Guest post by David Cooper, CEO and co-founder, Medical Mime.
As most of us involved in the healthcare industry already know, the Affordable Care Act calls for providers to adopt secure, confidential, electronic health information systems. Why? Because most experts agree that by using these electronic health records, we can collectively reduce paperwork and administrative burdens, cut costs, reduce medical errors and, most importantly, improve healthcare outcomes. But reality has had a funny way of challenging those expectations.
Yes, financial incentives have motivated doctors to get on the bandwagon, and many – if not most – office-based physicians have adopted some form of electronic health records. A study published in the journal Health Affairs reported that 78 percent of doctors working in office-based environments had implemented an electronic health record.
However, only about 48 percent of doctors had an EHR system with advanced functionality, according to the same source. Only 39 percent reported they had used their system to share medical data with other providers, and a stark 14 percent reported sharing data with providers outside their own practice. In short, the adoption of EHRs has not resulted in the promised integration of patient data that we hoped for. In fact, the use of electronic medical records – so far – may actually be having a negative impact on the quality of care doctors deliver.
According to a Northwestern University study published in the spring of 2014 in the International Journal of Medical Information, doctors who use electronic health records in their exam rooms spend one-third of their time looking at their computer screens. By comparison, physicians who rely on paper charting spend about 9 percent of their time looking at a patient’s records during an encounter. The study also asserts that because physicians spend so much time looking at their EHRs, they miss out on nonverbal communication cues from patients, thus affecting the quality of the care they’re delivering.
Twenty eight states, three territories and the District of Columbia will receive more than $665 million in Affordable Care Act funding to design and test healthcare payment and service delivery models that will try to improve healthcare quality and lower costs, Health and Human Services Secretary Sylvia M. Burwell announced.
Together with awards released in early 2013, more than half of states (34 states and three territories and the District of Columbia), representing nearly two-thirds of the population are participating in efforts to support comprehensive state-based innovation in health system transformation aimed at finding new and innovative ways to improve quality and lower costs.
The State Innovation Models initiative supports states in planning or implementing a customized, fully developed proposal capable of creating statewide health transformation to improve health care. Example initiatives include:
Improving primary care through patient centered medical homes, building upon current Accountable Care Organization models or integrating primary care and behavioral health services.
Providing technical assistance and data to healthcare providers and payers that are working to advance models of integrated, team-based care, or transition to value-based payment models.
Creating unified quality measure score cards that health care payers and providers can use to align quality improvement and value-based payment methodologies.
Expanding the adoption of health information technology to improve patient care.
Fostering partnerships among public, behavioral and primary healthcare providers.
Strengthening the healthcare workforce through educational programs, inter-professional training, primary care residencies and community health worker training.
Health spending continued to grow at a slow rate last year the Office of the Actuary (OACT) at the Centers for Medicare & Medicaid Services (CMS) reported today. In 2013, health spending grew at 3.6 percent and total national health expenditures in the United States reached $2.9 trillion, or $9,255 per person. The annual OACT report showed health spending continued a pattern of low growth—between 3.6 percent and 4.1– percent for five consecutive years.
The recent low rates of national health spending growth coincide with modest growth in Gross Domestic Product (GDP), which averaged 3.9 percent per year since the end of the severe economic recession in 2010. As a result, the share of the economy devoted to health remained unchanged over this period at 17.4 percent.
“This report is another piece of evidence that our efforts to reform the health care delivery system are working,” said CMS Administrator Marilyn Tavenner. “To keep this momentum going, we are continuing our efforts to shift toward paying for care in ways that reward providers who achieve better outcomes and lower costs.”
Total national health spending slowed from 4.1 percent growth in 2012 to 3.6 percent in 2013. The report attributes the 0.5 percentage point slowdown in health care spending growth to slower growth in private health insurance, Medicare, and investment in medical structures and equipment spending. However, faster growth in Medicaid spending helped to partially offset the slowdown.
Other findings from the report:
Medicare spending, which represented 20 percent of national health spending in 2013, grew 3.4 percent to $585.7 billion, a slowdown from growth of 4.0 percent in 2012. This slowdown was primarily caused by a deceleration in Medicare enrollment growth, as well as net impacts from the Affordable Care Act and sequestration. Per-enrollee Medicare spending grew at about the same rate as 2012, increasing just 0.2 percent in 2013.
