Posts Tagged ‘American Recovery and Reinvestment Act’

EHR Adoption Moving Forward

Wednesday, March 14th, 2012

The nation’s hospitals must demonstrate that they have collected the vital statistics of more than 80 percent of their patients in digital form if they want to continue receiving as much as $14.6 billion in federal grants for installing electronic health records (EHR) technology.  Awards as large as $11.5 million are available to hospitals that can prove “meaningful use” of the equipment, under preliminary rules issued by the Obama administration.  Physicians can apply for grants of $44,000 or $64,000, depending on whether they treat patients in Medicare or Medicaid.

The rules continue carrying out an initiative in the American Recovery and Reinvestment Act (ARRA) as a step toward overhauling the nation’s healthcare system, specifically in the Health Information Technology for Economic and Clinical Health (HITECH) Act.  Hospitals and doctors should achieve “substantial benefits” from adopting digital records, including lower record-keeping costs, fewer pointless tests, shorter hospital stays and reduced medical errors.

The percentage of U.S. hospitals that have adopted electronic records more than doubled between 2009 and 2011, to 35 percent, according to the American Hospital Association.  Approximately 85 percent of hospitals told the association that they plan to take advantage of government incentives by 2015.  The government expects that by 2019, 96 percent of hospitals will adopt electronic records and at least 36 percent of doctors’ practices.

In this second stage of adoption of EHR, the government is emphasizing making sure that electronic systems can talk to one another – or are “interoperable.”  According to Kaiser Health News, it’s “a real push ahead,” said Farzad Mostashari, the national coordinator for health information technology.  The rules require systems be able to transfer patient information across platforms.  A “summary of care” — including past diagnoses, procedures and test results – must be able to follow patients across referrals and changes in health care provider.  Additionally, the information should be available to some patients, who under Stage 2 requirements must be allowed to view their records online, as well as download and transfer information.  Finally, some patients must be able to communicate with their doctors through a secure, online system.

According to a survey of 302 hospital IT executives, more than one-quarter said they had already proven to the Centers for Medicare and Medicaid Services (CMS) that they have met the government’s standard for the first stage of meaningful use of health IT.  That means they have demonstrated that they have the baseline capabilities in their CMS-approved health IT system to collect and submit data.  Stage 2 also deals with security of exchanging patient information electronically, particularly the risk of a doctor mistakenly leaving his laptop or iPad accessible to the public.  “A huge, huge, huge portion of all breaches don’t occur because someone hacked into the system; they occur because people left their laptop on the train and they didn’t encrypt it,” Mostashari said.

Writing on the website, Robert Rowley, M.D., says that “Stage 2 is about connectivity.  So let us take a step back and re-assess the larger picture.  Stage 1 Meaningful Use is about adoption of EHRs into the daily practice of clinicians and hospitals.  It is about moving the documentation of healthcare away from paper, and onto a digital platform.  The platform didn’t really have to connect with anything, though the capability to connect needs to be built for the technology to be Certified.  Stage 2 is about connectivity.  Now that EHRs are adopted, implemented and used meaningfully, the next stage is intended to be about connecting the silos together.  Stage 3, to come later, will be about inserting Decision Support between the connections, so that best practices (as well as authorizations) become part of the daily fabric of healthcare.”

A little-known fact is that EHR adoption is having a positive impact on healthcare IT job creation.  According to job resource Medzilla, an estimated 50,000 new jobs have been created in the health IT field since 2009, when the government passed the HITECH Act, which authorized funding for the EHR incentive program.  “The statistics over the past few months have been more than encouraging,” said Del Johnson, director of client relations at Medzilla.  “Here you have two, previously separate industries that are rapidly growing into one another.  Where the two meet you have an opportunity to explore a completely new labor pool.”

National Health Service Corps Caring for More Medically Underserved Americans

Wednesday, October 19th, 2011

In the last three years, membership in the National Health Service Corps (NHSC) has tripled, according to Kathleen Sebelius, Secretary of Health and Human Services (HHS).  The NHSC is a national network of 10,000 primary-care providers and 17,000 sites in underserved communities with limited access to healthcare.

“When you don’t have access to primary care, small health problems grow into big ones,” Sebelius said.  “Way too many Americans have gone without check-ups, preventive screenings, vaccines, routine dental work and other care simply because there was no one to see,” Sebelius said.  The agency estimates that its providers care for approximately 10.5 million patients, compared with just 3,600 providers who cared for roughly 3.7 million patients three years ago.

The program, which is almost 40 years old — is administered by HHS’ Health Resources and Services Administration (HRSA) — and provides financial, educational and professional resources to medical, dental and behavioral healthcare providers.  According to HRSA the NHSC has awarded approximately $900 million in scholarships and loan repayment to healthcare professionals since 2008 to expand the agency’s primary-care workforce. That funding has come from the Patient Protection and Affordable Care Act (ACA), the American Recovery and Reinvestment Act (ARRA) and base appropriations.  “Eighty-two percent of NHSC clinicians continue to serve in high-need areas after they fulfill their service commitment,” HRSA Administrator Mary Wakefield said.  “These awards help ensure that underserved communities across the country have access to quality healthcare both today and in the future.”

“When you don’t have access to primary care, small health problems grow into big ones,” Sebelius said. “Most of these providers graduate with tens or even hundreds of thousands of dollars in loans, and it is very difficult to pay off while doing this important work.”

