Narrowing Healthcare Cost and Quality Variations through Shared Decision-Making and Interoperability
Mar 1, 2012 - 2:53:37 PM
(HealthNewsDigest.com) - Alarmed by spiraling healthcare costs and unexplained quality variations, public and private payers alike have long sought new methods to produce better outcomes and contain expenses. Adherence to baseline performance of Clinical Quality Measures (CQMs) and robust care are prompting payers to place greater emphasis on the role of primary care physicians as a patient’s Medical Home.
As the major healthcare payer, the federal government has taken the leading role in encouraging the use of information technology for improving and coordinating healthcare activities. Long-term bipartisan healthcare transformation projects have resulted in the Electronic Health Record (EHR) revolution, which was envisioned by President Clinton, enacted by President Bush and funded by President Obama.
Technology Can Enable Better Decision-Making
The increase in EHR use is an unparalleled development, since it has the potential to provide doctors with their patients’ complete medical histories, enabling sounder medical decision-making and facilitating the secure exchange of vital healthcare information across multiple specialties and medical systems. Health Information Technology (HIT) can also encourage patients to take a more active role in their own healthcare by producing educated consumers with access not only to their personal records but to aggregate data on hospital and individual healthcare professional performance. The US Department of Health and Human Services (HHS) already provides consumers with a comparison tool for hospitals (www.hospitalcompare.hhs.gov), and Congress has mandated a site patients can use to compare individual physician performance, which will be available in 2012.
Patients have an increasing stake in ensuring optimal care, since families are shouldering a greater cost burden as expenses rise, with direct out-of-pocket costs per family averaging more than $3,000 per year.
Unwarranted Variations in Costs and Quality
John E. Wennberg, MD, MPH, and his team at Dartmouth's Center for the Evaluative Clinical Sciences have demonstrated that “unwarranted variations” exist in both quality of care and cost of care, which cannot be explained on the basis of illness, medical evidence or patient preferences. This insight comes via groundbreaking regional analysis conducted though the Dartmouth Healthcare Atlas Project (www.dartmouthatlas.org). The work of Dr. Wennberg and others has shown that medical expenditures per patient can vary by as much as 100% between cities such as McAllen and El Paso, Texas and 80% between hospitals like the Mayo Clinic and the UCLA Medical Center. Studies show that health procedures are often needlessly performed, leading to variations such as six times as many hysterectomies performed in one city in Vermont than in another city in the state.
These findings, in addition to the fact that one in five hospitalized Medicare beneficiaries are readmitted within 30 days, point to a need for greater information sharing, care coordination and patient involvement. Cloud-based healthcare technology tools, CQM performance metrics and standardized health information exchange platforms may be the right prescription.
Interoperability Is Here Now
Cloud-based EHRs bring sophisticated capabilities at an affordable price even to small or solo physician practices. With the right technology partner, and armed only with a broadband connection and a browser-enabled device, doctors can gain access to robust EHR Practice Management systems designed for CQM performance with real-time business analytics.
It’s not as futuristic as it sounds: At the end of 2011, more than 50% of US doctors had already used cloud-based tools to manage patient medications through the use of electronic prescription systems. Government incentives that began in 2011 are driving EHR adoption, and the pace is accelerating: Over the next 1,000 days, physicians and hospitals will receive more than $40 billion in HITECH Act incentive payments for installing and meaningfully using EHR systems, thus fulfilling the vision of the Clinton and Bush Administrations.
The key feature of these EHRs is that they are mandated to provide interoperability between all healthcare providers in a standard electronic format and in plain language so that patients and their families can take a more active role. Fortunately, the work of creating an infrastructure to enable broad, secure sharing of health data is mandated by the HITECH Act through human and machine readable Continuity of Care Records (CCRs) and Continuity of Care Documents (CCDs).
A Rapid Metamorphosis
Those who have operated in the healthcare sector for a number of years may find the pace of change and the rate of adoption of new EHR systems too slow; after all, businesses of all types have been sharing records and exchanging data electronically worldwide for decades. However, healthcare is unique in that technology innovations are driven by penalties, such as Medicare’s requirement of electronic claims submissions in 2003, ePrescribing penalties beginning in 2012 and EHR incentives and penalties pursuant to the HITECH Act.
Additionally, new measures are in place that will continue to drive greater levels of care coordination. For example, on October 1st of this year, readmission rate penalties will go into effect to encourage medical communities to address the fact that about half of the patients who are discharged from a hospital fail to complete a follow-up visit with their physicians or collect their medications. Further along, ICD-10 will take effect, demanding greater granularity for claims coding and requiring far more detailed clinical documentation to support increasing public and private payer reliance on CQM performance to structure reimbursement.
For all the growing pains associated with these changes, it’s an exciting time in the healthcare information technology industry. We now have the tools we need to begin to identify and narrow variations in quality and costs. And patients have the resources and data they require to take a more active role in their healthcare.
About the Author
George S. Blumenthal is Chairman and CEO of eHealth Made EASY, LLC (eHME). Through its ImagineMD brand (www.imagine-md.com), eHME offers a secure, up-to-date, cloud-based, Software-as-a-Service (SaaS) solution that combines full Electronic Health Record (EHR), Practice Management (PM) and Revenue Management (RM) functionality, which is built around a CQM performance engine with real-time business analytics.
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