reverses the marked loss of CD4 and CD8 T cells, a hallmark of sepsis and a likely key pathophysiological event responsible for the morbidity and mortality of the disorder," Hotchkiss said.
Co-investigator Edward R. Sherwood, MD, a professor of anesthesiology at Vanderbilt, said patients suffering from septic shock often have low counts of these key immune cells.
"We believe that could play a role in the development and course of sepsis because without those cells, patients aren't able to clear as much harmful bacteria," Sherwood said.
The patients in the trial were hospitalized with septic shock and were randomly assigned to one of two therapies. Seventeen patients received the IL-7 drug, and 10 received a standard treatment. Those who received the drug experienced a threefold to fourfold increase in CD4 and CD8 counts.
"Even though the study was small, we were encouraged that IL-7 helped restore key cells in the immune systems of these patients," said Andrew H. Walton, a staff scientist in the Hotchkiss lab and co-author of the study. "Overall, that should help improve patient survival."
The research showed that IL-7 boosts the ability of CD4 and CD8 T cells help recruit other immune cells to kill bacteria that cause infections.
"IL-7 represents a potential new way forward in the treatment of sepsis by targeting the patient's immune system," Hotchkiss said. "This has a major advantaged caused by targeting the host, and should be effective against many diverse pathogens.”
Traditional approaches to sepsis therapy do not address patients' severely compromised immune systems. Without restoring immune function, Hotchkiss said, many patients develop lingering infections and are helpless to fight any new infections.
"We know that 40% of patients die in the 30- to 90-day period after the initial septic infection," Hotchkiss said. "Their bodies can't fight secondary infections, such as the blood infections and staph infections that can develop later on because their immune systems are shot. By strengthening adaptive immunity with IL-7 and increasing the numbers of CD4 and CD8 cells available to help fight infections, we think this approach can make a big difference."
As a next step, a larger trial is planned involving 300 to 400 patients, which Hotchkiss should have the statistical strength to determine whether IL-7 can improve survival rates.
A whistleblower lawsuit alleged that UPMC Hamot paid a cardiology group $2 million a year to secure patient referrals. The alleged scheme occurred before Hamot was affiliated with UPMC.
A University of Pittsburgh hospital in Erie, PA and a nearby cardiology practice will pay $20.75 million to resolve kickback allegations made in a whistleblower lawsuit, the Department of Justice said Wednesday.
Federal prosecutors said that UPMC Hamot and the regional cardiology group Medicor Associates Inc. submitted claims to Medicare and Medicaid that they knew violated Anti-Kickback Statutes and the Stark Law on physician self-referrals.
Hamot, a 424-bed tertiary care facility, regional referral hub and Level II Trauma Center, became affiliated with UPMC in February, 2011, after the alleged violations occurred.
UPMC is not commenting on the settlement, a spokesperson said Wednesday.
The whistleblower suit that prompted the settlement claimed that, from 1999 to 2010, Hamot paid Medicor up to $2 million per year under 12 physician and administrative services arrangements which were created to secure Medicor patient referrals. Hamot allegedly had no legitimate need for the services contracted for, and in some instances the services either were duplicative or were not performed, DOJ said.
"Financial arrangements that improperly compensate physicians for referrals encourage physicians to make decisions based on financial gain rather than patient needs," Acting Assistant Attorney General Chad A. Readler said in a media release.
The lawsuit was filed by Tullio Emanuele, MD, who worked for Medicor from 2001 to 2005, and who will receive $6 million of the settlement.
A primary care collaborative in the Cleveland area uses best practices to avert nearly 6,000 hospitalizations over five years, with cost savings estimated at about $40 million.
The Better Health Partnership, a primary care-led regional health improvement collaborative operating in the Cleveland area since 2007, identifies and shares best practices for patients with chronic conditions such as hypertension, heart failure and diabetes.
A study in Health Affairs estimated that the collaborative saw 5,746 fewer hospitalizations for ambulatory care-sensitive conditions from 2009-14, and generated savings of nearly $40 million.
