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Health Management Technology News
  February 17, 2014
In this issue:
 

 Use of telemedicine can reduce hospitalizations of nursing home residents and generate savings for Medicare

 Congress mulls probe of Cover Oregon health exchange as programmers try to fix it

 Paying doctors to shun hospitals

 Republican congressmen request a federal probe of Md. health insurance exchange


Use of telemedicine can reduce hospitalizations of nursing home residents and generate savings for Medicare

Hospitalizations of nursing home residents are frequent and result in complications, morbidity, and Medicare expenditures of more than a billion dollars annually. The lack of a physician presence at many nursing homes during off hours might contribute to inappropriate hospitalizations. Findings from our controlled study of eleven nursing homes provide the first indications that switching from on-call to telemedicine physician coverage during off hours could reduce hospitalizations and therefore generate cost savings to Medicare in excess of the facility’s investment in the service. But those savings were evident only at the study nursing homes that used the telemedicine service to a greater extent, compared to the other study facilities. Telemedicine service providers and nursing home leaders might need to take additional steps to encourage buy-in to the use of telemedicine at facilities with such services. At the same time, closer alignment of the stakeholders that bear the costs of telemedicine and those that might realize savings because of its use could offer further incentives for the adoption of telemedicine.

The hospitalization of nursing home residents has emerged as an important area of concern for policy makers. These hospitalizations are already frequent, and they are becoming more so. They result in complications, morbidity, and Medicare expenditures that amount to more than a billion dollars annually.

Empirical research suggests that both the quantity and type of nursing home staff members, especially physicians, might have an impact on the number of potentially avoidable hospitalizations. In particular, the lack of physicians at many nursing homes during off hours might be one cause of inappropriate hospitalizations. If a medical issue arises during the evening or weekend that cannot be addressed over the phone, the on-call physician can either travel to the facility or recommend that the nursing home resident be transferred to a hospital. All too often, the on-call physician recommends sending the resident to the emergency department.

Telemedicine makes real-time medical consultation available to nursing home patients and their families via two-way videoconferencing. By providing patients with this direct contact, telemedicine could prevent costly hospitalizations of nursing home residents.

This study was designed to answer two questions. First, did the residents of nursing homes that were randomly chosen to receive off-hours physician coverage by a telemedicine service experience a lower rate of hospitalization, compared to residents of homes that received standard physician coverage? And second, if the nursing homes with telemedicine coverage did have lower rates of hospitalization, did they realize substantial savings?

Read the full Health Affairs study here

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Congress mulls probe of Cover Oregon health exchange as programmers try to fix it

Influential members of Congress want a federal probe of the beleaguered Cover Oregon health insurance exchange for its troubles enrolling people -- even as exchange programmers try to get its site up and running.

On Thursday morning Rep. Greg Walden, R-Ore., announced a formal request to the Congressional Government Accountability Office to investigate how the federal government could have prevented the Oregon exchange debacle, as well as how federal funds were spent.

The dose of election-year politics only boosts the pressure on the only exchange in the country to not enroll anyone electronically as envisioned by the Patient Protection and Affordable Care Act, known as Obamacare.

On Thursday afternoon, the Oregon exchange's appointed board heard how the exchange continues to test the beta version of its website and software, possibly letting agents use it by this weekend. Meanwhile, a proposed budget would ratchet back spending, in part by cutting $5 million from the budget for advertising and outreach.

The exchange appears to be making progress on the human toll of its non-functioning website: Oregonians seeking health care but caught in limbo, many for months after submitting applications to the exchange's makeshift manual processing system. Officials said the exchange has cut its backlog of unprocessed applications for health insurance in half in just the last week, to about 10,000.

Though Gov. John Kitzhaber has already hired a consultant to review the mess, that firm may soon have federal company.

Walden joined with House Oversight and Investigations Subcommittee Chairman Tim Murphy (R-Penn), Health Subcommittee Chairman Joe Pitts (R-Penn), and Energy and Commerce Committee Chairman Fred Upton (R-Mich) to sign a Feb. 12 letter requesting an investigation to Gene Dodaro, the U.S. Comptroller General who oversees the Government Accountability Office.

"We've got to pull the cover off of Cover Oregon," Walden said, of the request to GAO. He said he's confident GAO will take on the job, as officials for the office even helped craft the letter.

Charles Young, a GAO spokesman, said the office typically takes a few weeks to review requests, "So we don't have any decision yet."

