NAHAM Webinar: Introducing NAHAM AccesKeys

Join NAHAM for a Webinar January 14th, 2:00-3:00pm EST, to discover NAHAM's exciting new tool for members: 

AccessKeys

NAHAM is excited to announce the unveiling of a project more than two years in the making, created from the minds of a dedicated group of your NAHAM member peers. Unprecedented in the field of Patient Access, this new tool will fill a gap in the front-end of the revenue cycle, helping define the complex and ever-changing registration processes, oftentimes little understood by revenue cycle managers. Furthermore, this new offering will reshape your understanding of how your facility’s Patient Access department’s performance compares to other, similar healthcare organizations across the United States.

Never before have Patient Access managers been able to use standardized, simple equations to measure, for example, Point of Service Collections to Revenue, and then compare that score against industry benchmarks, thus measuring outcomes, not merely activities.

The AccessKeys^® are set up as a series of equations created by NAHAM’s Industry Standards Committee (ISC), which was formed as a new standing committee of NAHAM tasked with continually updating these Access Keys and develop other industry standards and best practices. The 23 different KPIs measure how well front-end departments and staff are doing across six Patient Access domains:

• Collections
• Conversions
• Patient Experience
• Process Failures
• Productivity
• Quality

For each KPI, the committee has provided a simple equation, using easy-to-find data, and each equation comes with some helpful “tips and tricks” provided by the committee. Upon plugging in the corresponding numbers for your organization, you can see if your score falls into the “Good,” “Better,” or “Best” benchmark.

Members-Only Benefit

The NAHAM AccessKeys^® are a members-only benefit. To access them when they are released in mid-January, renew your membership today!  

Register Today for the AccessKeys^® Webinar

Wednesday, January 14, 2015
2:00 pm Eastern 

Paul Shorrosh, NAHAM Industry Standards Committee chair and key contributor to the AccessKeys^® will present a webinar to describe how to implement the tool in your facility. 

Register today!

Free Interactive Webinar: Ebola in the U.S. & the Role of Patient Access

Ebola in the U.S. & the Role of Patient Access 

Tuesday, November 4, 2014 at Noon EST

With the ongoing national news coverage surrounding the Ebola virus, your facility's leadership team may be implementing new screening protocols, and asking you to provide them with an immediate plan of action. What do you do? Where do you start?

Join NAHAM for this interactive webinar and explore how other organizations and facilities are tackling basic plan development in crisis situations, including ebola. 

Areas of discussion will include: 
• Complying with CDC requirements
• Integrating with infection control areas
• Alleviating employee anxiety with targeted communication tips and tricks
• Recommendations on quickly implementing your plan

This webinar will include time for participant discussion, providing you with an opportunity to learn best practices and examine the challenges in implementing a plan. If you have any specific questions you would like answered, please email us. 

This webinar is free of charge for all participants. Register now, and learn what you need to know to keep your facility up to speed on the Ebola virus.

Register Here 

Presenters
Stacy Calvaruso
Assistant Vice President, Patient Access, Ochsner Health System
Stacy is a Healthcare A/R Executive with over 24 years of progressive experience in both private and public sectors. Prior to joining Ochsner Health System, Stacy was the key developer/owner/operator of an organization that evolved from a small PFS A/R consulting and interim staffing organization, to a large national service center in the Urgent Care industry. Stacy’s current role with Ochsner includes managing over 600 FTEs dedicated to front line Patient Access service. She has held board positions for HFMA, NAHAM, UCBCA, as well as a Community Hospital in Louisiana.

Brenda Sauer
Director, Patient Access, New York Presbyterian Hospital
Brenda Sauer, RN, MA, CHAM, FHAM is Director of Patient Access at New York Presbyterian Hospital, Weill Cornell Medical Center in New York City, NY. She has held several board positions in NAHAM on both the local and national level; she is currently the Immediate Past President of NAHAM. Recently, she was named a Fellow in Healthcare Access Management. She has spoken on several topics including: Health Care Reform, patient privacy, disaster preparedness, patient throughput initiatives, and leadership for various organizations on the local, regional, and national level.

Join Webinar TODAY at 2pm EST: Enhancing the Revenue Cycle Experience for Patients

Enhancing the Revenue Cycle Experience for Patients 

October 29, 2014

Webinar Information: TODAY
2:00 pm – 3:00 pm Eastern
NAHAM Contact Hours: 1
Register Now 

Join NAHAM for a special patient experience webinar focused on front-end strategies to improve the revenue cycle experience for patients. Industry thought leaders from Texas Health Resources will review strategic initiatives for patient access leaders to further engage patients in their care experience – beginning before they enter the hospital’s front door. The session will present key strategies and related outcomes in patient satisfaction, staff performance and upfront patient collections. 

Presenters:
Patricia Consolver, CHAM
Senior Director, Patient Access Services
Texas Health Resources Scott Phillips, CHAM
Senior Director, Patient Access Services
Texas Health Resources


Register now and learn how to reduce registration times, increase point-of-service collections, and increase patient satisfaction! NAHAM members will enjoy free access to this live webinar, just one of the perks of NAHAM membership. For all non-members, the cost to attend this webinar is $35.

