Category: Health Care Quality

Accountable Care Enrollees to Triple by 2020

David Muhlestein of Leavitt Partners predicts that the number of patients enrolled in Accountable Care Organizations (ACOs) will rise from 23.5 million today to 72 million in 2020.F9What is an ACO? I am becoming less sure that it is a meaningful term. I mean, really, are you in favor of unaccountable care?

Unconnected Medical Devices Harm Patients

The federal government’s dominance of health information Technology (HIT) has been most apparent, and most harmful, in electronic health records (EHRs). However, the hand of government must lie heavily in other parts of health care, too.

An example is medical devices hooked up to patients at the hospital. Remarkably, these devices do not talk to each other, requiring nurses to waste time transcribing data from one device to another. This infographic summarizes a survey of 500 nurses commissioned by the West Health Institute:

Copyright: West Health Institute (2015)

Copyright: West Health Institute (2015)

 

These are appalling figures. I don’t know about you, but I figured out how to connect my VCR to my TV sometime during the 1980s. Medical devices are heavily regulated by the FDA. The fact that devices critical to hospital patients’ health are still not connected strikes me as a likely consequence of over-regulation.

More Evidence We’re Winning the War on Cancer

This blog has previously presented evidence of America’s remarkable success in the war on cancer. The factors leading to success included lifestyle changes (especially quitting smoking) as well as improved diagnosis and treatment.

New research looks only at diagnosis and treatment, and finds stunning improvements since 1990:

Men and women ages 50 to 64, who were diagnosed in 2005 to 2009 with a variety of cancer types, were 39 to 68 percent more likely to be alive five years later, compared to people of the same age diagnosed in 1990 to 1994, researchers found.

“Pretty much all populations improved their cancer survival over time,” said Dr. Wei Zheng, the study’s senior author from Vanderbilt University in Nashville. (Andrew M. Seaman, Reuters)

Improved diagnosis and treatment result from good research and development in the medical-device and pharmaceutical industries, not government-imposed mandatory health insurance.

GAO: Medicare, Medicaid, Veterans Health Administration at High Risk for Fraud, Waste, Abuse

The Government Accountability Office (GAO) has published its annual update of federal programs “that it identifies as high risk due to their greater vulnerabilities to fraud, waste, abuse, and mismanagement…”

Healthcare programs feature high on the list. Medicare, the entitlement program for seniors, and Medicaid, the joint state federal welfare program for low-income households, are longstanding members of the list; and the GAO notes that legislation will be required to fix them:

We designated Medicare as a high-risk program in 1990 due to its size, complexity, and susceptibility to mismanagement and improper payments.

We designated Medicaid as a high-risk program in 2003 due to its size, growth, diversity of programs, and concerns about the adequacy of fiscal oversight.

Has Telehealth Gone Too Far, Too Fast?

Jerry King is the cartoonist for the Kaiser Family Foundation’s Kaiser Health News (which publishes a valuable daily briefing and is a great resource for healthcare news).

One of our issues at NCPA is digital health, especially telehealth (which we have researched since at least 2007). Things are finally moving in the right direction on telehealth adoption. King’s cartoon this morning made us wonder whether things are going too far, too quickly.

voi-patients

Original at Kaiser Health News.

Is the Medical-Malpractice Crisis Being Solved?

In a JAMA article published last month, Michelle Mello and colleagues review trends in medical-malpractice claims and med-mail insurance costs.

Data show a decline in the rate of paid claims against physicians: 6.3% annually for MDs and 5.3% for doctors of Osteopathy, from 1994 to 2013. Further, the average amount paid per claim has been unchanged in real (inflation-adjusted) terms for the past seven years.

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Source: The Medical Liability Climate and Prospects for Reform from JAMA

83 Percent of Physician Practices Say Medicare’s Quality Reporting Does Not Improve Quality

The Medical Group Management Association (MGMA) has produced another painful report about the experience of being a physician or physician executive:

More than 83% of physician practices stated they did not believe current Medicare physician quality reporting programs enhanced their physicians’ ability to provide high-quality patient care. In addition to the lack of effectiveness, physician practices reported significant challenges in complying with Medicare quality reporting requirements. More than 70% rated Medicare’s quality reporting requirements as “very” or “extremely” complex. In addition, a significant majority of respondents indicated these programs negatively affected practice efficiency, support staff time, and clinician morale.

Industry’s User Fees Fail to Improve FDA’s Approvals of Medical Devices

In June 2012, I wrote an analysis of the effect of user fees, paid by the medical-device industry, on the Food and Drug Administration’s behavior with respect to approving new medical devices. My conclusion: The FDA had sucked up the dollars without increasing its productivity.

New research, commissioned by the California Healthcare Institute, a trade association, confirms that the industry’s user fees are disappearing into a black hole. Despite putting a positive spin on the behavior of the regulator, which has a choke-hold on the industry’s ability to launch new products, the evidence indicates that the millions of dollars that the industry has paid to the FDA have not improved its performance:

92 Percent of Nurses Dissatisfied with Electronic Health Records

Although we have frequently discussed physicians’ dissatisfaction with electronic health records, doctors are not the only victims of the federal government’s $30 billion adventure in underwriting poor IT investments. Nurses are even more disappointed in EHRs than doctors are, according to a new survey by Black Book Market Research:

Dissatisfaction with inpatient electronic health record systems among nurses has escalated to an all-time high of 92%, according to the Q3 2014 Black Book EHR Loyalty survey results to be published later this month. Disruption in productivity and workflow has also negatively influenced job dissatisfaction according to nurses in 84% of U.S. hospitals. 85% of nurses state they are struggling with continually flawed EHR systems and 88% blame financial administrators and CIOs for selecting low performance systems based on EHR pricing, government incentives and cutting corners at the expense of quality of care. 84% of nursing administrators in not-for-profit hospitals, and 97% of nursing administrators in for-profit hospitals confirm that the impact on nurses’ workloads including the efficient flow of direct patient care duties were not considered highly enough in their administration’s final EHR selection decision.

400 Additional Hospitals Face Obamacare Readmission Penalties Totaling $428 Million in Fiscal 2015

The Hospital Readmissions Reduction Program was created by Obamacare to penalize hospitals with excess numbers of patients readmitted within 30 days of discharge following treatment for heart attack, heart failure or pneumonia. In fiscal 2013, the penalty was up to a 1% dock in Medicare payments. That figure increased to 2% in fiscal 2014 and now sits at 3% for fiscal 2015. In addition to the increased fine, the program has added measures: Readmission rates for chronic obstructive pulmonary disease and total hip and total knee replacements. Modern Healthcare reports that 2,610 U.S. hospitals will see their Medicare payments docked in fiscal 2015, while just 769 U.S. hospitals will avoid such fines. Over the course of fiscal 2015, Medicare estimates the fines will total $428 million. Perhaps the measures are

not achieving their stated goal of improving care if fewer than one quarter of eligible hospitals can avoid the fines.