Study co-author Randall Cebul, MD, an internist affiliated with MetroHealth Medical Center, and a member of the collaborative, spoke with HealthLeaders Media about the findings. The following is a lightly edited transcript.
HLM: Why does primary care lead the collaborative?
Cebul: When the opportunity came about through for a national foundation grant, it was primary care physicians who signed up. That’s how it's grown from reporting 34 clinics and 26,000 diabetics in 2008 to now we are reporting those conditions plus some pediatric conditions plus colorectal cancer screening, which we don't report on here, on more than 400,000 patients, in more than 100 practices, and more than 1,000 docs.
Part of the secret sauce has to do with physicians taking ownership of the care of their patients and if that requires engagement of services that are outside the community health center that's what we recommend. We are using the data to document the best practices. The positive deviance approach we use identifies who does best, and if we can determine that there is something replicable, that is presented at twice-yearly annual meetings and we provide either consultation or coaching to practices.
HLM: How did the collaborative save $40 million?
Cebul: It's all reductions in hospitalization costs for cardiovascular conditions; diabetes and diabetes complications, high-blood pressure and heart failure. Heart failure is not the most prevalent but it clearly saw the most cost-savings for hospitalizations. About $20 million was the heart failure part of the $40 million and the other savings were related to diabetes. Hypertension, even though it is very common, doesn’t require hospitalizations that often.
HLM: Why did you target these chronic conditions?
Cebul: We chose these prevention quality indicators from the ambulatory care-sensitive conditions compiled by the Agency for Healthcare Research and Quality. There are a lot of conditions that, given proper outpatient care, should avoid hospitalizations.
Our collaborative was founded in 2007 and immediately chose to use diabetes as one of our conditions and use clinical measures that are familiar to all doctors for the care and the outcomes of patients with diabetes. That was vetted by the clinical advisory committee, which established the measures we should use. Heart failure hypertension followed on the tail of that.
HLM: Is there potential for more savings if you target other chronic conditions?
Cebul: Of course! You'll see that you’ve got chronic obstructive lung disease, and cancer and other chronic diseases that are costly in and of themselves.
This is also cost and not charges. We were able to identify the charges for hospitalizations and then reduce the costs multiplying the ratio of costs to charges.
In any case, what we have done since 2007 is provider led. It is not led by insurance companies or non-physicians who are looking for cost reductions. This is an organization that seeks to create a safe space for competitors to collaborate.
HLM: Who are these competitors?
Cebul: They are mostly doctors in big healthcare systems like Cleveland Clinic, MetroHealth, and the VA. The doctors wanted to improve the care of their patients even though they were competitors.
Those who take care of the least among us in the safety nets and community health centers, the public hospital system, were interested in participating, especially if we were able to capture social determinants of health such as race, income, language preference, and insurance type.
We are able to stratify our results and make it an even playing field for everybody, whether they are caring for the most affluent in our region or more similar to those in the community health centers.
HLM: Who gets the $40 million you saved?
Cebul: We didn’t specifically look at that in this study, but in the past I would say that it's likely to be public payment patients. Medicare would be most of the heart failure patients. Those wouldn’t be people who are exceptionally poor, except to the extent that they have Medicaid or Medicare.
HLM: Did the collaborative get any of the savings?
Cebul: That is a very good question. Maybe we will go cap-in-hand and ask for some of that savings.
It's actually a loss to the hospitals. They’re not filling beds with otherwise mostly insured. We are reporting on more than 400,000 patients and less than 6% of them are uninsured.
HLM: Does that make the collaborative a tough sell for hospitals?
Cebul: Hospitals need to be committed to lower costs, population health, the Triple Aim of better care, better outcomes and lower costs. It's just one more of those stressors that the healthcare community is facing. No hospitals that we asked to join us were unable to get the commitment from their visionary leaders.
HLM: What support mechanisms do these collaboratives require?
Cebul: These hospitals and the clinics that are mostly owned by these large medical centers really need to be using electronic health records and be willing to share their data. That creates variable problems.
We obtained data from eight different electronic health records systems. That’s a challenge on our end but it means that they need to commit to provide the data that we request, at the consensus of the primary care providers, in a timely and accurate way twice a year.
