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2010 Potpourri IX

By March 13, 2010Commentary

The American Academy of Family Physicians issued its comments on the proposed meaningful use rules.  As with most provider reactions, AAFP felt that there could be a number of beneficial changes.   (AAFP Statement) In particular, they recommended allowing more incentive payments for partial achievement of objectives; recognizing achievement for a care team, not necessarily only what was done directly by the physician; and removal of the CPOE criteria because of difficulties in ensuring that orders can actually be received.

The American Hospital Association also weighed in on the meaningful use rules.  (AHA Statement) It suggested many changes to the proposed rules.  One of its primary concerns was the limited amount of time left for providers to get systems in place and be able to use them effectively enough to get the incentive payments.   They also wanted to change the all or nothing nature of the incentives; replacing it with a system that would pay for a threshhold percentage of compliance in the first year and gradually increase that percentage in following years.

Many people would be surprised to learn of the Federal Communication Commission’s role in promoting or affecting telemedicine.  Among other things, the agency has provided a great deal of funding for infrastructure, primarily in rural areas.  Most recently the FCC announced funding of $145 million to build 16 broadband telehealth networks to connect hospitals.  This funding helps to improve access and quality for Americans living in areas with few health resources.   (FCC Story)

Virginia passed a law mandating coverage by insurers for certain telemedicine services.  (Va. Telemedicine Law) A number of other states have passed similar laws.  While mandating coverage of certain services tends to raise the cost of insurance and increase inappropriate demand, in this case it may be justified.  Telemedicine can lower costs and definitely improves access for residents both in underserved rural areas and in poor urban regions.

The Center for Healthcare Transformation and Research released a survey of Michigan residents regarding health status and insurance.  (Survey) The findings include a strong link between perception of health status and income; anxiety among both the insured and uninsured about the costs of health care; and anxiety about losing employment-based coverage.   Interestingly, uninsured persons were more likely to say they were in excellent health than were insured persons, probably a reflection of many healthy young people not having insurance.  People with a government source of payment were much more likely to rate their health poorly than those with private individual or group insurance.

The American Hospital Association also put out a brief piece intended to show what is driving increases in hospital’s internal costs, and in turn, spending on hospital services.  (AHA Link)(Link to document is on home page)  According to the AHA, that spending increase is primarily accounted for by hospitals experiencing higher costs, especially for labor.  The AHA says that such costs are responsible for 64% of the growth in spending and more use of services accounts for 34%.  This piece was likely released in reaction to recent research showing that hospital price increases are driving insurance premiums and that the growth in those hospital prices are unrelated to quality or the hospitals’ costs.  The AHA’s piece doesn’t really address that because while it talks about where hospital cost increases come from, it doesn’t connect those to price increases.  The reality is that whatever internal cost pressures hospitals face, for many of them, prices are rising far faster than their own costs are increasing.

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