Register Now 

Join NAHAM Webinar: Developing Patient Access Leaders for Tomorrow

Developing Patient Access Leaders for Tomorrow 

November 11, 2014

Join NAHAM for our monthly webinar and hear a detailed account of how WellSpan Health’s Patient Access Department instituted an internal leadership development program to prepare for growth and succession in their rapidly growing Access departments. From conception and development to the inaugural program and its evolution over time, experience a detailed dissection of the various elements of the program, aimed at cultivating our leaders for tomorrow.

The webinar will: 

• Describe how WellSpan Health's rapid growth drove the need for an internal leadership development program, and how that program was implemented and molded.

• Detail the various elements of the leadership development program, including what worked, what didn't and what has changed over time.

• Discuss the challenges and successes of the leadership development program, including lessons learned, success stories, facilitation, participation, and relevance.


Register now and learn how to reduce registration times, increase point-of-service collections, and increase patient satisfaction! NAHAM members will enjoy free access to this live webinar, just one of the perks of NAHAM membership. For all non-members, the cost to attend this webinar is $35.

Date: November 11, 2014
Time: 2:00 pm – 3:00 pm EST
Presented by: Lisa Woods, Manager of Access Operations, WellSpan Health
NAHAM Contact Hours: 1
Register Here 

Can't Miss NAHAM Webinar on Improvements to Patient Access Departments Through Automation, June 26th

NAHAM presents the "Building a More Efficient Patient Access Department Through Automation" webinar, free to NAHAM members on June 26, 2014, from 2:00-3:00 p.m. This webinar will be presented by Patrick Kelley, Dedicated Advisor at The Advisory Board Company, and Alexander Guambana, Senior Director at The Advisory Board Company.

In partnership with The Advisory Board Company and Lowell General Hospital, we will be walking through a health system’s response to new industry demands by leveraging automation and efficiency gains. The Advisory Board Company will present its research on new Patient Access trends across the industry, how patient estimation is becoming a major player in healthcare, and how hospital Revenue Cycle departments are responding to new legislation in the ACA. Join us as Lowell General Hospital and The Advisory Board present their experience of implementing a culture of point-of-service estimation and the utilization of technology.


Information
Building a More Efficient Patient Access Department Through Automation
Thursday, June 26, 2014
2:00 pm - 3:00 p.m. ET



This webinar is worth 1 contact hour.




Click here to register for the webinar. There is no cost for members!


Upon purchase, you will receive information via email about accessing the live webinar.

Congressional Gridlock Stalls Hopes for National Patient Identifier and Meaningful Use Stage 2 Delay

Many in the health IT field believe that implementing a national patient identifier and a deadline extension for stage 2 meaningful use requirements would ensure a more cohesive operation of patient access and identification systems and increase patient safety.  Both of these problems require congressional action to solve, but with a Congress that fails to pass even the most basic pieces of legislation and appropriations it is unlikely there will be any legislation addressing these issues in the year to come.

National Patient Identifier

A national patient identifier would go far to improve patient safety by improving the accuracy with which patients are matched with their medical records.  Ideally, a national patient identifier would be a unique number for each patient with a two-digit checksum at the end of the number. In practice this would allow a patient’s data to move completely through multiple data systems without comingling with other patients’ records that may contain similar names, addresses and other identifying factors.

However, the likelihood of legislation requiring a national patient identifier is very slim after Congress voted to overturn a HIPAA provision that would have required a patient identifier in 1998. Congressional opposition focused on privacy concerns and the capability providers have to identify patients with several different identifying factors. Former national health IT coordinator Farzad Mostashari, M.D., explained that he believed the odds were very low for a national patient identifier and that it would require the industry proving they are unable to keep patients straight by cross-checking a patient’s identity with other identifying factors available to the provider.

Meaningful Use Incentive Program

The electronic health records meaningful use incentive program was created to advance the adoption of health information technology nationwide. Beginning in 2014 eligible hospitals and professionals will have to comply with stage 2 of the regulatory standards in order to receive corresponding incentive payments. 

Senator Alexander and Senator Thune, along with 15 other Senators, wrote a letter to HHS Secretary Kathleen Sebelius requesting more time for implementation of stage 2 standards. Their letter stated, “If the goal is to improve care by achieving broad and meaningful utilization of EHRs, providing sufficient time to ensure a safe, orderly transition through Stage 2 is critical to having stakeholder buy-in, a necessary component of long-term success.

However, former national health IT coordinator Farzad Mostashari, M.D., does not think that this extension will be granted.  Without speaking to the merit of the request, Mostashari recently told a group gathered at the CHIME Fall Forum that the extension would take up to a year to approve, and the extension requested is a year. The overlap would through U.S. health IT into “total chaos” due to the uncertainty during the rulemaking process to amend the schedule.

 Resources

Don Fluckinger’s article, “Shut down thoughts of a national patient identifier,stage 2 extension,” 

A podcast discussing the benefits of a national patient identifier can be found here. 