HLM: Why was that problematic?
Cebul: Before mid-2010 a number of our smaller organizations were using paper records and did not have mastery of their EHR. When the High Tech Act was passed and we were able to demonstrate the benefits of EHR they all lined up. We only use electronic health records now.
HLM: Is seed money available to begin a collaborative?
Cebul: We're a lean operation. We got some funding from the Robert Wood Johnson Foundation back in 2007 as part of their aligning forces for quality initiative. That initiative sunsetted in 2015, but along the way we have gotten funds from regional community foundations and they’re probably about one-third of our operations. We have membership dues that people pay and we also have both federal and state grants, from the CDC, state Medicaid, and those sort of things.
HLM: Can your success be replicated elsewhere? What needs to be in place?
Cebul: You have to have people who care. We believe that all healthcare is local. So, being committed to a community is key. There has to be cooperation and leadership within the physician community and a willingness to share data and we’ve done that.
A federal complaint alleges that a skilled nursing facility did not provide 'reasonable accommodation' to an employee's religious objections. The SNF administrators say requiring nursing home workers to receive a flu shot is a public health issue.
The U.S. Department of Justice is suing a county-owned skilled nursing facility in Wisconsin that allegedly violated the religious rights of a former nurse's aide when it made her get a flu shot.
Barnell Williams was a nursing assistant at Lasata Care Center, a 136-bed, county-owned skilled nursing facility in Port Washington, Wisconsin, about 26 miles north of Milwaukee.
According to a complaint filed in the U.S. District Court for the Eastern District of Wisconsin, Lasata failed to accommodate Williams’ religious beliefs when she sought an exemption to Lasata's requirement of a flu vaccine.
The complaint alleges that Lasata's policy at the time required a flu vaccine but provided a religious exemption for employees who could produce a written statement from their clergy leader supporting the request.
Williams requested a religious exemption from the flu shot requirement because of her belief that Bible scriptures prohibited flu shots. However, she could not provide the clergy letter because she did not belong to an organized religion.
When Lasata denied Williams' religious exemption, she got the flu shot because she otherwise faced termination. The suit alleges that Lasata's policy permitting only employees who could obtain a letter from a clergy member to receive a religious accommodation violated Title VII of the Civil Rights Act of 1964.
DOJ said the policy denies religious accommodations to employees, like Williams, who do not belong to churches with clergy leaders. The complaint also alleges that Lasata unlawfully denied Williams a reasonable accommodation of her religious objection to the flu shot by denying her a request for an exemption without the requisite showing that doing so would cause an undue hardship.
DOJ is seeking compensatory damages for Ms. Williams, in addition to injunctive and other appropriate relief.
"When employees’ religious principles conflict with work rules, they should not have to choose between practicing their religion and keeping their jobs if a reasonable accommodation can be made without undue hardship to the employer," said Acting Assistant Attorney General John Gore for the Civil Rights Division.
"Employers should take care not to craft policies that disfavor individuals because of their sincerely held religious beliefs or practices in violation of Title VII," Gore said.
Ozaukee County issued the following statement on Wednesday afternoon: "Ozaukee County is aware of a lawsuit filed by the United States Department of Justice, alleging religious discrimination against a former employee. The County is confident that its position under the existing law is correct. Requiring employees who work at a nursing home to receive a flu shot is not religious discrimination, it's an issue of public health and safety.
The County works with its employees to accommodate religious beliefs, but this particular employee waited until the last day to request an accommodation and failed to present evidence of a sincerely held religious belief. The County is disappointed that the federal government would use federal tax dollars to advocate on behalf of one person's untimely request for an accommodation.
The flu is a real and imminent threat to the residents of the Lasata Care Center and the County takes its responsibility to protect those residents very seriously."
Commercial health plans urged to follow federal government's lead, provide patients access and portability to digital claims data. Overhaul for Meaningful Use, end of data blocking in the works.
The federal government on Tuesday unveiled two initiatives designed to improve patients' access and control over their personal electronic medical records, and also pledged to overhaul Meaningful Use and refocus on data interoperability and ease of use among providers.
