Health IT Gets a Boost
The American Recovery and Reinvestment Act of 2009, commonly known as the stimulus bill, includes about $19 billion to help subsidize the adoption of electronic medical records by hospitals and physician practices under the Health Information Technology for Economic and Clinical Health (HITECH) Act.
The HITECH funds, distributed through incentive payments under Medicare and Medicaid, would provide more than $40,000 per physician and up to several million dollars to hospitals to adopt electronic medical records. To receive the payments, providers will have to demonstrate "meaningful use" of certified health systems. By 2015, providers that have not yet adopted electronic records will be penalized.
The Association of Medical Directors of Information Systems, an organization of physicians interested in health IT, has created a Web site, www.meaningfuluse.org, to track the debate over defining "meaningful use." David Blumenthal, M.D., head of the Office of the National Coordinator for Health Information Technology at the Department of Health and Human Services, has said that he expects to have a working definition for "meaningful use" by late spring or early summer. The Office has released an operating plan that details its plans to implement the health IT provisions in the HITECH legislation.
Meanwhile, technology companies hoping to capitalize on the stimulus funds have formed the EHR Stimulus Alliance, which aims to educate doctors about the tools available to help set up electronic health records. These companies include Allscripts, Cisco, Citrix, Dell, Intel, Intuit, Microsoft, and Nuance Communications. The Alliance will use webcasts, a telephone hotline, and other communication channels to explain EHR technology and showcase case studies of where it has improved care. The group says it wants to reach a half of a million doctors.
Patients Do Not Receive 40 Percent of Recommended Care, Report Finds
The sixth annual National Healthcare Quality Report, issued by the Agency for Healthcare Research and Quality, finds that, while the quality of U.S. health care continues to improve, Americans still do not receive 40 percent of recommended care. For example:
- Only 40 percent of diabetic patients received three recommended preventive exams in the past year, and this rate has not improved over time.
- Only half of obese adults and children are given advice to exercise more and eat a healthy diet.
- Only three of 10 adults with mood, anxiety, or impulse disorders received appropriate reatment; the majority received inadequate treatment or no treatment at all.
The report tracks trends on 45 measures of effectiveness of care, patient safety, timeliness of care, patient-centeredness, and efficiency of care. Across all these quality measures, the median annual rate of change was 1.4 percent, with greater improvements for acute care than for preventive and chronic care.
It also found that, although the rates of avoidable hospitalizations have decreased overall since 2000, total national costs associated with potentially avoidable hospitalizations have increased in this same time frame.
Measures of patient safety have declined by nearly 1 percent each year for the past six years—in part because of a rise in health care–associated infections. U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius recently announced the availability of $50 million in federal stimulus grants to help health care facilities prevent such infections. HHS will allocate $40 million to create or expand state infection and surveillance programs and $10 million to improve processes and increase the number of inspections at ambulatory surgical centers.
National Healthcare Disparities Report
An accompanying report found that the U.S. has not made substantial improvement in narrowing health care disparities among racial and ethnic groups. The National Healthcare Disparities Report, which takes into account 220 quality measures, found either no improvement or worsening care between 2000–01 and 2005–06 on 60 percent of the quality measures.
Blacks are twice as likely as whites to have a leg amputated because of diabetes, while pregnant black women are twice as likely as white women not to receive prenatal care during their first trimester, according to the report.
The disparities report did reveal some bright spots. For example, the rate of deaths per 1,000 discharges among African-American patients from complications potentially resulting from care declined between 2000–05.
Reducing Readmissions Focus of Legislation, IHI Initiative
Earlier this month, Sen. Michael Bennet (D-Co) announced a bill intended to reduce hospital readmission rates. The Medicare Care Transitions Act of 2009 would create a nationwide network of community-based "transitional care coaches." These coaches would help patients manage their conditions and medications, provide follow-up care, and serve as a single point of reference for patients changing care settings. The proposed legislation is intended to improve quality of care and reduce costs. As many as one of five Medicare beneficiaries are readmitted to hospital after their initial discharge—many for conditions that are considered potentially preventable.
Also this month, the Institute for Healthcare Improvement (IHI) launched the STate Action on Avoidable Rehospitalizations (STAAR) Initiative, a major Commonwealth Fund–supported effort to reduce rehospitalizations by working across organizational boundaries in three states—Massachusetts, Michigan, and Washington. The initiative will engage health care payers, state and national stakeholders, patients and families, and caregivers at multiple care settings. It will provide a learning community, as well as targeted technical assistance to address systemic barriers to reducing avoidable rehospitalizations, and will expand to other states over time.
STAAR resources for state policymakers, providers, and others are posted on the IHI Web site.
More Hospitals Meet Safety Standards, But Much Room for Improvement
The Leapfrog Group's 2008 Hospital Survey found that, while some progress has been made, most hospitals still are not meeting standards known to improve the quality and safety of care. Detailed results of the survey, which was voluntarily completed by 1,282 acute care hospitals across the nation, are available at www.leapfroggroup.org/cp.
Only 7 percent of hospitals met Leapfrog's standard for preventing medication errors, which requires hospitals to use computerized order entry systems for at least 75 percent of inpatient medication orders and to evaluate their CPOE tool to ensure it alerts prescribers to common, serious prescribing errors. Research indicates that CPOE systems could reduce the number of adverse drug events by 88 percent—potentially preventing 3 million serious medication errors each year.
Nearly a third (31%) of hospitals met Leapfrog's standard for ICU physician staffing, and another 7 percent plan to do so by the end of 2009. This is a major improvement over 2002, when only 10 percent of hospitals met this standard. It requires hospitals to use intensivists for care management in the ICU at least eight hours a day, seven days a week. Mortality rates are lower in hospitals where ICUs are managed by intensivists, who are trained in critical care medicine.
In 2008, 65 percent of hospitals did not have all recommended practices in place to prevent hospital-acquired infections—which kill nearly twice as many people as breast cancer and HIV/AIDS combined. Still, this represents an improvement from 2007, when 87 percent of hospitals did not have all recommended policies in place.
For the first time, the Leapfrog survey included measures of efficiency, defined as the highest quality and lowest resource use. Among surveyed hospitals, the efficiency standards were met by only 24 percent of hospitals for heart bypass surgery, 21 percent for heart angioplasty, 14 percent for heart attack care, and 14 percent for pneumonia care.