Category: Health Care Quality

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.

The Case for Drugstore Clinics

In The Atlantic, Richard Gunderman, MD, PhD, has delivered “The Case Against Drugstore Clinics“. It is a weak case. Let’s take his strongest argument first:

A woman with a sore throat went to a retail clinic and received a prescription for antibiotics. After a few days, she hadn’t gotten better, so she went to her family physician. The physician determined that the sore throat was probably due to a viral infection. He also, however, talked to her about her overall health and life. This conversation led to a previously unsuspected diagnosis of clinical depression. The patient is now in treatment and doing much better.

A case like this illuminates three important differences between the retail clinic and the physician’s office. First, the retail clinic prescribed an antibiotic, but in the physician’s judgment the infection was not bacterial. Overusing antibiotics can promote the development of antibiotic-resistant strains of bacteria. Second, the minute clinic focused exclusively on the sore throat. And third, the physician’s more comprehensive evaluation led to a diagnosis with important implications for the patient’s overall, long-term health.

We’re Number 44! Bloomberg Ranks Countries on Efficient Health Care

Bloomberg (the media business, not the former mayor of New York, although the latter appears to have regained control of the former), has ranked 51 high- and middle-income countries on healthcare efficiency. The U.S ranks 44th.

44 of 51 is pretty bad. (Indeed, we are bracketed by the Dominican Republican and Bulgaria). However, the Bloomberg rankings suffer from some of the same problems that we see with other rankings. NCPA has never thought the U.S. healthcare system was efficient, but neither do we think that other countries do a great job. NCPA scholars addressed this in a monograph published in 2009: Health Care Reform: Do Other Countries Have the Answers? My criticism of Bloomberg’s rankings draws largely from that monograph.

Another Doctor Rebels: “The Patient Should be the Arbiter of the Physician’s Quality of Care”

Mark Sklar, MD, in the Wall Street Journal:

The push to use electronic medical records has had more than financial costs.

Yet to avoid future financial penalties from Medicare, I must demonstrate “meaningful use” of the electronic record. This involves documenting that I covered a checklist of items during the office visit, so I spend 90 minutes each day entering mostly meaningless data. This is time better spent calling patients to answer questions or keeping updated with the medical literature.

My practice quickly adopted the new Medicare requirements for electronically prescribing medications. Yet patients often do not want their prescription sent electronically.

If I don’t electronically prescribe for a certain number of Medicare patients, I am penalized with a decrease in reimbursement that can rise to a maximum of 5%. Patients should have a choice in how their prescriptions are delivered, and physicians shouldn’t be penalized for how the patients choose.

Who Should Regulate Telemedicine, and How?

Readers of this blog know that NCPA has long been a supporter of telemedicine. The question of who should regulate telemedicine, and how, is now coming to a head.

The practice of medicine is regulated by the states. For many years, advocates of telemedicine have pointed to inconsistencies in how medical licensing boards recognize out-of-state physicians as a limit to telemedicine. In 2012, health economist Jason Shafrin reviewed literature, which indicates that requiring a doctor to be physically present with a patient to prescribe reduces access and harms patients.

State-based medical licensing boards’ inability to overcome this problem, despite many years of effort, has led to frustration and the rise of a movement that has not quite come out for a federal takeover of telemedical licensing — but certainly looks like it might tip that way.

Medical Marijuana Might Reduce Opioid Overdoses

Newly published research indicates that medical marijuana laws reduce overdose deaths from abuse of Oxycontin and other opiods by a statistically — and economically — significant amount.

Examining state laws permitting medical use of marijuana that passed between 1999 and 2010, Dr. Marcus Bachhuber and colleagues estimate that medical marijuana reduces the number of overdose deaths by 25 percent.

That adds up to lots of savings. Sean Williams at the Motley Fool reviews the research on the cost of opiod abuse:

Pesky Patients Asking Awkward Questions: Doc, Do I Really Need That?

A recent New York Times article lamented that employers are increasingly offering employee health plans that cover few medical expenses until a fairly high deductible has been met. About one-third of large employers offer only a high-deductible plan. Many other employers encourage enrollment in high-deductible plans by offering low employee contributions. As a result, more employees are covered by high-deductible plans and workers increasingly have to reach for their wallet before insurance kicks in.

As news stories often do, the article used a tear-jerker of an anecdote to drive home its point. The subject of the story was Anita Maina. Although her monthly premiums were only $34 per month, her deductible was $6,000 and her health savings account not well-funded. Here’s the story:

Anita Maina was working on an arts and crafts project she found on Pinterest — creating a table out of wood and cork — when she ripped off a fingernail while removing staples from a piece of wood.

But she ultimately skipped the [office] visit since she had not met the $6,000 deductible on her health plan, and she knew she probably did not have much left in her health savings account…

The New York Times article even included a photo of Ms. Maina with her injured finger!

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