JANUARY 2007 FEATURE ARTICLES

Industry Watch

Patient Safety

“Never Events” Back in the News Two years ago, Minneapolis-based HealthPartners Inc. made headlines by requiring providers who serve their members to report the commission of “never event” medical errors to the state health department and to not bill members for these errors. Now, never events are back in the headlines. In mid-November 2006, The Leapfrog Group and the Midwest Business Group on Health joined forces to urge hospitals to commit to a new policy on how they treat never events. This corporate joining of hands and urging of support followed the National Quality Forum’s (NQF) finalization of its revised list of 28 “Serious Reportable Events,” dubbed never events. The updated NQF never-event list includes 21 events from NQF’s original 2002 list that have remained uncharged, plus six never events for which specifications have changed and the addition of a new event (artificial insemination via the wrong donor). Today, 11 states use this information as the foundation of their public accountability mandate for reporting to state health departments or reporting authorities. As Leapfrog conducts its 2007 Hospital Quality and Safety Survey, it will offer hospitals the opportunity for public recognition if they agree to a series of steps following the occurrence of a never event. These include: 1) apologizing to the patient and/or family; 2) reporting the incident to at least one reporting program such as a state agency or JCAHO; 3) conducting a root cause analysis in accordance with the reporting agency’s requirements; 4) waiving costs and not seeking reimbursement from the patient or a third party payer for the error. Among supporters of the new Leapfrog policy are Aetna, General Motors, Caterpillar, IBM, Intel, UPS and a variety of state and regional business coalitions. To read the NQF’s updated list of 28 never events, logon to www.qualityforum.org and click on “News.” Look for the press release entitled, “National Quality Forum Updates Endorsement of Serious Reportable Events in Healthcare” from Oct. 16, 2006. For Leapfrog’s call to arms, logon to www.leapfroggroup.org and look for a PDF press release entitled, “The Leapfrog Group Issues Call for Hospitals to Commit to New Policy on Health Care ‘Never Events.’”

 

EHR Certification

CCHIT Expands Its Reach
Later this month, the Certification Commission for Healthcare Information Technology (CCHIT) will broaden its reach with certification of electronic health records (EHRs) geared to medical specialty practices and specialized care settings. CCHIT is expected to announce, later this month, the first medical specialties it will concentrate on. Interim National Coordinator for Health Information Technology Robert Kolodner, M.D., made the announcement in late November 2006, along with CCHIT Chairman Dr. Mark Leavitt who said, “We can only tackle two or three specialized areas during this next year, but these will pave the way to do even more in the future.”

That move will likely garner support from at least one prominent physician in a state known for healthcare IT adoption. Interviewed by “Digital HealthCare & Productivity,” Dr. B. Dale Magee, the president-elect of the Massachusetts Medical Society (MMS) laid forth an agenda for Massachusetts physicians that includes increased adoption of EHRs along with integration of pay-for-performance programs, public reporting of physician data and standards for office-based surgeries. Magee is a practicing OBGYN in Shrewsbury, Mass., who deployed an EHR in his practice four years ago, and MMS was the first state medical society to endorse e-prescribing technology for its members, contracting with DrFirst’s Rcopia three years ago. Magee estimates that less than 25 percent of MMS’ 18,500 members now use EHRS, but also predicts that in 10 years, they will be commonplace.

Transparency

HHS Advocates Value-driven Healthcare
It’s easy to get lost in the nuances of the vernacular—value-based purchasing, consumer-directed healthcare, transparency, pay for performance, value-driven healthcare—and miss the forest because of so many dissimilar trees. Essentially, however, the push is on at the federal level to spur public disclosure of price and quality information on all healthcare services so consumers—who inevitably face higher deductibles and greater cost-sharing—can use the information to make better treatment decisions.

Department of Health and Human Services (HHS) Secretary Mike Leavitt addressed the National Summit on Health Care Transparency, convened by the Business Roundtable, on Nov. 17, 2006, and unveiled a new federal initiative. Leavitt described a future healthcare system in which “patients will receive cost and quality comparisons on doctors and hospitals based on standards developed by the medical family; everyone in the system will be rewarded by decisions that increase quality and lower costs. It will be health care competition, based on value. This system will be built on four cornerstones.”

The first cornerstone is a system that is electronic and interoperable. Leavitt said that within five years, every hospital, doctor, lab and pharmacy should adopt electronic medical records using standards that support interoperability. Quality is the second cornerstone; Leavitt wants collection of quality data based on standards, electronic data recording and public disclosure of the data. Price is the third cornerstone, and Leavitt wants comprehensive, comparable and public pricing. The final cornerstone is incentives. Leavitt purports that with public information on price and quality, every player in the equation can be rewarded for making high-quality, lower-cost decisions.