Alexander-Thune Letter from 17 Senators to Secretary Kathleen Sebelius requesting a meaningful use stage 2 delay can be found here. 

Debt Collectors Find Their Way Into Hospitals

The New York Times reports that “Hospital patients waiting in an emergency room or convalescing after surgery are being confronted by an unexpected visitor: a debt collector at bedside.”  Go to http://www.nytimes.com/ to find the article, "Debt Collector is Faulted for Tough Tactics in Hospitals," in the NYT Business Day (April 24, 2012).


The online article, by Jessica Silver-Greenberg , continues: “This and other aggressive tactics by one of the nation’s largest collectors of medical debts, Accretive Health, were revealed on Tuesday by the Minnesota attorney general, raising concerns that such practices have become common at hospitals across the country.”


The article also indicates tactics of embedding debt collectors as employees in emergency rooms who would be expected to demand that patients pay before receiving treatment.


To patients, the debt collectors may look indistinguishable from hospital employees.  They may demand that the patient pay outstanding bills and may discourage the patient from seeking emergency care at all.  According to reported allegations, Accretive Health employees were told to stall patients entering the emergency room until they had agreed to pay a previous balance. 


The report indicates that in some cases these workers would have access to health information while asking patients to pay overdue bills, what the Minnesota attorney general speculates may be a violation of federal privacy laws.  The Minnesota general asserts that “the hounding of patients violated the Emergency Medical Treatment and Active Labor Act, a federal law requiring hospitals to provide emergency health care regardless of citizenship, legal status or ability to pay,” and that “by giving its collectors access to health records, Accretive violated the Health Insurance Portability and Accountability Act.” In addition, the attorney general says that the company broke state collections laws by failing to identify themselves as debt collectors when dealing with patients.


It is noted that hospitals “have long hired outside collection agencies to pursue patients after they have left hospital facilities,” and “to achieve promised savings, hospitals turn over the management of their front-line staffing — like patient registration and scheduling — and their back-office collection activities.”


According to the New York Times report, “Accretive says that it trains its staff to focus on getting payment through revenue cycle operations. Accretive fostered a pressurized collection environment that included mandatory daily meetings at the hospitals in Minnesota, according to employees and the newly released documents. Employees with high collection tallies were rewarded with gift cards. Those who fell behind were threatened with termination.”


The Minnesota attorney general is currently in discussions with state and federal regulators about a coordinated response to Accretive Health’s practices across the country.

National Community Health Center Partnership Forms to Improve Health IT Services

Recognizing the need for trusted resources with relevant experience to help safety-net providers manage increasing demands for quality, cost, and outcome data, as well as navigate a complex and ever changing HIT marketplace, The National Association of Community Health Centers (NACHC), in partnership with three Health Center Controlled Networks (HCCNs) - Health Choice Network of Florida, OCHIN of Oregon, and the Alliance of Chicago, announced the launch of THQLink (connecting Technology, Health, and Quality).

THQLink aims to harness decades of investment in Community Health Center specific expertise, resources, and thought leadership under one organization to strengthen our nation’s Community Health Centers and other safety-net providers by leveraging technology to advance quality in healthcare.

“We didn’t want to recreate the wheel. This is about bringing together the thought leaders in the field with their proven track records and expertise to quickly implement what works so that Community Health Centers can be well positioned for the future,” said Tom Van Coverden, President and CEO of NACHC.

The three founding HCCNs came together with NACHC as the culmination of a joint strategic planning process. These primary partners built THQLink as an infrastructure that will allow the three Networks, along with other safety-net participants, to share resources to carry out three aims:
1) Achieve greater value for Community Health Centers as they improve quality and cost effectiveness of care delivery by jointly deploying state of the art information technology.
2) Promote high quality resources specializing in the safety-net to support efficient and effective use of Health Information Technology to improve quality and achieve Patient Centered Medical Home recognition.
3) Develop and implement a robust data aggregation and analytics platform to measure outcomes, share best practices and improve population health.

Health Choice Network, Alliance of Chicago, and OCHIN currently serve approximately 12% of all Federally Qualified Health Centers in 27 states. As the electronic health record (EHR) market matures, achieving economies of scale and attracting and maintaining skilled workers who know health centers requires Health Center Controlled Networks (HCCNs), Primary Care Associations (PCAs), and Regional Extension Centers (RECs) to work closer together than ever before. In this spirit, and as part of the arrangement, all three organizations have agreed to deploy a consolidated aggregation and analytics system powered by Microsoft Amalga, an enterprise health intelligence platform.

“Health Choice Network is breaking new ground in using Amalga to combine clinical and educational data to improve care processes in South Florida,” said Nate McLemore, general manager, Microsoft Health Solutions Group. “We’re excited to build on that foundation and collaborate with THQLink and community health centers nationwide to implement the Amalga platform and applications in support of population health initiatives across the country.”

For more information about THQLink, please click here.

Source: NACHC News Release

Patients in ER With Non-Emergency Problems Being Charged Up Front

An article from Kaiser Health News reveals that hospitals are beginning to charge up front those patients who show up at the emergency room with non-emergency issues as a way to reduce costs and ensure that care isn't diverted away from treating true emergencies.