Spending on private health insurance premiums (a 33 percent share of total health care spending) reached $961.7 billion in 2013, and increased 2.8 percent, slower than the 4.0 percent growth in 2012. The slower rate of growth reflected low enrollment growth in private health insurance plans, the continued shift of enrollees to high-deductible health plans and other benefit design changes, low underlying medical benefit trends, and the impacts of the Affordable Care Act.
Medicaid spending grew 6.1 percent in 2013 to $449.4 billion, an acceleration from 4.0 percent growth in 2012. Faster Medicaid growth in 2013 was driven in part by increases in provider reimbursement rates, some states’ expanding benefits, and early Medicaid expansion.
Out-of-pocket spending (which includes direct consumer payments such as copayments, deductibles, spending by the insured on services not covered by insurance, and spending by those without health insurance) grew 3.2 percent in 2013 to $339.4 billion, slightly slower than annual growth of 3.6 percent in both 2011 and 2012.
Among health care goods and services, slower growth in spending for hospital care and physician and clinical services contributed to slower growth in national health care spending in 2013. However, faster spending growth for retail prescription drugs in 2013 partially offset the overall slowdown.
Hospital spending increased 4.3 percent to $936.9 billion in 2013 compared to 5.7 percent growth in 2012. The lower growth in 2013 was influenced by slower growth in both price and non-price factors (which include the use and intensity of services). Growth in private health insurance and Medicare hospital spending decelerated in 2013 compared to 2012.
Spending for physician and clinical services increased 3.8 percent in 2013 to $586.7 billion, from 4.5 percent growth in 2012. Slower price growth in 2013 was the main cause of the slowdown, as prices grew less than 0.1 percent. Growth in spending from private health insurance and Medicare, the two largest payers of physician and clinical services, experienced slower spending growth in 2013, while Medicaid growth accelerated as a result of temporary increases in payments to primary care physicians.
Retail prescription drug spending accelerated in 2013, growing 2.5 percent to $271.1 billion, compared to 0.5 percent growth in 2012. Faster growth in 2013 resulted from price increases for brand-name and specialty drugs, increased spending on new medicines, and increased utilization.
In 2013, households accounted for the largest share of spending (28 percent), followed by the federal government (26 percent), private businesses (21 percent), and state and local governments (17 percent).
As part of its ongoing effort to increase transparency and accountability in healthcare, the Centers for Medicare & Medicaid Services (CMS) released today the first round of Open Payments data to help consumers understand the financial relationships between the healthcare industry, and physicians and teaching hospitals.
This release is part of the Open Payments program, created by the Affordable Care Act, and lists consulting fees, research grants, travel reimbursements and other gifts the health care industry, such as medical device manufacturers and pharmaceutical companies – provided to physicians and teaching hospitals during the last five months of 2013. The data contains 4.4 million payments valued at nearly $3.5 billion attributable to 546,000 individual physicians and almost 1,360 teaching hospitals. Future reports will be published annually and will include a full 12 months of payment data, beginning in June 2015.
“CMS is committed to transparency and this is an opportunity for the public to learn about the relationships among health care providers, and pharmaceutical and device companies,” CMS Administrator Marilyn Tavenner said. “This initial public posting of data is only the first phase of the Open Payments program. In coming weeks, we will be adding additional data and tools that will give consumers, researchers, and others a detailed look into this industry and its financial arrangements.”
Financial ties among medical manufacturers’ payments and health care providers do not necessarily signal wrongdoing. Given the importance of discouraging inappropriate relationships without harming beneficial ones, CMS is working closely with stakeholders to better understand the current scope of the interactions among physicians, teaching hospitals, and industry manufacturers. CMS encourages patients to discuss these relationships with their healthcare providers.
Guest post by Anil Jain, MD, FACP, chief medical officer, Explorys, and staff, Department of Internal Medicine, Cleveland Clinic.
Nearly every aspect of our lives has been touched by advances in information technology, from searching to shopping and from calling to computing. Given the significant economic implications of spending 18 percent of our GDP, and the lack of a proportional impact on quality, there has been a concerted effort to promote the use of health information technology to drive better care at a lower cost. As part of the 2009 American Reinvestment and Recovery Act (ARRA), the Health Information Technology for Economic and Clinical Health (HITECH) Act incentivized the acquisition and adoption of the “meaningful use” of health IT.