HHS has designed a robust Web site dedicated to the topic. It is worth visiting. Logon to www.hhs.gov/transparency/ for a truckload of info on the “Value-Driven Health Care” initiative.

Aetna Commits to Cornerstones
When HHS Secretary Mike Leavitt addressed the Business Roundtable summit last November (see above), he brought paper for attendees—specifically, a Purchaser Statement of Support for employers to sign, indicating their commitment to the four cornerstones of value-driven healthcare. Less than two weeks later, Aetna publicly declared itself the first health plan and one the first U.S. Fortune 100 employers to commit to purchasing healthcare for its 30,000 employees based on value, quality and efficiency. Aetna, which provides healthcare benefits to 29.8 million people, was one of the first major payers to publicly release physician-specific information on costs and quality and to provide a personal health record for covered members. In making the announcement, Aetna Chairman, CEO and President Ronald Williams said, “We are encouraging our employer clients to support the ‘Four Cornerstones’ because we believe that they will help employers get the most value for their healthcare dollars by directing them [toward] organizations and providers who are committed to improving the quality and value of health care in America.”

Consumer-Directed Health Plans

Room for Improvement With CDHPs
Employees enrolled in an employer-sponsored consumer-directed health plan (CDHP) basically like their plans; 57 percent would bestow an “A” or “B” ranking for performance. Nevertheless, 50 percent would be “very” or “somewhat” likely to change plans if offered the opportunity, and 41 percent feel vulnerable to high medical bills. The Kaiser Family Foundation’s “National Survey of Enrollees in Consumer Directed Health Plans,” released about one month ago, is a study in contradictions. It paints a portrait of CDHP enrollees as generally well educated with moderate to healthy incomes, very good current health status and few chronic conditions. However, when it comes to not getting healthcare service because of plan type, CDHP enrollees hands-down surpass their counterparts enrolled in traditional health plans.

During the past year, 26 percent of CDHP enrollees didn’t fill a prescription because of cost, compared to only 15 percent in traditional plans. Also because of cost, 25 percent skipped a recommended treatment or test compared to only 15 percent in traditional plans; and 23 percent needed care but didn’t get it, compared to just 11 percent in traditional plans. On the other hand, CDHP enrollees are conscious of costs. Fifty-seven percent always or sometimes ask their doctors about lower cost treatments, compared to 38 percent in traditional plans, and 39 percent always or sometimes ask about the cost of an office visit. But just 17 percent of CDHP enrollees actually chose a lower cost treatment or test. Only six in 10 CDHP enrollees even know whether their plan has a Web site that offers cost and quality information on their plan providers; of that 60 percent, only 11 percent have used the Web site to explore quality and only 8 percent have used it to explore costs. A PDF summary of the survey is easy to find at www.kff.org.

Briefly

California Med Schools Get Telemed Money. California voters approved in November 2006 Proposition 1D, a $10.4 billion education bond that will deliver $200 million to expand telemedicine capabilities at five University of California medical schools. According to UC Vice President Lawrence Hershman, plans for specific utilization of the funds have yet to be cemented, and the medical schools will return for legislative approval once their plans are firmed. The UC San Diego medical school has indicated it expects $35 million in bond funds that it may dedicate to building a new on-campus telemed center and assembling faculty-doctor teams for six underserved areas. Phoenix Rising. The Phoenix Project is a $70 million endeavor that will allow the University of Chicago Hospitals to replace their current but aging EMR technology with a new EMR from Epic Systems. The organization took nearly a year to make its decision and award the contract, and will implement an incremental roll out over the next two or three years in an effort not to instantly overwhelm clinical staff with new technology. New Web Site for St. Louis Consumers. SSM Health Care-St. Louis, an integrated delivery network of seven hospitals, nearly 2,000 staff physicians and more than 10,000 employees, has launched a new Web site for local patients, offering easy-to-read information on hospital quality scores for heart attack or heart failure care, pneumonia care and surgical infection rates within hospitals. The data applies to the network’s five adult, acute-care hospitals. The data, tracked by the Centers for Medicare and Medicaid and the Joint Commission on the Accreditation of Healthcare Organizations, is updated twice a year by SSM Health Care-St. Louis. View the Web site at www.ssmhealth.com/quality.