Emergency care physicians and consumer groups worry the policy -- now in place at about half of the nation's emergency rooms -- will scare off patients with true emergencies from seeking ER care.

Click here to read the article.

Source: Kaiser Health News

Study: Consumers Choose High-Value Health Care Providers When Given Good Cost, Quality Info

When asked to choose a health care provider based only on cost, consumers choose the more expensive option, according to a new study funded by HHS' Agency for Healthcare Research and Quality (AHRQ) that appears in the March issue of Health Affairs.

The study found that consumers equate cost with quality and worry that lower cost means lower quality care. But higher costs may indicate unnecessary services or inefficiencies, so cost information alone does not help consumers get the best value for their health care dollar, according to the study.

The study, entitled "An Experiment Shows That a Well-Designed Report on Costs and Quality Can Help Consumers Choose High-Value Health Care," found that when consumers were shown the right mix of cost and quality information, they were better able to choose high-value health care providers—defined as those who deliver high-quality care at a lower cost.

Health care consumers want to visit high-quality doctors and hospitals, and many public report cards are available to help them compare providers. However, few report cards include information on cost, and there has been little scientific evidence to guide the presentation of that information to help consumers choose high value providers.

A team of researchers, led by Judith H. Hibbard, Dr. P.H., at the University of Oregon in Eugene, studied 1,400 employees in a randomized experiment to find out how they responded to different presentations of quality and cost information. When providers were clearly identified as high quality, cost had less influence on consumers' decisions and consumers were more likely to choose a provider with lower cost but better quality than a high-cost provider.

"This study has important implications for the more than 150 public reports on physician and hospital care," said AHRQ Director Carolyn M. Clancy, M.D. "It's not simply a question of providing information on cost, but providing it in a way that is integrated with quality scores."

The study explored a number of ways to present cost and quality information effectively, using combinations of symbols such as dollar signs and stars, specific information such as dollar amounts and percentages, and labels such as "appropriate use" or "better." Consumers were more likely to choose high-value providers when presented with strong, unambiguous quality and cost information. In addition, a check mark indicating a "high-value" provider, along with the cost and quality information, also helped consumers use the information to make high-value choices. Given strong quality signals, consumers were also more confident in their choices.

The study's findings have implications for the design of public report cards that offer consumers information on the quality and cost of health care providers. Although report producers have been adopting strategies to help consumers process and use comparative information on quality and cost, many reporting websites still use overly technical information or present other barriers to easy comprehension, according to the study.

For additional AHRQ information about public reporting, please visit http://www.ahrq.gov/path/publicreporting.htm.

Source: AHRQ News Release

AHRQ Quality Indicators Toolkit for Hospitals

The Agency for Healthcare Research and Quality (AHRQ) has developed an array of health care decision making and research tools that can be used by program managers, researchers, and others at the Federal, State and local levels. The Quality Indicators (QIs) are measures of health care quality that make use of readily available hospital inpatient administrative data. The current AHRQ QI modules expand HCUP QIs. The QIs can be used to highlight potential quality concerns, identify areas that need further study and investigation, and track changes over time.

In response to high demand for a recent Webinar about the AHRQ Quality IndicatorsTM Toolkit for Hospitals, AHRQ is repeating this popular event. Participants will hear live presentations about the toolkit from its developers and learn from a quality expert at a hospital that tested it.

The toolkit is a free resource to guide hospitals through the process of using the AHRQ Inpatient Quality Indicators (IQIs) and Patient Safety Indicators (PSIs) to improve care.

Webinar information:
Date: Tuesday, March 13
Time: 3:00-4:30 pm Eastern Standard Time
Register at: http://meet63385651.adobeconnect.com/hospitaltoolkitregistration2/event/event_info.html
(Note: If you registered for the first Webinar but could not participate, you can register for the repeat Webinar by simply entering your email address and password.)

The Webinar will cover:
-The purpose of the toolkit.
-How it was developed.
-How it is organized for easy use.
-How a hospital has used it to assess performance on the indicators, identify priorities, and implement changes to improve quality and safety.

Download the AHRQ Quality IndicatorsTM Toolkit for Hospitals at: http://www.ahrq.gov/qual/qitoolkit

More information on the AHRQ Quality Indicators is available at: http://www.qualityindicators.ahrq.gov/

New Health care Law Helps Expand Primary Care Physician Workforce

The National Health Service Corps (NHSC) awarded $9.1 million in funding to medical students in 30 States and the District of Columbia who will serve as primary care doctors and help strengthen the health care workforce, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced at the Eisner Pediatric and Family Medical Center, a community health center in Los Angeles, Calif.

Made possible by the Affordable Care Act (the new health care law), the National Health Service Corps’ Students to Service Loan Repayment Program provides financial support to fourth year medical students who are committed to a career in primary care in exchange for their service in communities with limited access to care.

“This new program is an innovative approach to encouraging more medical students to work as primary care doctors,” said Secretary Sebelius. “This is an important part of the Administration’s commitment to building the future health care workforce.”

