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Patient respect drops when doctors diagnose with computer
Patients understand that sometimes physicians need help in making a diagnosis, but more evidence suggests that they are less comfortable when that advice comes from a computer. Previous research has found that the use of clinical decision support seems to turn off patients, who grade doctors seeking such computer assistance about 10% lower than physicians who make a diagnosis without electronic aid. Findings published in January demonstrate that it is not merely doctors’ asking for outside help that it is troublesome, but something about the computer interaction that is turning them off. The results are especially surprising, because the research was conducted among college-age students who grew up with technology. Researchers surveyed 543 college students and provided them with three episode-of-care vignettes in which they visited a physician. Everything about the care provided was the same except how the doctor reached the diagnosis: unaided, with the EHR’s help, or consult [Read more]
Health care trends most likely to pressure physicians
PwC’s annual “Top Health Industry Issue” report predicts that the pace of health care transformation will increase in 2013 because of technology, budget pressures and the Affordable Care Act. But an overarching theme in many of the trends is the role of the patient and how consumerism is expected to drive the way health care is delivered, especially in the primary care setting. “The days of a very transactional approach to health care … is getting some pushback from consumers,” said Warren Skea, director in PwC Health Industries Advisory. Consumers are more informed and are demanding from health care the service they can expect in other areas, such as retail. Keeping patients happy will not only help patient satisfaction and retention, it also will help physicians’ pay, Skea said. More payment models are tying patient satisfaction to payment, he said. In addition, population health models will rely on good relationships between physicians and patients and prompt [Read more]
White House to safeguard Medicaid in budget talks
The Obama administration plans to use the health system reform law’s Medicaid expansion provision as a shield against funding reductions to the rest of the program. At a Jan. 31 health policy conference, a top White House official announced that the administration would reject cuts to the Medicaid program during deficit reduction negotiations because “the world has changed and, because of that, our policies are being affected.” Republican lawmakers have been eyeing significant cuts to entitlement programs as one of several mechanisms to reduce federal deficits, said Gene Sperling, director of the White House National Economic Council, who spoke during a conference hosted by advocacy group Families USA in Washington. Such reductions have included $830 billion in proposed reductions to Medicaid, or a third of its budget, he said. Sen. Orrin Hatch of Utah, the ranking Republican on the Senate Finance Committee, has cautioned that Medicaid and Medicare reforms need to be an [Read more]
Quality demo cuts repeat hospital Medicare trips by nearly 6%
A Medicare test project that emphasized care coordination to keep patients from going back to the hospital scored lower readmission rates compared with similar regions without such a program in place. A study on the Medicare quality improvement organization pilot in the Jan. 23/30 Journal of the American Medical Association reported that 30-day readmission rates in 14 communities were reduced by 5.7% over two years beginning in 2008. In an average locale serving 50,000 Medicare beneficiaries, the care coordination model would cost $1 million a year but also save $4 million by preventing return trips to hospitals, said lead author Jane Brock, MD, MSPH. “When you have a bunch of providers trying to function in concert on behalf of the population they already mutually serve, we think that’s the key intervention that explains our success,” said Dr. Brock, who is chief medical officer for the Colorado Foundation for Medical Care. Following the success during the trial period, [Read more]
Quality of e-visits not yet equal to office visits
Research that compares care given through virtual visits with care given in person at a physician’s office rebuts some of the concerns physicians have about e-visits while supporting other worries, says a Jan. 14 study in JAMA Internal Medicine, formerly Archives of Internal Medicine. Study co-author Ateev Mehrotra, MD, assistant professor at the University of Pittsburgh School of Medicine and policy analyst for the RAND Corp., said patients have sought care from places such as retail clinics and emergency departments because they were able to access them immediately, without the wait they would have faced at a primary care physician’s office. Although tele-health has been considered as an option to get those patients back, “the concern I always hear from my physician colleagues about these electronic visits is, ‘Can you really do this? Can you really accurately diagnose someone using these tele-medicine options?’ ” Dr. Mehrotra said the study provides mixed evidence [Read more]
Medicare pay: Insurers preview a post-SGR world
A frustratingly familiar solution to the latest Medicare sustainable growth rate cut was signed into law after the new year with another pay patch enacted by Congress. The relief physicians felt at not sustaining a major cut — in this case 26.5% — was tempered by the knowledge that the next major reduction threatens to strike when the temporary measure expires. Medicare’s physician payment system continues to be panned universally by lawmakers, health economists, physicians, hospitals and insurers who would prefer a more stable, innovative system. But cost issues and a variety of other factors have stymied meaningful pay reform for the government-run entitlement program. For lawmakers, it was easier to pass the $25 billion stopgap measure at the last minute than to approve a package 10 times as costly — one that repeals the SGR and moves the Medicare pay system to one that rewards quality and efficiency. Still, physicians and insurers are not waiting for Medicare to chang [Read more]
States using health IT to boost Medicaid sign-ups
Parents and adults without children continue to face difficulties in getting signed up for Medicaid despite otherwise successful state efforts to use health information technology tools and simplify enrollment procedures, according to a 50-state survey released Jan. 23 by the Kaiser Commission on Medicaid and the Uninsured. States are facing important changes to their programs before the Affordable Care Act’s Medicaid expansion starting in 2014, said Diane Rowland, the commission’s executive director. She’s also the executive vice president of the Kaiser Family Foundation. Many states are weighing their options on expanding their programs up to an effective rate of 138% of poverty, but at least 20 plan to do so, Rowland said during a Washington briefing to discuss the survey’s findings. The survey demonstrates that many states already have taken innovative steps to modernize their programs and improve access before 2014, Rowland said. A majority of states provide online a [Read more]
Will deferred care follow rise in Medicaid co-pays?
A federal proposal that would allow states to increase certain co-pays for Medicaid patients seeks to encourage the more prudent use of costly services such as emergency department care, but some health care professionals believe the measure could lead to more access problems for beneficiaries. On Jan. 14, the Centers for Medicare & Medicaid Services issued a proposed rule that included a provision to simplify and update Medicaid premium and cost-sharing policies. Maximum co-payment amounts can vary based on what states pay for services and on income levels. In the interest of streamlining the system for the states, CMS is proposing an overall flat maximum rate of $4 for outpatient services for those under 100% of poverty, as well as higher cost sharing for certain services: an $8 maximum for using non-preferred drugs and for non-emergency use of the emergency department for individuals at or below 150% of poverty. Cost sharing isn’t a new idea for Medicaid — nominal fees for [Read more]
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