In 2009, the federal government budgeted $30 billion to incentivize doctors and hospitals to install electronic health records and use them “meaningfully”. Here are the results from Boston’s Brigham & Women’s Hospital — one of the leading academic medical centers in the country:
Of 858 physicians, 540 (63%) were “meaningful users”. Meaningful use was associated with marginally better quality for 2 measures, worse quality for 2 measures, and not associated with better or worse quality for 3 measures.
Meaningful use of electronic health records was correlated with better control of cholesterol in patients with diabetes and of blood pressure in hypertensive patients. The meaningful-use group provided worse treatment of asthma and depression than the non-MU group did.
HT: Ken Terry, Medscape.
Posing as patients, researchers made almost 13,000 calls to doctors’ offices in ten states, seeking appointments for a variety of ailments. For those posing as privately insured patients, they got appointments 85 percent of the time. For those posing as patients on Medicaid, they only got appointments 58 percent of the time. Researchers also posed as uninsured patients who were willing to pay in full at the time of the appointment.
The result? 78 percent were successful (for appointments costing more than $75) — 36 percent better than those posing as Medicaid patients and quite close to those posing as privately insured.
Doctors reacted swiftly and indignantly to Wednesday’s release of government records revealing unprecedented details about Medicare payments to physicians…The top 10 doctors alone received a combined $121.4 million for Medicare Part B payments in 2012…In interviews, many of the doctors said they were just passing through the payment to drug companies. Some said they were unfairly singled out even though they were billing for an entire practice. And still others disputed the accuracy of Medicare data. (Washington Post)
Congress has given up on repealing the Sustainable Growth Rate (SGR) as a way to pay physicians under Medicare. This blog has previously written about the futility of politicians’ efforts to “fix” the way they pay physicians (especially here, here and here).
The one they just passed last week runs for a year. And, just as always, these politicians who are elected for two-year to six-year terms voted to massively increase spending today, in exchange for draconian cuts a decade hence.
According to the Congressional Budget Office’s score of the bill, it increases Medicare’s physician payments by $15.8 billion over ten years. However, $11.2 billion (71 percent) is spent by 2015, and $13.3 billion (84 percent) is spent by 2016.
The savings to pay for this? Those come later, much later: Savings don’t become greater than spending until 2020, and not significant until 2024 — the last year of the mandated scoring “window“, when the law is supposed to claw back $9.3 billion from hospitals and re-impose the sequester on Medicare.
Good luck with that. Congress continues to make a mockery of Medicare-physician payment reform.
We find that a surgeon’s additional day away from the operating room raised patients’ inpatient mortality risk by up to 0.067 percentage points (2.4% relative effect) but reduced total hospitalization costs by up to 0.59 percentage points…Our findings are consistent with the hypothesis that after returning from temporal breaks surgeons may be less likely to recognize and address life-threatening complications, in turn reducing resource use. (NBER Working Paper)
Health plans selling on the federal marketplaces in 2015 must include 30 percent of area “essential community providers,” which are usually health centers and other hospitals serving mostly low-income patients. That’s up from a 20 percent requirement in 2014, the first year of expanded overage under the health care law. (Washington Post)