Administered by HHS’ Health Resources and Services Administration (HRSA), Students to Service is a pilot program that provides loan repayment assistance of up to $120,000 to medical students (MDs and DOs) in their last year of education. In return, they commit to serve in a health professional shortage area upon completion of a primary care residency program.

“The average medical school debt of the students receiving these awards is more than $200,000,” said HRSA Administrator Mary K. Wakefield, Ph.D., R.N. “The Students to Service program relieves a tremendous debt burden, allowing them to follow their passion for primary care and serve some of the country’s most underserved rural and urban communities.”
These newest NHSC providers must serve three years of full-time service or six years of half-time service in rural and urban areas of greatest need.

Alongside current NHSC members, Secretary Sebelius spoke with Eric Schluederberg, one of the awardees announced today and a 4th year medical student at Western University of Health Sciences in Pomona, Calif. He was always attracted to the field of primary care, but the story of his fiancé, Nancy, who has Spina Bifida, has helped inspire him to serve in the NHSC and ensure that women get the pre-natal care they need.

“I always knew my calling was primary care, “Mr. Schluederberg said. “I’m not a social researcher, and I’m not an economist. But it seems that there are a lot of underserved people in this nation, and that providing sound primary care is a good economic investment. For example, ensuring that pregnant women know to take folic acid supplements is one way to prevent the cost of the numerous surgeries required to help someone with Spina Bifida become an independent member of society.”

With significant investment from the Affordable Care Act, thousands of new primary health care providers have been added to the ranks of the NHSC. The awardees will join the many NHSC providers already serving and providing culturally competent primary care at more than 14,000 health care sites in urban, rural, and frontier areas.

The NHSC provides financial, professional, and educational resources to medical, dental, and mental and behavioral health care providers who bring their skills to areas of the United States with limited access to health care. The NHSC was established in 1972 and has connected over 41,000 primary health care practitioners to communities all over America.

For more information about NHSC programs, please visit http://www.NHSC.hrsa.gov.

Source: HHS News Release

Doctors Are Cautious, Patients Enthusiastic About Sharing Medical Notes

Patients are overwhelmingly interested in exploring the notes doctors write about them after an office visit, but doctors worry about the impact of such transparency on their patients and on their own workflow, a Beth Israel Deaconess Medical Center (BIDMC) study suggests.

In a study published in the Dec. 20 issue of the Annals of Internal Medicine, patient and doctor attitudes were surveyed extensively prior to the launch of the OpenNotes trial in which patients at BIDMC, Geisinger Health System of Danville, PA, and Harborview Medical Center in Seattle were offered online access to their doctors’ notes written after office visits. Such notes have long been primarily within the doctors’ domain, even though patients have the legal right to obtain them.

"Doctors were divided in many of their expectations, and the issues we highlight have important consequences for both their work life and quality of care," writes lead author Jan Walker, RN, MBA, of BIDMC’s Division of General Medicine and Primary Care.

While many of the more than 100 primary care doctors who volunteered to participate in this experiment predicted possible health benefits from allowing patients to read their notes, the majority of those who declined participation were doubtful about positive impacts. And among the 173 doctors completing surveys, the majority expressed concerns about confusing or worrying patients with the content. Doctors also anticipated that they would write their notes less candidly and that responding to patient questions might be exceedingly time-consuming.
In contrast to the doctors surveyed, the nearly 38,000 patients who completed the baseline survey were almost uniformly optimistic about OpenNotes, and few anticipated being confused or worried

"The enthusiasm of patients exceeded our expectations," wrote Walker. "Most of them were overwhelmingly positive about the prospect of reading visit notes, regardless of demographic or health characteristics."

More than 90 percent favored making the notes available. Well over half anticipated improved adherence to their medications, 90 percent expected to feel more in control of their care, and four out of five predicted they would take better care of themselves.

"We know a lot more about our cars than our own bodies," responded one patient. "We leave all of that to the clinicians. I think by having access to our notes, we can take control, and that’s important."

In addition, half of patients surveyed reported that they would consider sharing their notes with other people, including other doctors.

"As I help my aging mother with her medical needs, I wish I could see the notes her doctors have made," wrote one patient. "I think it would help me in caring for her."

In an accompanying editorial, Thomas W. Feeley, MD, of the MD Anderson Cancer, and Kenneth I. Shine, MD, of the University of Texas, urged that electronic health records be used to engage participants in all parts of the health care delivery system.

"Expanding who uses the records and how they use them promises to facilitate communication, decrease redundant testing, and enhance our care delivery in ways we have yet to imagine."

The year-long OpenNotes study period has now ended, and Walker and her colleagues in the three diverse sites are eager to learn how the baseline expectations will play out. They are currently evaluating reports from follow-up surveys completed by participating doctors and patients and analyzing other metrics, such as how often patients reviewed their notes, shared them with others, or corrected errors their doctors may have made.

"They said they wanted the notes. They said they’d use them, but we have no idea if they actually went online and read them," said Walker. "And if they did read them, we don’t know yet what impact that had on the patients or the doctors."