Even prior to the HITECH Act, patient care had been profoundly impacted by the use of health informationtechnology. Over the last decade we had seen significant adoption of electronic health records (EHRs), use of patient portals, creation of clinical data repositories and deployment of population health management (PHM) platforms — this has been accelerated even more over the last several years. These health IT tools have given rise to an environment in which providers, researchers, patients and policy experts are empowered for the first time to make clinically enabled data-driven decisions that not only at the population level but also at the individual person level. Not only did the 2010 Affordable Care Act (ACA) reform insurance, but it also has created incentive structures for payment reform models for participating health systems. The ability to assume risk on reimbursement requires leveraging clinical and claims data to understand the characteristics and needs of the contracted population. With this gradual shift of risk moving from health plans and payers to the provider, the need to empower providers with health IT tools is even more critical.
Many companies such as Explorys, a big data health analytics company spun-out from the Cleveland Clinic in 2009, experienced significant growth because of the need to be able to integrate, aggregate and analyze large amounts of information to make the right decision for the right patient at the right time. While EHRs are the workflow tool of choice at the point-of-care, an organization assuming both the clinical and financial risk for their patients/members needs a platform that can aggregate data from disparate sources. The growth of value-based care arrangements is increasing at a staggering rate – many organizations estimate that by 2017, approximately 15 percent to 20 percent of their patients will be in some form of risk-sharing arrangement, such as an Accountable Care Organization (ACO). Already today, there are currently several hundred commercial and Medicare-based ACOs across the U.S.
There is no doubt that there are operational efficiencies gained in a data-driven health system, such as better documentation, streamlined coding, less manual charting, scheduling and billing, etc. But the advantages of having data exhaust from health IT systems when done with the patient in mind extend to clinical improvements with care as well. We know that data-focused health IT is a necessary component of the “triple-aim.” Coined by Dr. Donald Berwick, former administrator of the Centers for Medicare and Medicaid Services (CMS), the “triple-aim” consists of the following goals: 1) improving health and wellness of the individual; 2) improving the health and wellness of the population and 3) reducing the per-capita health care cost. To achieve these noble objectives providers need to use evidence-based guidelines to do the right thing for the right patient and the right time; provide transparency to reduce unnecessary or wasteful care across patients; provide predictive analytics to prospectively identify patients from the population that need additional resources and finally, use the big data to inform and enhance net new knowledge discovery.
Eric Munz, vice president of business process crowdsourcing at Lionbridge Technologies, where he manages and leads the delivery of in-person, telephonic and video crowd-enabled interpretation solutions to meet the unique needs of customers across a broad range of industries, discusses here the need for interpretation services in health systems.
He also touches upon interpretation mandates for hospitals, the struggles large and small health systems face with interpreting to ensure the best patient care; he discusses the benefits of using a secure interpretation solution; and provides advice for implementing such a solution.
What are interpretation mandates for hospitals? How has equal access to language changed recently with ACA?
There are about 10 different places in the Affordable Care Act (ACA) that require hospitals to develop and implement a system that provides interpretation services to patients with limited English proficiency (LEP), to have equal access to healthcare. For example, Section 1557 of the Patient Protection and Affordable Care Act focuses on non-discriminatory policies and procedures, including those based on the grounds of language and national origin.
Now, healthcare facilities are facing a renewed struggle to provide such interpretation services because of the influx of LEP patients newly enrolled in insurance plans under the ACA. According to the UCLA Center for Health Policy Research, 36 percent of newly insured individuals under the ACA in the state of California are LEPs — compared to only 9 percent of LEP patients prior to the ACA enactment. That is a dramatic increase in non-English speaking patients to serve.
Other states facing a jump in patients speaking foreign languages include Texas, Arizona and Florida. Across the nation, healthcare providers must be at the ready to interpret more than 300 languages to remain compliant. Otherwise, they risk incurring monetary penalties.
Why is it often a struggle to deliver interpretation for patients in large and small hospitals alike?
A big city hospital could serve patients representing a dozen different languages or more on any given day. That presents a very practical logistical problem for facilitating so many different conversations in so many different languages. This is why many facilities partner with vendors to provide on-site interpretation, but these interpreters often work on an on-call basis, delaying treatment. They also often charge two-hour minimum rates for their service even if it’s a 30-minute conversation. In a rural hospital, there simply may not be someone with the skillset to speak a particular language within the geographic area.