Walden dismissed Kitzhaber's hiring of Atlanta-based First Data to review the Cover Oregon problems, noting that media accounts have shown numerous warnings of mismanagement and poor decision-making by the project's top managers were discounted or ignored.

Walden was joined by Rep. Dennis Richardson, R-Central Point, considered the Republican frontrunner to challenge Kitzhaber in November. Richardson already had floated an online petition asking the GAO to look into the exchange problems. He criticized the feel-good promises made by exchange managers in the months prior to the intended Oct. 1 launch date. "If you know a train wreck is coming, you don't sit in the club car and toast each other."

Read the full The Oregonian article here

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Paying doctors to shun hospitals

In an attempt to tame growing Medicare costs, the Affordable Care Act encourages doctors and hospitals to form groups called accountable care organizations, or ACOs. The idea is to get doctors, hospitals, nursing homes, and other providers to work together to treat Medicare patients. They’re supposed to avoid unneeded or redundant procedures and emphasize preventive care and chronic-disease management. These alliances typically invest in electronic health records to track patient treatments and hire social workers to make sure patients take their medication and don’t miss checkups. In exchange for lowering Medicare’s bills, ACOs get to keep a portion of the savings.

Three years into the voluntary program, 367 groups of health-care providers nationwide have formed ACOs. They’re responsible for 5.3 million Medicare patients, or about one in eight people on the federal insurance program for Americans 65 and older. Some 115,000 doctors in the U.S. are involved in a Medicare ACO in some way, according to data from Leavitt Partners, a consulting firm. Doctors forming an ACO generally create a new corporate entity responsible for their Medicare patients, but most stop short of merging their practices entirely. The first class of 137 ACOs, formed in 2012, has saved $380 million over the first year, Medicare announced on Jan. 30.

ACOs have achieved those savings in part by doing something the law didn’t anticipate: excluding hospitals from their groups. Although the program is designed to align the incentives of hospitals and physicians around keeping people healthy, more than half of ACOs are led by doctors’ practices and leave out hospitals entirely. “Some had come with the hypothesis that those who formed ACOs would be led by hospital-dominated systems,” Jon Blum, principal deputy administrator at the Centers for Medicare & Medicaid Services, told reporters in January. “Quite the opposite has happened.”

Read the full Bloomberg Businessweek article here

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Republican congressmen request a federal probe of Md. health insurance exchange

Two Republican congressmen have called for an investigation of the tens of millions of federal dollars that Maryland spent to build an online health exchange that state officials say has so many defects that they might have to abandon parts, or even all, of it.

Reps. Andy Harris (Md.) and Jack Kingston (Ga.) sent a letter Wednesday to the inspector general of the Department of Health and Human Services and asked for an immediate “formal investigation into the flagrant waste and abuse of taxpayer monies.” The inquiry would focus on how federal money was spent, how contractors were hired, who provided oversight and whether the federal government can recoup any of its money.

Harris and Kingston, both vocal opponents of the Affordable Care Act, wrote that Maryland officials had been warned that the exchange’s Web site was unstable.

“Despite all of these warning signs, Maryland chose to continue to waste and abuse federal taxpayer money by opening up what they knew was a flawed exchange to the public,” the letter states. “Subsequent to the disastrous rollout, additional federal dollars continue to be spent.”

Joshua M. Sharfstein, Maryland’s secretary of health and mental hygiene, has said that although officials expected to encounter problems after launching the exchange, he did not know the gravity of the problems. A spokeswoman for Sharfstein did not respond Thursday to questions about the letter, first reported by the Baltimore Sun.

Maryland is one of 14 states that decided to build their own online health insurance marketplaces, rather than use the federal one. But Maryland’s system crashed on its first day and has been plagued with problems ever since.

Maryland’s enrollment numbers are among the worst in the country. State officials had hoped that at least 150,000 Marylanders would sign up for private coverage plans during the exchange’s first year, but barely 30,000 have done so, with less than two months left in the enrollment period.

The exchange is expected to cost more than $260 million over four fiscal years, Sharfstein said. That estimate includes not only the cost of building the system, but also administrative and operational costs, including salaries. Much of the funding came from the federal government, but Maryland is expected to pick up $47 million of the total cost.

In recent months, Maryland has spent millions extra on additional technical help and call centers to process applications. The exchange has asked permission to spend an additional $33 million this year in federal grant money that had been secured for future years.

More than two weeks ago, The Washington Post submitted a list of questions to the exchange’s chief financial officer, Allan Pack, about the program’s finances and spending. He has not responded.

Read the full Washington Post article here

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