Differing Hospital Ratings

Hospitals all over the country often compete to be listed as a “top hospital”, or to be named to the “hospital honor roll.” Evaluations of hospitals are proliferating, giving patients unprecedented insight into data that they can use when choosing where to go for care. The lists are put out by non-profits and professional organizations alike, both on a state and national level, and can lead to more recognition, more patients, and more money.

According to Kaiser Health News, though, these ratings can sometimes provide as much confusion as clarity. Each organization uses their own methodology to rank facilities, sometimes resulting in wildly different conclusions. St. Mary Mercy Linovia Hospital in Michigan, for example, was given an “A” by The Leapfrog Group, a respected nonprofit that promotes patient safety. The company Healthgrades named it one of America's best 50 hospitals. But the Joint Commission and U.S. News and World Report omitted St. Mary from their best hospital lists due to high readmission rates and what they deemed to be excessive tests.

The process of ranking hospitals is still in its infancy and the quality of the data is rudimentary. Some agencies are also shifting their criteria as the Affordable Care Act changes the focus from procedural based rating to quality based ratings. This could lead the ranking systems to get more confusing before they equal out.

For a fee, most ratings can be used in hospital promotional materials. Others can be viewed online, which is important in an age where the internet is the first research step. While the debate over the ratings scales will continue, most hospitals still aspire to be on the various lists. 

Healthcare Costs Under Fire in Budget Battles

The budget battle is underway in Washington, and healthcare programs seem to be in the cross hairs. Republicans in the House and Democrats in the Senate have come out with budget proposals that differ dramatically. House Budget Committee Chair and former Vice-Presidential Candidate Rep. Paul Ryan (R-WI) announced his budget at a press conference on Tuesday. His plan would balance the federal budget by 2023, largely by reducing spending. Certain provisions proposed in the plan, however, have Washington insiders calling it a non-starter.

The Ryan plan, similar to the budget that he released last year, would deal a huge blow to healthcare programs in general, and specifically calls for the repeal of the Affordable Care Act. According to Politico, defunding the ACA alone accounts for almost half of the $2.72 trillion in healthcare spending cuts outlined in the plan. The Ryan plan also calls for Medicaid to be changed into block grants, and for Medicare to introduce a voucher system while raising the eligibility age for those who are currently under 55. The budget all together recommends $3.93 trillion in spending cuts on top of the sequestration cuts, which would stay in place.

Democrats responded to the Ryan budget proposal by releasing their budget on Wednesday. The proposal, announce in Committee by Senate Budget Committee Chair Patty Murray (D-WA), includes a sharp contrast of only $275 billion in healthcare spending cuts. Of that, $265 billion would come from Medicare and $10 million would come from Medicaid. The specific ways that the cuts would be implemented was unclear. The bill proposes a total of $1.85 billion in deficit reduction over 10 years through a combination of spending cuts and increased revenue. That is in addition to the $2.4 trillion in deficit reduction called for in current law. Read more about the Murray proposal in this Politico article.

Both of these proposals would have to pass both houses of Congress, which is highly unlikely in their current forms.  These budgets are through to be the starting points for each side of the aisle, from which they can work to a compromise. If a budget is passed, would be effective for the next fiscal year. The Senate is currently debating a continuing resolution, already passed by the House, that would fund the government from of March 27th through the end of the fiscal year.

Health Insurance Marketplace Draft Application Released

The Department of Health and Human Services (HHS) came out this week with a draft insurance application, showing what applying for benefits under the Affordable Care Act exchanges may look like. The application runs 15 pages for a family of three, extinguishing some hopes that signing up for a plan could be as simple as online shopping.

According to a CNBC/AP article, the online application outline is not much shorter, running at least 21 steps. Some of the steps have multiple questions included. The information will then be reviewed by at least three major federal agencies, including the IRS, to verify an applicant’s identity, citizenship, and income. The IRS is supposed to process online financial application in real time because the ACA is means-tested, meaning that lower income people get the most generous help to pay premiums.  Middle class applicants will be eligible for tax credits to help pay premiums to private companies, while low income applicants may be eligible for social programs like Medicaid.

The draft applications in paper and online form were posted by HHS seeking feedback from consumer and industry groups. HHS estimates that the online application will take about 30 minutes to complete, and the paper version will take about 45 minutes. Some groups are concerned that at that length, the form may overwhelm uninsured people, leading them to simply give up. Giving up will be an issue next year when carrying health insurance becomes mandatory.

HHS estimates it will receive more than 4.3 million applications for financial assistance in 2014, with online applications accounting for about 80 percent of them. Because families can apply together, the government estimates 16 million people will be served.

Auditors Urge Security for EHR Networks

Government auditors stressed the need for hospital network security in the New England Journal of Medicine last month. The auditors claimed that hacking into patient electronic health records (EHRs) can be as easy as tapping into the system using a laptop in the hospital parking lot. To prove it, they did exactly that.