For these reasons, the biggest challenge for hospital management is determining how to efficiently meet the demand for interpretation services, which are required by law, while remaining cost conscious throughout the process.
Patient-centered healthcare technology is putting the power of good health into patients’ hands. All of the changes in American healthcare regulations point to one top priority, and that’s patient centered care. Why does this matter? Because patients who are empowered to manage their own health are more likely to be proactive and, theoretically, therefore healthier.
Knowledge in the world of healthcare can be a great thing, and the technology community is responding with thousands of apps and other healthcare IT initiatives, such as activity tracking devices and websites designed to help consumers keep close track of their wellness.
Researchers at the Mayo Clinic provided FitBits to 149 post-surgical heart patients. The researchers determined that using the FitBit to monitor mobility wirelessly was “easy and practical, and led to a significant relationship between the number of steps taken in the early recovery period, length of stay and dismissal disposition. The research indicates that an activity monitor such as a FitBit could positively affect post-discharge outcomes by empowering patients to take their recovery into their own hands. Better discharge outcomes leads to lower costs in the long run. This is just one example of many.
Consumer health technology is attracting a lot of supporters on the business and medical ends of the spectrum because some of the more recent advances in this area are making it possible for people to be more proactive about their own health and initiate preventive measures. Awareness is a major component of effective prevention, and when consumers have the ability to discover any potential problems before they get out of hand, it can potentially save them a lot of money and improve their overall health status.
The question, then, is how companies can empower consumers to take responsibility for their own health through accurate and convenient information.
The resources that are scattered around the Internet would seem like the most obvious choice, but the problem there is that a consumer can just as easily base his or her decision on the large amount of misinformation that is circulating in and around the data that could really help them understand their condition.
A patient won’t prevent a thing if they misdiagnose their own problems. Even then, simply determining the potential problem doesn’t automatically suggest the appropriate answer or treatment. There have, however, been some technological advances that can address these concerns.
Making Reliable Technology Available If the Internet isn’t the most reliable source, then, what other options are available? How can consumers find the best information and make sure they get an accurate diagnosis without actually going to the doctor?
QuantiaMD, the largest social learning network for physicians, developed by Quantia, Inc., conducted a recent poll of its members to understand physician perspectives regarding the implementation of the Affordable Care Act. Despite millions of enrollees, individuals and doctors remain confused about the law – a troubling fact as many patients look to their physicians as a primary resource on health care policy.
The poll garnered responses from 1,265 physicians from around the country and opened up a dialog about the ACA. Results of the study included:
84 percent of physicians said they did not feel like they had enough information on the ACA to serve as a reliable resource to their patients.
81 percent of physicians don’t feel they have enough information on the ACA to understand its impact on their practice and comply with its requirements.
When asked where they get the most reliable information about the ACA, the majority (35 percent) of physicians responded saying there aren’t any reliable sources of information.
79 percent said they would use an HHS-produced FAQ with their patients if such a resource were available.
“This poll proves how physicians have been left out of the health care reform process,” said Mike Paskavitz, Editor-in-Chief, Quantia, Inc. “As the patient’s most trusted point of access to the healthcare system, physicians can be a tremendous communication channel for the ACA, and this poll demonstrates that there hasn’t been much, if any, communication directed at them. This poll was a huge eye opener for Quantia and validates the importance of the Affordable Care Act curriculum we have been developing for our members.”
In the new healthcare ecosystem that is increasingly migrating to cyberspace, who can healthcare consumers rely on? Who in the healthcare service supply chain will prevail? Who will be the next Amazon or Yelp? Chances are it will be the organization that can deliver and mediate a centralized consumer experience – connecting healthcare consumers not only with care and treatment options, but also with pharmacists, labs, therapists, clinics, wellness coaches and other resources along the care chain.
More today than ever before as the care conundrum continues, fewer and fewer crave office visits, hospital stays or trying to reach physicians by phone. When we’re well, we see no reason to visit a physician. When we’re sick we increasingly wait until we’re sicker. And when we’re somewhere in between, we avoid calling because we know we’ll be put on hold. If there were a better way to consume healthcare, most of us would likely take it.
Interestingly, within this conundrum lies an opportunity for the myriad of healthcare players – from payers and providers at one end of the supply chain to wellness tacticians, retailers and mobile tool providers at the other end – to create a sustainable dialogue with healthcare consumers.