"Patients want to look into the doctor’s black box, and many doctors are a bit nervous about what they’ll find," said Tom Delbanco, MD, senior author and co-principal investigator of OpenNotes. "But I expect that over time everyone will benefit enormously from such transparency."

"While OpenNotes represents a simple change of practice, the effect on the patient-doctor relationship could be profound. The fact that there’s such a gap between how most patients and many doctors expect that patients will handle the information contained in these notes hints at just how profound that effect might be," added Steve Downs, Robert Wood Johnson Foundation’s Chief Technology and Information Officer. In addition to Walker and Delbanco, the study’s co-authors include: Henry Feldman, MD and Long Ngo, PhD, BIDMC; Suzanne G. Leveille, PhD, RN, University of Massachusetts Boston; Jonathan D. Darer, MD, MPH, Marc J. Lichtenfeld, PhD, Geisinger Health System, Pennsylvania; Shireesha Dhanireddy, MD, Joann G. Elmore, MD, MPH, Natalia Oster, MPH, Elisabeth Vodicka, BA; Harborview Medical Center, Seattle; James D. Ralston, MD, MPH, Group Health Research Institute, Seattle; and Stephen E. Ross, MD, University of Colorado Health Sciences Center.

Source: OpenNotes Press Release

Report on Identifying Health Care Quality Measures in Medicaid-Eligible Adults Released

The Agency for Healthcare Research and Quality (AHRQ) released a background report documenting the process, deliberations, and results of AHRQ's National Advisory Council Subcommittee for Identifying Health Care Quality Measures for Medicaid-Eligible Adults.
The Affordable Care Act requires the Secretary of the Department of Health and Human Services to identify and publish a core set of health quality measures for Medicaid-eligible adults.

Source: AHRQ Release

Choosing Wisely Campaign Launches to Help Physicians Better Manage Health Care

Recognizing that patients often ask for tests and treatments that are not necessarily in their best
interest, and physicians often struggle with decisions about prescribing tests and procedures as a way of covering all possible bases, the ABIM Foundation has joined with nine leading medical specialty societies to develop evidence-based lists of tests and procedures for patients and physicians to question as part of Choosing Wisely TM.

The goal of the campaign is to help physicians, patients and other health care stakeholders think and talk about overuse or misuse of health care resources in the United States.

Consumer Reports, the nation’s leading expert, independent, nonprofit consumer organization, has also joined the campaign to provide resources for consumers and physicians to engage in these important conversations. The campaign is part of the ABIM Foundation’s goal of promoting wise choices by clinicians in order to improve health care outcomes, provide patient-centered care that avoids unnecessary and even harmful interventions and reduce the rapidly-expanding costs of the health care system. The lists of Five Things Physicians and Patients
Should Question is modeled after the successful National Physicians Alliance (NPA) project titled “Five Things You Can Do in Your Practice,” which was funded by the ABIM Foundation in 2009.
As part of Choosing Wisely, each participating specialty society will identify its own list of five common tests or procedures whose use in their profession should be discussed or questioned. The lists will be unveiled in April 2012. The societies were given the following parameters to develop the lists:
- Each item should be within the specialty’s purview and control;
- Procedures should be used frequently and/or carry a significant cost; and
- There needs to be evidence to support each recommendation.

“Physicians play a leading role in addressing problems with our nation’s health care system. That is why the ABIM Foundation is proud to be working with specialty societies that have proactively decided to address some of the most important issues in health care head on,” said Christine K. Cassel, MD, president and CEO of the ABIM Foundation. “By identifying specific procedures or tests that may commonly be ordered, but not always necessary to improving patient care, we’re kicking off an important and overdue conversation about making wise choices in health care. Everyone – providers, patients and others – plays a part in being better stewards of the system’s finite resources.”

The Congressional Budget Office estimates that up to 30 percent of care delivered in America goes toward unnecessary tests, procedures, medical appointments, hospital stays and other services that may not improve people’s health – and in fact may actually cause harm. If current trends remain unchanged, the Centers for Medicare & Medicaid Services project U.S. health care spending will reach $4.3 trillion and account for 19.3 percent of the nation’s gross domestic product by 2019.

First announced in March 2011, Choosing Wisely is part of a multi-year effort led by the ABIM Foundation to support and engage physicians in being better stewards of finite health care resources. It is part of the ABIM Foundation’s long history of advancing medical professionalism and supporting similar initiatives. In 2002 the Foundation, along with the American College of Physicians Foundation and European Federation of Internal Medicine, authored Medical Professionalism in the New Millennium: A Physician Charter. The Physician Charter has as its fundamental principles the primacy of patient welfare, patient autonomy and social justice and articulates professional responsibilities of physicians, including a commitment to improving quality and access to care, advocating for a just and cost-effective distribution of finite resources and maintaining trust by managing conflicts of interest.

To learn more about Choosing Wisely visit www.ChoosingWisely.org.

Source: Choosing Wisely News Release

CMS Issues Rule on Availability of Medicare Data for Performance Measurement

Consumers and employers will have the health care information they need to make more informed choices about their care, thanks to the Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) announced in a final rule.

