DIVURGENT

Since consumers rely on quality and cost information in many other segments of their lives, I believe it is the consumer who will soon begin to drive improvements in quality and price transparency in healthcare. Further, the American Recovery and Reinvestment Act of 2009 will result in the industry’s increased adoption of technologies that are critical to creating the environment of transparency that consumers will demand.

As consumers become more and more involved in their care, they are coming to realize that better information about cost and quality will allow them to make better, more informed choices. Just as they can book hotel rooms anywhere around the world—and find data on cost and quality that is readily available—they will begin to expect the same in healthcare. Providers operating in a competitive environment will be forced to improve the quality and cost of care if they are to compete effectively. In addition, transparency will encourage these consumers to reward high quality/low cost care. Over time, consumers will not tolerate a healthcare system without quality and cost transparency.

Hotels and healthcare

Already, today’s consumers feel that the current state of information is inadequate. They rarely have cost and quality details about healthcare services, and even physicians rarely have comparative information on the quality of their own care or of the care of physicians to whom they refer patients .

Quite unlike decisions about a hotel stay, the unique characteristics of healthcare decision-making includes a high degree of risk and value–both perceived and real. Healthcare decisions therefore necessitate that consumers maintain a high level of involvement in the decision-making process. Unfortunately today, most consumers overall could spend considerable time and effort to uncover a minimal level of information to make their final purchase decision. Further, even though they have researched the service, sometimes the end-user experience differs greatly from what they expected, since the healthcare delivery processes includes many touch points. This variance in the consistency of services and involvement of diverse processes in the system raises additional issues of cost and quality transparency.

Opportunities and solutions

Cost and quality transparency would help patients to make informed choices about their care, encourage private insurers and public programs to reward quality and efficiency, and compel providers to improve services by benchmarking their performance against others . To develop and implement a national strategy for health care quality measurement and reporting, for example, the National Quality Forum (NQF), a private not-for-profit membership organization, was incorporated in 1999. NQF is also involved in standardizing health care performance measurement and reporting. Some of the selected projects include cancer care quality measures, mammography standards for consumers, cardiac surgery performance measures and nursing care performance measures. Some effective state-driven transparency efforts in the US include various programs such as the Pennsylvania Health Care Cost Containment Council, California health care reform, Florida Compare Care and the Massachusetts Health Care Quality and Cost Council.

The demand for details and quality in the form of report cards and rating systems for hospitals has also provided business opportunities for private companies. Some of these report card providers are:
- “Consumers’ CHECKBOOK,” which provides “desirability” ratings for hospitals based on surveys of physicians, risk-adjusted mortality figures, and adverse outcome rates for several surgical procedures
- “Leapfrog Group,” which surveys hospitals on about 30 safety practices and then combines them to provide an overall safety score
- “HealthGrades,” which rates hospitals by individual procedures and conditions .

These report card providers may differ in the methodology of their rating systems, so it’s become important for consumers to have a broad perspective in order simply to evaluate these ratings.

Key conclusions

Going forward, the cost and quality transparency and standardization of services will act as key purchase drivers and contribute to the success of a healthcare system.

Therefore, if stakeholders in the health sector wish to look forward to assured profits from this industry, they have to execute activities such as in-depth planning, deployment, execution, and monitoring of various parameters which can equip them to deal with customer sensitiveness for quality and cost transparency.

What might the role of technology play in this arena?

HHS Announces Members of Committees That Will Advise on Implementation
of Health IT Policy and Standards Committees Will Meet Next Week

The Department of Health and Human Services announced the
appointment of three members to the Health Information Technology (HIT)
Policy Committee as well as members of the HIT Standards Committee. The
two new federal advisory committees were established by the American
Recovery & Reinvestment Act of 2009. The first meeting of the Health IT
Policy Committee will be held on Monday, May 11 in Washington, D. C.

“The Policy and Standards committees bring together a wide diversity of
key stakeholders to help guide the advancement of health IT as an
integral part of health reform,” stated Dr. David Blumenthal, National
Coordinator for Health Information Technology at HHS and Chairman of the
Policy Committee. “It is an honor to lead one of these committees, and
I am confident that these committees will provide valuable insight to
help develop important health IT policy in the next few years.”

The HIT Policy Committee will make recommendations to the National
Coordinator for Health Information Technology on a policy framework for
the development and adoption of a nationwide interoperable health
information infrastructure, including standards for the secure and
private exchange of patient medical information.

The HHS appointees to the Policy Committee are:

David Blumenthal, MD, MPP,
National Coordinator for Health Information Technology, U.S. Department
of Health and Human Services.

Michael J. Klag, MD, MPH
Dean, Johns Hopkins Bloomberg School of Public Health.

Deven C. McGraw, JD, MPH, Director
Health Privacy Project, Center for Democracy & Technology.

An additional 13 members were appointed by the Acting Comptroller
General of the United States, and four members appointed by the Majority
and Minority Leaders of the Senate and the Speaker and Minority Leader
of the House of Representatives. A complete list of the Policy Committee
members and information about the May 11th meeting can be found at
http://healthit.hhs.gov/. The Presidential appointments from relevant
federal agencies are expected to be announced prior to the HIT Policy
Committee’s second meeting in June.

In addition, appointments were made to the HIT Standards Committee, also
a federal advisory body, which is charged with making recommendations to
the National Coordinator on standards, implementation specifications,
and certification criteria for the electronic exchange and use of health
information. The first meeting of this committee is scheduled for
Friday, May 15, 2009.

