Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Reblog] Value-Based Care’s Data Problem

From the 22 May 2015 post at The Healthcare Blog

I believe the concept of value-based care is good for healthcare. VBC encourages providers to make changes that put the patient at the center of care, so that different services can be provided across providers in a collaborative way. If all went according to the VBC vision, there would be fewer redundant tests, more emphasis on preventative care, and an effort to keep high-risk patients out of the emergency room. It’s also better for costs, something we desperately need in the US, where healthcare spending per capita is more than twice the OECD average.

But Lisa’s story, at the leading edge of the value-based experiment, is not good at all. ACOs and most other value-based models are new, constantly changing, and unproven. ACOs report on 33 metrics that are supposed to represent the quality of care provided by their networks of providers. While still extremely limited in scope, any more than 33 metrics would have made Lisa’s job impossible. So far, few ACOs have reported any savings. Worse — the metrics are unproven. What if they overemphasize standardized process over patient outcomes? And what if efficiency measures result in neglectful and impersonal care? A lot is riding on Lisa’s testing ground.

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The administrative challenge

By engaging with and learning from people like Lisa, I have begun to understand the problems frontier administrators face — the same problems countless others will face if we don’t address the administrative burden early on. Here are a few of the top headaches being rolled out in the name of value:

Selecting metrics

For ACOs, 33 metrics are tracked today. Inevitably, these will expand and change as accountable care evolves. There are also countless other systems of metrics encouraged by other incentive programs: the Physician Quality Reporting System measures, Meaningful Use metrics, Agency for Healthcare Research and Quality Indicators, the Consumer Assessment of Healthcare Providers and Systems for patient experience metrics, indicators for each specialty (Stroke and Stroke Rehabilitation Physician Performance Measurement Set, Endoscopy and Polyp Surveillance Physician Performance Measurement Set, and the Heart Failure Performance Measurement Set, to name a few). The document outlining protocols for the Physician Quality Reporting System is 18 pages long, with a mouthful of a title to match: “The 2015 Physician Quality Reporting System (PQRS) Measure-Applicability Validation (MAV) Process for Claims-Based Reporting of Individual Measures.” Got that? A new piece of legislation that passed the House of Representatives last week — the “doc fix” bill — is about to revamp many of these requirements once again.

Collecting data

Lisa had to fumble through different electronic systems and paper charts to extract the relevant data for each patient in her panel at dozens of different clinics. In many cases, it was clear that care had been provided (e.g. an unstable patient had been upgraded from a cane to a walker), but the documentation wasn’t there (to fulfill the “Screening for Future Fall Risk” metric, documentation must state whether the patient had no falls, one fall without major injury, two or more falls, or any fall with major injury.) Therefore, even though care was provided to prevent future falls, the documentation did not meet the CMS requirement and no credit was given.

For the next reporting year, Lisa is designing her own reporting mechanisms for clinics and doctors. She says that her first reporting experience “was invaluable in learning ways to improve the reporting for year 2015 and beyond,” and she is putting processes in place to facilitate reporting next year. But each clinic is different: some need a page at the front of their paper chart with check boxes, and some have templates in their electronic health records. Her new processes may improve the situation, but additional tracking could also cut into time doctors spend with patients and add to the squeeze they already feel.

Integrating data

Lisa integrated all the data from each clinic manually, and this is a problem for small institutions who are trying to communicate and coordinate with each other. Right now it takes a long time and is not very scalable. Even at larger institutions with leading electronic health record systems, the data is locked away within proprietary databases, often in incompatible formats. Clinical data is rarely integrated with financial and patient-reported data in the way required to tie outcomes and claims to reimbursements in a value-based model.

Reporting

After all of her data collection, Lisa still had to submit her data to a third part to produce reports, and she will wait many months for the results. The CMS websites are comically complex ; the instruction manual for using the CMS metric reporting interface is 127 pages long.


Putting patients at the center

If these problems aren’t addressed, we’re in for a long and painful healthcare reform. Administrative costs will continue to rise, along with another generation of frustrated physicians and admins. Moreover, value-based care could be deemed a failure not because it’s a bad idea but because of poor implementation. Instead of putting patients at the center of care, it could breed more bureaucracy and force doctors to spend more time reporting on metrics and less time with patients.

We can address these issues and we must — to give value-based care a chance at moving the US toward more patient-centered, less exorbitant healthcare.

 

May 23, 2015 Posted by | health care | , , , , , , , , , | Leave a comment

[Research article] High value health IT: Policy reforms for better care and lower costs

From the 16 March 2015 Brookings news release

Achieving better health outcomes at a lower cost and succeeding with payment reforms that shift from volume to value is difficult without health information technology (IT). Health IT can engage and support health care providers, patients, and consumers with access to timely and accurate clinical information from electronic health records (EHRs) and other sources. It can also provide access to cost and coverage information that avoids burdensome administrative processes and unexpected costs. Health IT can achieve these benefits through interoperability across information and data exchange platforms – avoiding duplicative parallel systems and additional data entry. Engaged patients and providers, supported by flexible, usable and useful health IT, can make informed shared decisions about testing and treatment which can lead to more timely, efficient, and higher-value health care.

 

Download the issue brief.

March 21, 2015 Posted by | health care, Medical and Health Research News | , , , , | Leave a comment

5 Trends For Health CIOs In 2014 – InformationWeek

5 Trends For Health CIOs In 2014 – InformationWeek.

From the 23 December 2013 article at Information Week Health Care

Patient portals, direct messaging, and medical identity theft will keep healthcare execs on their toes in the new year.

Hackers Outsmart Pacemakers, Fitbits: Worried Yet?

Hackers Outsmart Pacemakers, Fitbits: Worried Yet?

(click image for larger view)

As healthcare CIOs are well aware, 2014 promises to be the year of “the perfect storm.” The potential impact of ICD-10 and Meaningful Use Stage 2, coupled with the transition to value-based reimbursement and new-care-delivery models, promise to overwhelm their budgets and burn out their already overworked staffs.

Nevertheless, there are some other trends healthcare CIOs should pay attention to in 2014, partly because of their bearing on the main events. Here are five significant trends.

1. Patient portals
Because of rising consumer interest in health IT, the industry transition to accountable care, and most of all, Meaningful Use Stage 2, patient portals are hot. Nearly 50% of hospitals and 40% of ambulatory practices already provide patient portals, according to a Frost & Sullivan report. The firm predicted that the value of the portal business would soar to nearly $900 million in 2017, up 221% from its worth in 2012.

[ What Obamacare sites can learn from online retail stores: Health Insurance Exchanges Struggle To Charm Customers. ]

KLAS Research, in a poll of 200 healthcare organizations, found that MU Stage 2 had made patient portals a “must-have” technology for doctors and hospitals. The government EHR incentive program requires providers to allow patients to access their health records electronically. In addition, providers must send care reminders and education materials to at least 10% of their patients. All of these tasks are most easily done through portals attached to EHRs. But there’s also some interest in untethered, standalone portals that can help patients assemble their records from multiple providers in one place.

 

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Read the entire article here

 

January 2, 2014 Posted by | health care | , , , , , , | Leave a comment

   

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