Security breaches like the one demonstrated by the auditors have resulted in 300,000 Medicare beneficiary numbers being compromise. This has ramifications for all of us, not just the individual whom the number belongs to. According to MedPage Today and the New England Journal of Medicine, breaches in patient information can enable insurance fraudsters to defraud private insurers as well as Medicare and Medicaid. Taxpayer money is then drained away from services, resulting in waste and higher costs for beneficiaries. Additionally, patients can suffer harm if hackers change information in the patient’s EHR. Mislabeling a medical condition can lead to improper treatment, and changing the frequency that a prescription can be filled can leave patients without critical medicine.

Auditors and their colleagues from the Office of the Inspector General (OIG) at the Department of Health and Human Services (HHS) recommend that best practices for security be employed both in and out of hospitals. They recommend measures like password protection, firewalls, antivirus software, private consultation rooms, controlled prescription pads, paper shredding, biometrics, and secured copy machines.

The same security practices should be employed when healthcare workers access records from home laptops or home computers. These networks are often less secure, and scammers can obtain information to use when calling hospitals or practices pretending to be referring physicians, pharmacies, friends, or family.

The Office of the National Coordinator for Health Information Technology (ONC) recommends best practices for mobile devices here. 

CDC Cuts Mean Slow Response

The Centers for Disease Control and Prevention (CDC) is facing a funding cut of close to nine percent as a result of the budget cuts known as sequestration. The cuts total $350 million from its $6 billion budget over seven months.

These reduction could means that diseases would be detected more slowly and spread more widely before public health officials could begin efforts to contain them. This is even more relevant coming off of a flu season in which NAHAM News tracked it spread using CDC reports. According to a CQ HealthBeat article, CDC Director Thomas Frieden said that a new outbreak of influenza, such as the H1N1 epidemic that spread a few years ago from Mexico to the U.S. and other nations, wouldn’t be detected as quickly and countermeasures wouldn’t be started as promptly.

There would also be 2,000 fewer disease control specialists, which Director Frieden defined as “disease detectives and others in state and local governments — finding and stopping food-borne disease outbreaks, meningitis, pneumonia, flu, HIV, other critical health problems.” Additionally, recent progress in helping hospitals lessen the degree of infection acquired in their facilities would be slowed at a time when “superbugs” are in the news. 

CMS and ONC Renew Push for EHR Implementation

The heads of the Center for Medicare and Medicaid Studies (CMS) and the federal health information technology office stated this week that they will renew their efforts to implement electronic health records in hospitals and provider offices throughout the country. To do this, they are soliciting ideas for incentive programs and ways to improve the implementation process, according to a CQ report.

On Wednesday, Farzad Mostashari, the National Coordinator for Health Information Technology (ONC), announced a “request for information” to invite comments on how to speed up information exchanges. The request specifies that implementing the information exchanges is crucial to reforming the healthcare system, and CMS Acting Administrator Marilyn Tavenner said that they must be a routine part of care delivery.

The request for information is designed to solicit ideas for incentive programs that will reward providers for implementing the systems to lower costs and improve quality of care. The information exchanges are expected to speed the pace of sharing lab results, medical imaging, prescription drug use summaries, and other clinical data. This will avoid wasteful duplication of tests and treatments, and ward off medical errors. 

The goal of this new push is to have 50 percent of doctors’ offices using electronic health records by the end of 2013, and 80 percent of eligible hospitals receiving “meaningful use” incentive payments by that time. 

Effort to Create a Single EHR System between DOD and VA Scrapped

Last month, the Department of Defense and the Department of Veterans Affairs scrapped a much touted project to build a shared electronic health record system. The initiative, which was announced in May, was supposed to create a single virtual lifetime electronic record, or VLER, that could be accessed for DOD service members and veterans at any VA facility.

On February 5^th, VA Secretary Eric Shinseki and (then) Secretary of Defense Leon Panetta announced that they were discontinuing the program. Instead of creating a single new system for military EHRs, the agency heads decided that it would be faster and cheaper to integrate existing systems. According to representatives of the agencies, doing this would allow “quick wins” to improve healthcare.

According to the Washington Post, representatives from the agencies testified at a House Committee on Veterans Affairs hearing late last month, telling the committee that the single system plan was not feasible. Even though the first milestone was not set to come until 2014, the Director of Information Management and Technology Resources for the Government Accountability Office (GOA) told the Committee that “longstanding institutional differences” between the agencies could stand in the way of creating the system.

Members of both political parties joined veterans groups in expressing their dismay over the discontinuation of the program. According to the American Legion, over the past four years about a billion dollars has been spent working on the new system. The Defense Department continues to insist that they are still focused on achieving an integrated EHR for veterans.