NowClinic, which started in 2010 and has expanded into 22 states, is part of the explosion of Web- and telephone-based medical services that experts say are transforming the delivery of primary health care, giving consumers access to inexpensive, round-the-clock care for routine problems — often without having to leave home or work.
Source: Kaiser Health News.
Despite the widely held assumption that having computer access to patients’ test results will reduce testing, a new study shows that doctors who have such access to tests in the ambulatory care setting are more likely to order imaging and lab tests…
McCormick and his colleagues found that point-of-care electronic access to electronic imaging results, sometimes through an electronic health record, was associated with a 40-70 percent greater likelihood of an imaging test being ordered. Physicians without such access ordered imaging in 12.9 percent of visits, while physicians with access ordered imaging in 18.0 percent of visits.
View full study on the cost of adopting health information technology in Health Affairs.
Doctors who use EHRs may actually order more diagnostic testing, and therefore make health care even more expensive, according to a study published in the Health Affairs journal.
View entire post on electronic health records by Jenny Gold in the Kaiser Health News.
Disease registries enable doctors and hospitals to learn about and share the latest information on best clinical practices for disease and conditions. According to a post on the Health Affairs blog, other countries have adopted disease registries faster than the United States:
For example, Sweden began a registry for hip replacement surgery in 1979. Since then, Sweden has reduced its revision burden (the number of surgeries that have to be repeated as a share of total hip replacements in a given year) to 10 percent—saving some $14 million per year. The authors estimate that if the United States had in place a similar registry for hip-replacement surgery, it would avoid some $2 billion of an expected $24 billion in total costs for these surgeries in 2015.
Apparently yes, according to this New York Times report:
Poorly designed, hard-to-use computerized health records are a threat to patient safety, and an independent agency should be set up to investigate injuries and deaths linked to health information technology, according to a federal study released Tuesday. The report by the Institute of Medicine comes as the government is spending billions of dollars in incentive payments to encourage doctors and hospitals to adopt electronic health records.
The Institute of Medicine committee also called for tracking the safety performance of electronic health records in use. Results from studies done so far, the report said, are mixed. Success stories are offset by reports of patients harmed. The advisory group recommended that electronic health record suppliers drop “hold harmless” clauses from their sales contracts. Such language often limits the freedom of doctors and hospitals to publicly raise questions about software errors or defects.
Medicare has about 7,500 different tasks for which physicians can get reimbursed. If you add in regional adjustments, there are potentially 6 billion different prices. If this isn’t complicated enough, doctors and hospital currently have about 18,000 different billing codes they can use when sending bills to insurers. However, the federal government doesn’t believe 18,000 codes allows for enough detail. According to the Wall Street Journal:
A new federally mandated version will expand the number to around 140,000—adding codes that describe precisely what bone was broken, or which artery is receiving a stent.
It will also have a code for recording that a patient’s injury occurred in a chicken coop. (See code.)
Indeed, health plans may never again wonder where a patient got hurt. There are codes for injuries in opera houses (see code), art galleries (see code), squash courts (see code) and nine locations in and around a mobile home (see codes), from the bathroom to the bedroom.
The level of detail is astounding. For example, there are three different codes for getting bitten by a squirrel. See for yourself.
This is Kevin Outterson at The Incidental Economist:
In October 2013, the US health care system will undergo a dramatic coding change as we transition from ICD-9 to ICD-10….
[H]ospital inpatient procedural codes will grow from 3,800 to 72,000; physician diagnostic codes from 14,000 to 69,000. Implementation costs for a three physician practice may average $83,000, with the per-doctor implementation cost dropping to $28,500 in a ten doctor practice. (see Harris Meyer’s reporting in May 2011 Health Affairs). No one reimburses providers for these transition costs.
The National Programme for IT in the National Health Service was launched in 2002 with a 2010 goal of providing every NHS patient with his very own electronic medical record. Yet in its most recent report, the British National Audit Office states that the Department of Health there has been a:
steady reduction in value delivered not matched by a reduction in costs. On this basis we conclude that the £2.7 billion spent on care records systems so far does not represent value for money, and we do not find grounds for confidence that the remaining planned spend of £4.3 billion will be different.
As in the U.S., the system was sold with claims that it would improve services and the quality of care. In fact, many of the proposed applications, like internet appointment scheduling, electronic prescribing, computerized order entry in hospitals, and a secure organizational broadband communications network are already in use, without government subsidy, in the U.S.
Maine’s high risk pool has only 14 people in it. HT to Yglesias
Dodd-Frank regulation maze. (neat graphic) (HT to David Henderson)
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