The rule gives qualified organizations, like employers and consumer groups, access to data that can help them identify high quality health care providers or create online tools to help consumers make educated health care choices. Information that could identify specific patients, however, will not be publicly released and strong penalties will be in place for any misuse of data.
“This is a giant step forward in making our health care system more transparent and promoting increased competition, accountability, quality and lower costs,” said Marilyn Tavenner, Acting CMS Administrator. “This provision of the health care law will ensure consumers have the access they deserve to information that will help them receive the highest quality care at the best value for their dollar.”

For years, employers, consumers, and health care quality advocates have expressed frustration about the limited and piecemeal availability of Medicare data that could be used to help evaluate health care provider or supplier performance. Although many health plans have created provider and supplier performance reports, these reports are based solely on the health plans' own claims, and do not reflect information from other health plans, including Medicare.

Providers, too, have expressed frustration at receiving performance reports that are piecemeal and produced without an opportunity for review and correction. This final rule creates a framework for providers to receive a single, actionable performance report covering all or most of their practice.

The final rule makes a number of important changes from the original proposed rule. The final rule makes this data less costly for qualified entities, gives qualified organizations more flexibility in their use of Medicare data to create performance reports for consumers, and extends the time period for health care providers to confidentially review and appeal performance reports before they become public. The rule also includes strict privacy and security requirements to protect patients, health care providers, and suppliers as well as stringent penalties for any misuse of Medicare data.

Click here for more information on the final rule.

The final rule on Availability of Medicare Data for Performance Measurement may be viewed here: http://www.ofr.gov/OFRUpload/OFRData/2011-31232_PI.pdf

Source: CMS News Release

HHS Announces Refined Survey Standards to More Constitently Measure Care Disparities

The U.S. Department of Health and Human Services (HHS) released final standards to more consistently measure race, ethnicity, sex, primary language, and disability status, thereby improving the ability to highlight disparities in health status and target interventions to reduce these disparities.

“It is our job to get a better understanding of why disparities occur and how to eliminate them. Improving the breadth and quality of our data collection and analysis on key areas, like race, ethnicity, sex, primary language and disability status, is critical to better understanding who we are serving,” said HHS Secretary Sebelius. "Today, through these new standards, we are providing a new set of powerful tools to help us achieve our vision of a nation free of disparities in health and health care.”

The Affordable Care Act requires new standards for the collection and reporting of health care information based on race, ethnicity, sex, and primary language. Making data standards consistent will help identify the significant health differences that often exist between and within ethnic groups, particularly among Asian, Hispanic/Latino and Pacific Islander populations.

For example, a study showed that the diabetes-related mortality rate for Mexican Americans (251 per 100, 000) and Puerto Ricans (204 deaths per 100, 000) was twice as high as the diabetes-related mortality rate for Cuban Americans (101 deaths per 100, 000). However, this information would have remained unknown if only the umbrella terms of “Hispanic” or “Latino” had been used.

By adding Mexican American and Chicano/a, Puerto Rican, Cuban, and other Hispanic Latino/a or Spanish origin as explicit categories required on all HHS-sponsored health surveys, we can better capture the individual ethnic group challenges that are often found within minority populations. This specificity allows for better measurement and tracking of health differences in these populations and target interventions appropriately.

The new data collection requirements also will improve researchers' ability to consistently monitor more dimensions of health disparities among people with disabilities. Collection of all data will take place under HHS’ longstanding, strict commitment to protecting privacy.

“Many racial and ethnic minorities, people with limited English proficiency, people with disabilities, and other populations face unique health challenges, often have reduced access to health care and often pay the price with poorer health,” said Garth Graham, M.D., MPH, HHS deputy assistant secretary for minority health. “Today we are implementing an important provision of the Affordable Care Act that reinforces our commitment to reducing these health disparities. These new standards will help us carry forward the HHS Action Plan to Reduce Racial and Ethnic Health Disparities and our work to address disparities in people with disabilities as well.”

The standards, effective upon publication today, apply to health surveys sponsored by HHS where respondents either self-report information or a knowledgeable person responds for all members of a household. The standards will be used in all new surveys and at the time of revision to current surveys.

For more information on the final data standards, visit www.minorityhealth.hhs.gov/section4302.

Source: HHS News Release

Analysts: Debt Reduction Talks Stalling Hospital Expansion

Wall Street panelists at the Center for Studying Health System Change's (HSC) recent "Wall Street Comes to Washington" Conference say that expansions and construction of new hospitals aren't happening because of investor fears and over potential cuts that may be made by Congress to reduce the national debt.

"I think right now the biggest hurdle is planning," said Fitch Ratings analyst Jeff Schaub. "There are so many things that are unknown. And the planning cycle at acute care providers is five years, 10 years they’re looking out and there’s a big black hole starting 2013, 2014 and extending through 2017. So capital decisions that need to be made now, organizational decisions, affiliation decisions that really need to be made now are being made with a certain amount of contingency. Very often when I meet with hospitals they’re talking about...five, six, maybe even 20 different alternative views of the future and trying to quantify and make decisions among that entire array of possible outcomes."

