Thursday, May 14, 2015

Legislation to promote interoperability of electronic health records

The U.S. House of Representatives’ Energy and Commerce Committee will consider language designed to ensure that electronic health information systems are interoperable (can talk to each other) as part of its markup of the so-called 21st Century Cures legislation by Chairman Fred Upton, R-Mich., and Diana DeGette, D-Colo.

This reported by Congressional Quarterly.

In an interview last week, Texas Republican Michael C. Burgess told Congressional Quarterly that he has long been concerned about incentive programs to get health care providers to adopt electronic health record systems, which were included in the 2009 stimulus package. In his view, the programs pushed a lot of money out the door without a clear plan for what should be accomplished and the results have been disappointing.

Burgess told Congressional Quarterly that his effort will build on interoperability provisions in a recently-enacted law that changes the way Medicare doctors are paid. The legislation set a national goal of achieving widespread exchange of health information through certified technology by the end of 2018. (NAHAM News will be looking into this.)

The American Hospital Association cited the Medicare law’s new interoperability requirements and maintained that putting additional constraints on providers is unnecessary and could limit flexibility.  AHA recommended that the committee focus on developing policies that ensure vendors are accountable for designing and supporting interoperable products.

Vendor accountability? 
The American Medical Association reportedly favors language that instructs the administration to develop tools to ensure that recipients and patients are accurately identified, among other things.

Accurate patient identification? Wow, but I digress again.

The AMA pointed to the federal incentive program for "meaningful use" in outlining the problems with interoperability.

The existing program gives Medicare or Medicaid bonus payments to physicians, hospitals and other providers who demonstrate that they "meaningfully use" electronic health records and in later stages, penalizes providers who don't comply.

Physicians and the companies that sell the technology are focused on meeting the complex requirements of the existing program "and often do not have the time and resources to focus on actions that fall outside of the numerous MU measures—including interoperability.”

Congressional Quarterly also reports that the Senate Health, Education, Labor and Pensions Chairman Lamar Alexander also wants to address concerns about electronic health records, though his committee is not as far along as the House. From Senator Alexander –

The federal government has spent $28 billion to speed the adoption of electronic health records, and the result is that doctors don’t like the systems and many say they disrupt workflow, interrupt the doctor-patient relationship, and haven’t been worth the effort. We are working in the Senate health committee to identify the five or six things that Congress or the administration can do to help make the failed promise of electronic health records something that physicians and providers look forward to instead of something they endure.

Stay tuned. We’ll keep an eye on this legislation.

Medicare cards will no longer be issued with Social Security Numbers

NAHAM News reported on this on April 23.  The New York Times article, New Cards for Medicare Recipients Will Omit Social Security Numbers (April 20, 2015), gives a good account of the issue as part of a larger bill signed by President Obama recently. 

The two lead paragraphs help with the background -

Concerned about the rising prevalence and sophistication of identity theft, most private health insurance companies have abandoned the use of Social Security numbers to identify individuals. The federal government even forbids private insurers to use the numbers on insurance cards when they provide medical or drug benefits under contract with Medicare.

But Medicare itself has continued the practice, imprinting Social Security numbers on more than 50 million benefit cards despite years of warnings from government watchdogs that it placed millions of people at risk for financial losses from identity theft.

The change, mandated in a larger bill focused primarily on overhauling the way doctors are paid for treating Medicare patients, doesn't come without a cost -

Congress provided $320 million over four years to pay for the change. The money will come from Medicare trust funds that are financed with payroll and other taxes and with beneficiary premiums.

Medicare will have up to four years to start issuing cards with new identifiers and will have four more years to reissue cards held by current beneficiaries. Medicare intends to replace the Social Security number with “a randomly generated Medicare beneficiary identifier,” but the NYT reports that details are still being worked out.

On an interesting side note, the article also points out the long call from within government to discontinue the practice of using SSNs on Medicare cards and the slow response to those calls by the Department of Health and Human Services.

Senator Susan Collins, Republican of Maine and chairwoman of the Senate Special Committee on Aging, said she was puzzled by the delays. “This still does not appear to be a priority” for Medicare administrators, she said.