The Association of American Medical Colleges estimates that the nation will have a shortage of 91,500 physicians across all specialties just nine years from now. 

Despite the program’s recent significant growth, Wakefield said there are underserved areas of the country that qualify for National Health Service Corps members, but there is not enough money to fund providers there.  “It is a significant challenge,” Wakefield said.  “We have more sites that are designated or eligible than we have clinicians.  We also have, on the flip side, more students applying to National Health Service Corps than we have availability” to fund.

In Minnesota, for example, a state with vast wilderness areas, the federal government is providing $6.6 million in incentive dollars to doctors and nurses to increase the state’s number of primary-care providers.  According to Minnesota Public Radio, “Minnesota’s rural healthcare system is feeling new pressure.  National healthcare reform is forcing expensive record-keeping changes.  Greater reliance on Medicare and Medicaid reimbursement makes rural providers vulnerable.  Rural people tend to be older and poorer, are less likely to have insurance and suffer more chronic illness.  And the doctor shortage has gotten harder to deal with.  In response, care is changing.  Services like mental health counseling are delivered via teleconference.  Clinics and hospitals are consolidating.  ‘Mid-level’ practitioners like paramedics and dental therapists are starting to play new roles.”

Hospital Executives’ Priority Is to Control Costs

Tuesday, October 19th, 2010

Hospital CEOs’ top priority is to bring their costs in line with Medicare payment levels. The American College of Healthcare Executives (ACHE) tested the waters of how its members feel about the Affordable Care and Patient Protection Act by conducting an in-depth survey.  The primary finding is that hospital executives are reacting to healthcare reform by slashing expenses. Their goal is to bring their per-patient costs into line with Medicare payment levels.

Based in Chicago, the trade association for hospital and healthcare system executives, queried 539 CEOs and learned that more than 75 percent plan to cut per-patient costs.  Additionally, they intend to study means to avoid penalties for preventable readmissions over the next year as a response to the healthcare reform law.

Thomas Dolan, ACHE President and CEO, said “Hospital CEOs are actively taking steps to ensure their communities are going to benefit from the advantages offered by healthcare reform legislation.”

Approximately 72 percent of executives who took the survey plan to build closer relationships with physicians so all can benefit from incentives for care coordination, enhanced quality, patient safety and reduced costs.  Another 68 percent plan to apply for subsidies through the American Recovery and Reinvestment Act to purchase electronic health record systems.  Fully two-thirds are investigating ways to prevent infections and avoid penalties.  Almost 50 percent of respondents plan to look into ways to decrease the average patient stay or partner with community organizations to promote wellness.

Finding the Right Line Between Healthcare Privacy and Accessibility

Tuesday, July 27th, 2010

Privacy versus accessibility duking it out in the healthcare arena.  One of healthcare’s biggest challenges is balancing the sharing of health information with the need to assure patient privacy.  Although privacy has been assured since the implementation of the 1996 HIPAA law, the issue of patient consent is now at the forefront because the American Recovery and Reinvestment Act’s (ARRA) financial support of electronic medical records has reignited interest in data-sharing and patient privacy rights.

Providers must be able to show that they are sharing information to improve patient care to be eligible to receive subsidies to acquire electronic healthcare records-keeping technology.  Conversely, the stimulus bill modifies HIPAA and allows patients to demand that their records for a treatment or service not be shared with their insurance company if they pay the full cost directly.  Also included in the stimulus bill is a ban on selling patient data.

Federal officials believe that protecting patient privacy is critical to developing a national health information exchange that patients trust.  Doug Fridsma, acting director of the Office of the National Coordinator for Health Information Technology (ONC) said “We always put in here that privacy and security is paramount.” The government “plays an integral role in assuring trust and ensuring privacy and security of health information.”  Because the ONC has come under criticism for being insincere about privacy, the organization is now under pressure to release privacy and security policies.

According to Fridsma, “It’s going to be an iterative, incremental approach.  We have a lot of moving parts.  I’ve been trying to do as much as I can to support the work that’s been going on and to at least keep the channels of communications open.”

Rick Mattoon: Is the Recession Over?

Monday, March 8th, 2010

 The Fed says the recession is over.  Economic indicators show that the recession is over.  This is the opinion of Rick Mattoon, a senior economist and advisor in the economic research department of the Federal Reserve Bank of Chicago and a lecturer at the Kellogg School of Management at Northwestern University.  Rick’s primary research focuses on issues facing the Midwest regional economy.

In a recent interview for the Alter Inspire Podcasts, Mattoon warned that most people probably don’t feel like the nation is coming out of a recession because there are few signs of job creation or easier access to credit.  One of the major concerns economists have is that this will be a double-dip “W-shaped” recession because once the bump from the $787 billion stimulus ends, there will be scant pent-up consumer demand for products and services to take the place of government spending.

One positive sign is an uptick in hiring by temporary employment agencies, which usually is considered to be a good harbinger of what future demand will be.  Another interesting theory about this particular recession in terms of jobs is the idea that companies adjusted their employee levels much more aggressively at the beginning of this cycle.  As a result, they are operating at extremely lean levels and so may hire earlier rather than later.

One problem is that there is a skills mismatch in the economy.  Many people who have lost their jobs don’t possess the right skills to find employment in growth industries such as clean energy or healthcare.  The challenge is training these individuals to bring their skills up to par.