Under the MyHealthEData initiative, patients will have access to their complete electronic health record, which they can take from doctor to doctor, choose the provider they want, and give that provider secure access to their data, leading to greater competition and reducing costs, the Centers for Medicare & Medicaid Services said.
Under a second initiative, Medicare has launched Blue Button 2.0, which allows traditional Medicare beneficiaries to access and share personal health data in a universal digital format, and connect claims data to the secure applications, providers, and services they trust.
CMS said the initiative will reduce testing duplications and improve continuity of care, and generate competition among technology companies to find better ways to use claims data to serve patients.
CMS Administrator Seema Verma unveiled the initiatives on Tuesday in Las Vegas at the annual conference of the Healthcare Information and Management Systems Society,
"CMS serves more than 130 million beneficiaries through our programs, which means we are uniquely positioned to transform how important healthcare data is shared between patients and their doctors," Verma said.
She urged private sector health insurers that contract through Medicare Advantage to follow CMS’s lead and give patients access to their claims data "because enabling patients to control their Medicare data so that they can quickly obtain and share it is critical to creating more patient empowerment."
Verma said that more than 100 organizations are designing applications for Blue Button 2.0 that will help these patients manage their health.
Meaningful Use Overhaul
Additionally, CMS plans to overhaul its Electronic Health Record Incentive Programs to refocus on interoperability, improve the clinician experience, and reduce the time and cost for providers to comply with programs requirements.
The overall retools documentation requirements of Evaluation and Management codes to make it easier for providers to use their EHRs. That will include an update and streamlining for billing requirements “so that doctors can spend less time using their EHRs, and more time with their patients,” Verma said.
CMS is also taking an aggressive stance against data blocking, and in some instances now requires hospitals and clinicians to show they’re not doing it.
"Let me be crystal clear, the days of finding creative ways to trap patients in your system must end," Verma said. "It's not acceptable to limit patient records or to prevent them and their doctor from seeing their complete history outside of a particular healthcare system."
"Too many patients suffer from this lack of control, and it is the priority of this administration to ensure that every patient and their doctor can receive free and timely access to their electronic data," she said.
Researchers found a 26% to 85% increase in preventive healthcare use among employees with at least 10 or more paid sick leave days compared to those with two or fewer paid sick leave days.
Workers with 10 or more paid sick days are far more likely to seek preventive healthcare services such as flu shots, cholesterol screenings, and mammograms, a new study shows.
Researchers from Cleveland State University and Florida Atlantic University used a sample of 3,235 working adults age 49 to 57 in 2014 from the National Longitudinal Survey of Youth.
More than 93% of the sample had some sort of healthcare plan. The median number of paid sick days was seven, with 27% reporting no paid leave sick days. Only 10% had 20 or more paid sick days, 26% had two or fewer sick days, and 43% had 10 or more paid sick days.
"It took 10 or more days — more days than are mandated in any of the local U.S. paid sick leave laws – for us to see statistically significant increases in the likelihood of reporting having received a flu vaccination, mammography, and screenings for blood sugar and blood pressure," said study lead author LeaAnne DeRigne, an associate professor in social work at FAU.
"For policy makers who want to increase preventive health care services use in this age group, a longer and more generous paid sick leave plan of at least 10 days should be considered," DeRigne said.
Female-focused preventive services showed a 55% increase in the use of preventive mammography.
Workers with 10 or more paid sick leave days had a 33% increase in getting a flu shot, a 28% increase in screening their blood sugar, and a 69% increase in checking their blood pressure as compared to those with zero to two paid sick leave days. Employees with 10 or more days of paid sick leave also had a 34% increase in cholesterol screening.
Study co-author Patricia Stoddard-Dare, an associate professor of social work at Cleveland State, said the study findings show that a lack of paid sick leave influences work health and public health.
"Workers who lack paid sick leave are more likely to go to work when they are sick and spread contagious diseases, such as influenza, in the workplace," Stoddard-Dare said. "Paid sick leave is incredibly valuable because it provides both job protection and pay during times when employees must miss work for health related reasons."