Medicare officials said their top information technology specialists had been preoccupied with efforts to build and repair, the online system for buying health insurance under the Affordable Care Act, which was overcome by technical problems soon after it began operating 18 months ago.

Well, generating a random number as an identifier is a not so novel concept.  As Medicare works on replacing the SSN with a new identifier for purposes of beneficiary benefits, it is to be hoped others give thought to the use of viable identifiers to be used for purposes of patient safety, through put and access to health records.  Let us know your thoughts on this.  What would the set of identifiers or unique identifier look like for the purpose of positive patient identity?

Friday, May 8, 2015

When a hospital closes

Kaiser Health News cites a recent study that finds that patients are not hurt when the local hospital closes.  See "Patients Not Hurt When Their Hospital Closes, Study Finds."

Here is a summary statement of the findings -

"While the researchers noted that some people might be inconvenienced by having to travel further for care, they found no significant changes in how often Medicare beneficiaries were admitted to hospitals, how long they stayed or how much their care cost."

One important caveat -

Lead researcher Dr. Karen Joynt said "the researchers had no way of examining whether the health of low-income and uninsured people suffered from the closures, so it was possible those closures did have deleterious effects. The paper looked at Medicare patients because their records are easiest to analyze and compare."

Of particular interest in a map of hospital closures between 2003 and 2011.

Also of interest if the characteristic found by the study -
"The closed hospitals tended to be financially troubled, with revenues averaging 13 percent less than the cost of running the institutions."

Additionally, a third of the closed institutions were safety net hospitals that treated large numbers of the poor and uninsured.
Another finding, keying off another NAHAM News post looking at the closure of Lakewood Hospital in Cleveland - 70 percent of the hospital closures were in urban areas rather than in rural regions, where hospitals have had trouble staying afloat for decades. But the article notes that the impact of a hospital closure in rural areas can be more devasting.

Regarding the findings of the study, Dr. Joynt is quoted by Kaiser Health News -

"It’s possible that we didn’t see any change in outcomes because patients instead went to nearby hospitals that had better finances and may have had more resources to provide care."

Changing suburban demographics impact hospital systems

An article by Kaiser Health News, "Losing A Hospital In The Heart Of A Small City" reveals a growing and challenging trend. 

The trend is one of hospitals closing their doors in communities they have served for years if not generations.  In this case it's the Cleveland suburbs and the hospital is Lakewood, a part of the Cleveland Clinic heralthcare system.  Lakewood Hospital has reportedly lost money since 2005 and the expectation is that it will close within two years.  To be clear, it will be replaced by a small clinic and emergency room that Cleveland Clinic says will make it a sustainable point of care.

Lakewood is experiencing something that is increasingly common across the country -

The hospital, like others, has fewer patients and they aren’t staying as long – which can cut into revenues. Who is using the hospital is also a factor - there are fewer privately insured and more Medicare and many more Medicaid patients.  As many as 16% of Cleveland population live at the poverty level, up from 2% reported in 2002.

The trend of hospitals closing because of the inability to sustain revenues is a particular problem in rural areas.  Kaiser Health News article, "Georgia Weighs Medicaid Experiment (But Not Expansion)," cites a novel yet not guaranteed approach by the State of Georgia to shore up its rural healthcare. 

While to article unfolds within the politics of the Affordable Care Act and a state that has opposed the law's Medicaid expansion, it highlights the same issue of hospitals not able to sustain a presence where populations are withouht private insurance and reliant on Medicaid -

"Dozens of rural hospitals face funding shortfalls so acute that they threaten access to care for tens of thousands of Georgians across the state. Since 2001, eight rural hospitals have closed and more than a dozen are considered financially fragile."

From a related NAHAM News post ("When a hospital closes"), we find one significant difference in the closure of a rural hospital versus the closure of an urban hospital -

"Rural closures can be devastating when the hospital is the only one in the region."  In an urban area, patients arguably have an easier time finding and getting to alternative care settings.

Since 2010, 50 rural hospitals have closed, 16 of them last year, according to the N.C. Rural Health Research Program.