• JANUARY 2007 FEATURE ARTICLES •
Industry Watch
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“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.’”
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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.
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.”
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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.
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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.
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