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RAND points fingers after health IT predictions fizzle
Researchers at the RAND Corp. say their 2005 prediction that health information technology could save the U.S. more than $81 billion annually has not come to pass. But the organization isn’t placing the blame on itself for its inaccurate prognostication. Instead, in a report in the January Health Affairs, researchers from the policy think tank placed the blame on “shortcomings in the design and implementation of health IT systems”. They blamed vendors for creating systems that are difficult to use and can’t connect with other electronic health records, echoing physician complaints about them. However, the researchers also said doctors and hospitals have not invested the “considerable” time and effort necessary to learn how to use the systems, and adapt their workflow to ensure that technology is smoothing processes, not hindering them. While various studies show some “marginal” success by health IT in increasing quality and efficiency of patient care, and while [Read more]
Economists outline strategy to counter primary care shortage
Greater use of several physician practice reform strategies that are growing in popularity could help stem the primary care physician shortage, according to a study in the January Health Affairs. Using simulation methods to estimate the projected need for primary care doctors, researchers from the Columbia Business School in New York and the University of Pennsylvania’s Wharton School in Philadelphia highlighted various operational changes that are becoming more widely adopted. These include the use of health care teams, more reliance on non-physicians and improved information technology methods. Taken together, they could help to eliminate shortages by increasing access to care, the study suggests. Primary care teams, for example, are in sync with the objectives of patient-centered medical homes, which aim to boost access, the study said. The researchers cited Geisinger Health System’s “shared practice” approach, which is part of the health system’s medical home model, [Read more]
Keys to drug compliance may be trust and pill shape
Patients who give their physicians low grades are likelier to have lapses in drug adherence, said a study of nearly 10,000 Northern California patients with diabetes. Thirty-nine percent of patients who said they never or only sometimes have confidence in their primary care physicians skipped their cardio-metabolic medicines at least 20% of the time, the study said. That is a non-adherence rate 11 percentage points higher than for patients who said they usually or always trust their doctors. Similar drug compliance gaps were found for patients who said their doctors did not involve them in decisions or understand their problems with treatment, or put the patient’s needs first, said the study. The findings shed light on the critical role the patient-physician relationship plays in achieving the optimal drug compliance essential to attaining treatment goals, said Neda Ratanawongsa, MD, MPH, lead author of the study, which was published online Dec. 31, 2012, in Archives of Inte [Read more]
HHS settles first small data breach case at medical practice
For the first time, the Dept. of Health and Human Services has reached a settlement over a data breach that affected fewer than 500 people, reinforcing its message that no medical practice is too small to be held accountable for not following privacy and security laws. On Jan. 2, Hospice of North Idaho settled a 2010 security case by agreeing to pay $50,000 to HHS. The case stemmed from a stolen laptop with unencrypted data containing the protected health information of 441 patients. HHS reached the agreement after a long investigation by its Office for Civil Rights, which found that the practice never conducted a risk assessment to safeguard patient data, a requirement under the Health Insurance Portability and Accountability Act. The agency also found that there were no policies and procedures to address mobile security, despite the fact that the practice routinely uses laptops as part of its field work. “This action sends a strong message to the health care industry that, [Read more]
VA finds shorter stays don’t lead to readmissions
Hospitals have been under pressure to reduce costs and send patients home earlier, and there has been speculation that shorter stays would mean more re-admissions. But a 14-year study of Veterans Affairs hospitals found that reducing a patient’s stay does not increase the chance that person will be readmitted later. Researchers studied more than 4 million admissions from 1997 to 2010 in 129 VA hospitals. Hospital lengths of stay dropped 27%, and readmission rates after 30 and 90 days went down by 16%. Mortality rates at 30 and 90 days decreased by 3%. The study was published in the Dec. 18, 2012, issue of Annals of Internal Medicine. Reducing the length of a hospital stay can have positive effects for the patient as well as a hospital’s bottom line, he said. “Every day someone sits in a hospital bed is one more day they can get an infection,” said Peter Kaboli, MD, lead author of the study, who conducted the research with colleagues from the Iowa City VA Medical Center [Read more]
Rule change lets House ignore Medicare IPAB
Any recommendation sent to Congress by the Medicare Independent Payment Advisory Board likely will never be taken up by the Republican-controlled House. The House adopted rules for the 113th Congress that included a provision addressing the IPAB’s authority to make recommendations on Medicare payment policy. The House rules are an attempt to nullify provisions in the Affordable Care Act “that limit the ability of the House to determine the method of consideration for a recommendation from” IPAB. “The rules package will better enable us as an institution to perform our constitutional duties and obligations with integrity and transparency, while streamlining our operations,” House Rules Committee Chair Pete Sessions (R, Texas) said in a statement. House Republicans, who have controlled the chamber since 2011 and will do so at least through 2014, have voted numerous times to repeal the 2010 health system reform law or eliminate certain sections. The IPAB was authorized [Read more]
Demand rises for CME linked to physician quality improvement
As physicians face increasing pressure to demonstrate performance improvement, more are utilizing a model of continuing medical education that gives them tools to assess the care they provide patients, and make measurable enhancements. The concept of Performance Improvement Continuing Medical Education was introduced in the early 2000s, and the model has expanded significantly since then. In 2011, 44,275 physicians and 7,492 nonphysician health professionals participated in 502 PI CME activities offered in the U.S., according to the Accrediting Council for Continuing Medical Education. That’s a steep increase from the 744 physicians and 175 nonphysician health professionals who participated in 22 PI CME activities offered just six years earlier. The model makes up a small fraction — less than 1% — of the more than 132,000 CME activities offered nationwide. But demand for PI CME is expected to grow as the country shifts to a pay-for-performance system of care that emphasizes [Read more]
Medicaid primary care pay to more than double in 6 states
Primary care doctors who provide services to Medicaid patients may experience significant fee increases starting in January 2013, when an Affordable Care Act provision to boost Medicaid pay rates to Medicare levels goes into effect for the next two years. Rhode Island doctors, for example, will see primary care fees go up by nearly 200% on average. For New York state, the overall increase will amount to 156%, and in California, 136%, according to a 50-state survey conducted by the Urban Institute on behalf of the Kaiser Commission on Medicaid and the Uninsured. In three other states — Florida, Michigan and New Jersey — fees also are expected to more than double for primary care physicians that qualify for the increase. “The states that are seeing the high percentages are merely the states that have been paying such abysmal rates to start with,” said Jeffrey Cain, MD, president of the American Academy of Family Physicians. Rhode Island, the state with the highest projected [Read more]
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