Citigroup analyst Gary Taylor said that facilities that should be being built right now are probably not because investors do not know if how or if Congress will cost shift Medicare and Medicaid cuts to publicly-traded hospitals. “Since this debt ceiling debate took over and we’ve made commitments to reduce entitlement spending etcetera, publicly traded hospital stocks are down probably 40 percent on average, [and] nursing home stocks are down 70 and 80 percent on average,” Taylor said according to a report in CQHealthbeat (subscription required). “The collective wisdom of the market right now is that investing in . . . certain types of health care providers is extraordinarily risky because of the policy changes, primary reimbursement cuts, that are going to potentially come out of Congress.”

Source: CQ Healthbeat (subscription required); HSC Conference Transcript

HSPH Study: Lower Quality, High Cost Hospitals Treat More Poor, Minorities

Hospitals with the lowest scores on certain quality and cost measures treat more than twice as many minority and poor patients as hospitals with the highest scores, according to a Harvard School of Public Health study published in Health Affairs.

The study compared quality and cost measures at roughly 3,200 hospitals with the proportion of minority and Medicaid patients the hospitals served. "As the United States embarks on efforts to improve hospital care using value-based purchasing principles, we will need to help hospitals improve quality and efficiency simultaneously and to monitor the results of their efforts, so that we do not inadvertently worsen disparities in care," the study concludes.

Maulik Joshi, president of the Health Research & Educational Trust and senior vice president of research for the AHA, said the AHA "is committed to sharing with hospitals tools and strategies that can help eliminate disparities in care. As noted by today's study and others in Health Affairs, there are many community-based influences on health and health care. We need to address the many factors that impact community health, such as access to preventive and follow-up care, and work with all stakeholders to ensure improved care for patients and communities."

Source: AHA News Release

Medicare "Plan Finder" Available

In advance of the new, earlier annual enrollment period, people with Medicare can begin reviewing plan benefit and cost information on Saturday, October 1st, 2011. The Centers for Medicare & Medicaid Services (CMS) will launch access to its popular web-based Medicare Plan Finder that allows beneficiaries, their families, trusted representatives, and senior program advocates to look at all local drug and health plan options that are available for the 2012 benefit year.

“With Open Enrollment coming early this year, it is important that people with Medicare take advantage of the next couple weeks to review their current coverage and compare it with the options that are available for next year,” said CMS Administrator Donald M. Berwick, M.D. “The information that’s available now on the Plan Finder will also help caregivers, health providers, and partners that support and counsel seniors and people with disabilities in selecting the best plan for their needs.”

The annual enrollment period begins earlier this year, on October 15th, and runs through December 7th. People with Medicare will have seven weeks to review Medicare Advantage and Part D prescription drug coverage benefits and plan options, and choose the option that best meets their unique needs. The earlier open enrollment period also ensures that Medicare has enough time to process plan choices so that coverage begins without interruption on January 1, 2012.

This year, as beneficiaries look over their available plan options, they will see better value in the Medicare Advantage (Part C) and Prescription Drug (Part D) plan benefits. All beneficiaries will have access to Medicare-covered preventive services at zero cost-sharing, including an Annual Wellness Visit. Those in the Part D coverage gap, or donut hole, will continue to receive 50 percent discounts on covered brand name drugs thanks to the Affordable Care Act. On average, Medicare Advantage premiums will be four percent lower in 2012 than in 2011, and plans expect enrollment to increase by 10 percent. Average premiums for Part D prescription drug plans will also decrease to $30 in 2012, about 76 cents less compared to the average 2011 premium. The premium amount is based on bids submitted by Part D plans for the 2012 plan year. Benefits in 2012 remain consistent with those offered in 2011.

People can use the Plan Finder – available at www.Medicare.gov –by inserting their home zip code to find out which Medicare Advantage (Part C) and Prescription Drug (Part D) plans are available in their areas. If the zip code search shows multiple counties it will prompt users to select one county to continue the search. For 2010, the Plan Finder was the most popular tool on www.Medicare.gov, with more than 280 million page views. Also available online is Medicare’s Formulary Finder, which allows beneficiaries to insert their prescribed medications and zip code to see a display of plans offered locally that cover their drugs.

Due to provisions in the Affordable Care Act, Medicare will begin to financially reward Medicare Advantage plans which achieve high quality ratings. Part D plans will also continue to receive quality ratings. Beginning October 12, the Medicare Plan Finder will include each plan’s quality star rating for 2012. For the first time this year, people who use the Plan Finder will also see a gold star icon designating the top rated 5-star plans, and will continue to see warnings for those plans who consistently are poor performers. “We encourage all Medicare beneficiaries enrolled in private plans to know their plan’s overall star rating and to consider enrolling in plans with high ratings,” said Jonathan Blum, CMS Deputy Administrator and Director, Center for Medicare. When comparing plans, beneficiaries should consider the plan’s quality in addition to its costs, coverage, and other conveniences. On October 15, people with Medicare will be able to make informed decisions when they select their plan for the coming year.

More information is available at http://www.healthcare.gov/, a new web-based portal brought to you by the U.S. Department of Health & Human Services.

Source: CMS News Release