2010 Potpourri XXIV

The Leapfrog Group is devoted to improving quality and safety in health care.  It recently conducted a survey of hospitals’  use of computerized physician order entry, which is typically hailed as one of the information technology-based saviors for health care.   (CPOE Study) The survey, however, indicates that the 214 hospitals who evaluated their systems continued to have problems with around 50% of orders, including around 33% potentially fatal problems.  The results suggest an ongoing need to test and evaluate IT systems for accuracy and completeness.

Accountable care organizations are another heavily promoted fix for the health care system.  An article on the AIS Health site indicates that many groups are concerned that guidance for how Medicare’s version of this concept will work is very late, given the start date.  Federal officials are not indicating when the guidance will be out.  Planning for such a complex undertaking is difficult and there will be many changes  the provider groups will need to make, so a long lead time would be beneficial.   (AIS Article)

Oh, Massachusetts, how we love you.  The leading edge of health reform constantly instructs and informs us.  In one story, we learn that emergency room visits are actually up since the reform law was passed.  Increasing access through better coverage was supposed to save money by decreasing such visits and allowing people to use primary care physicians.  Instead ER usage is up by 9% during the time period before and after reform, according to a state report.   (Boston Globe Article) In a second story, the state has temporarily given up on trying to reform how providers are paid.  Based on a massive report which basically recommended some kind of global payment, the state legislature was working toward a new reimbursement model.  But, gee whiz, the payers, regulators, providers and others couldn’t agree on what that should look like.  The state senate president said “Nobody is in agreement on anything.”  It was farcical to ever expect that providers in particular would quickly agree to changes in reimbursement which would have an unknown effect on their revenue.  (Boston Globe Story)

Doctors in one hospital created an imaging guideline that reduced use of unnecessary x-rays by 83%.  (Imaging Story) The physicians observed that a number of regular x-rays were being ordered for patients with a spine condition after a CT scan of the same area had already been performed.  The doctors noted that not only is money being saved, but the equipment and staff can be used more efficiently and patients are protected from excessive radiation exposure.

URAC is an independent group which accredits and supports various health care management efforts.  It has released early findings from its most recent survey of trends in medical management.  (URAC Press Release) Companies report using more information technology in these efforts, but also report difficulty in meeting the cost of the systems.  Medical managers are attempting to allow consumers to access information about the status of their case electronically, but few have internet portals fully in place for this purpose.  Many managers are incorporating medical records in their systems and believe that having EHRs become more widespread will facilitate that effort.