Members appointed by HHS are:

Jonathan Perlin, MD, Chair
Healthcare Corporation of America

John Halamka, MD. Co-Chair
Harvard Medical School

Dixie Baker, PhD
Science Applications International Corporation

Anne Castro
BlueCross BlueShield of South Carolina

Christopher Chute, MD
Mayo Clinic College of Medicine

Janet Corrigan, PhD
National Quality Forum

John Derr, R.Ph.
Golden Living, LLC

Linda Dillman
Wal-Mart Stores, Inc.

James Ferguson
Kaiser Permanente

Steven Findlay, MPH
Consumers Union

Douglas Fridsma, MD, PhD
Arizona Biomedical Collaborataive 1

C. Martin Harris, MD, MBA
Cleveland Clinic Foundation

Stanley M. Huff, MD
Intermountain Healthcare

Kevin Hutchinson
Prematics, Inc.

Elizabeth O. Johnson, RN
Tenet Health

John Klimek, R.Ph.
National Council for Prescription Drug Programs

David McCallie, Jr., MD
Cerner Corporation

Judy Murphy, RN
Aurora Health Care

J. Marc Overhage, MD, PhD
Regenstrief Institute

Gina Perez, MPA
Delaware Health Information Network

Wes Rishel
Gartner, Inc.

Sharon Terry, MA
Genetic Alliance

James Walker, MD
Geisinger Health System

Representatives from relevant federal agencies will be named separately.
For more information about these committees, meeting dates and
preliminary agendas please visit http://healthit.hhs.gov

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National Coordinator to Announce Members of Committees That Will Help Implement Health IT

Dr. David Blumenthal, National Coordinator for Health IT will announce members of two committees – the Health IT Policy Committee and the
Health IT Standards Committee – that will help establish a nationwide, interoperable health information technology infrastructure on a conference call with reporters on Friday, May 8 at 11:00 AM.

The Health IT Policy Committee will make recommendations to the National Coordinator for Health Information Technology on a policy framework for the development and adoption of a nationwide interoperable health information infrastructure, including standards for the secure and private exchange of patient medical information. The Health IT Standards Committee is charged with making recommendations to the National Coordinator on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information.

WHAT: Dr. David Blumenthal to host conference call with
reporters

WHEN: Friday, May 8, 2009
11:00 AM EDT

DIAL IN: 877-950-3597
Passcode: HHS

It has been reported that President Barack Obama has announced today that he has selected Virginia Secretary of Technology, Aneesh Chopra, to fill the position of chief technology officer (CTO) for the federal government. Congratulations to Secretary Chopra! As someone who has had the opportunity to work with him, I am not surprised at the choice. Secretary Chopra will serve the administration well in this role.

In his address, Obama stated “Aneesh Chopra, who is currently the Secretary of Technology for Governor Kaine of Virginia, has agreed to serve as America’s Chief Technology Officer. In this role, Aneesh will promote technological innovation to help achieve our most urgent priorities – from creating jobs and reducing health care costs to keeping our nation secure.”

From the White House Press Secretary today at 6am. “In his weekly address, President Barack Obama announced that Jeffrey Zients, a CEO, management consultant and entrepreneur, will join the administration as the Chief Performance Officer, and that Aneesh Chopra, Virginia’s Secretary of Technology, will serve as the Chief Technology Officer. Zients will also serve as Deputy Director for Management of the Office of Management and Budget. He will work to streamline processes, cut costs, and find the best practices throughout the government. As Chief Technology Officer, Chopra will promote technological innovation to help the country meet its goals from job creation, to reducing health care costs, to protecting the homeland. Together with Chief Information Officer Vivek Kundra, they will help give all Americans a government that is effective, efficient, and transparent.”

Again, congratulations and good luck to Secretary Chopra!

ck

I’ve recently been appointed to the Commonwealth of Virginia’s Electronic Prescribing (e-Prescribing) committee (CommonwealthRx). As a Pharmacist, I’ve been interested in the lack of adoption of e-Prescribing technologies across the US when there is substantial data detailing the benefits to both patient safety and quality. One such study predicts that a shift to electronic prescribing systems could avoid more than 2 million adverse drug events annually, of which 130,000 are life-threatening. e-Prescribing also has enormous potential to create savings in health care costs, through reduction of adverse drug events and in improved workflows.

Our committee’s mission is of course to improve patient safety within the Commonwealth through increased adoption of e-Prescribing technologies.

Although we have a long way to go in the US regarding e-Prescribing, we are making great improvements. At the end of 2008, there were ~75,000 active e-Prescribers and by now it is closer to 100,000+. (Source: SureScripts).

95% of Chain Pharmacies are ready for e-Prescribing and an optimal future state involves involvement of the independent Pharmacy community, where adoption is only at 45%.

Why is adoption of e-Prescribing technologies not higher?

Mainly, due to the inability of multiple systems to share information effectively, and the lack of a standard format and vocabulary. This reduces the effectiveness and attractiveness of using an electronic system.

Some stats I’ve come across regarding the implementation of e-Prescribing:

• Tuffs Health Plan – 8.9 fewer safety errors per physician per year

• Henry Ford Foundation – 1.7 million prescriptions sent electronically in 2006. 150K prescriptions were canceled due to drug-drug interaction warnings, 11K prescriptions canceled due to drug-allergy warnings and$540K estimated savings from reduced ADEs.

• Institute of Medicine (IOM) – 1.5 million Americans are injured by medication errors. 25% of these injuries are preventable.

• Journal of the American Medical Informatics Association – Over a 4-week period, 61% of the physicians who used clinical reference software believed that the use of the clinical reference prevented adverse drug events or medication errors 3 or more times.

• e-Prescribing systems can avoid more than 2 million ADEs annually, of which 130,000 are life-threatening.

• Tuffs Health Plan – Savings of up to one hour per day for pharmacists.

• Henry Ford Foundation – Over 70K prescriptions were changed or canceled due to formulary warnings

• AHRQ – Estimated 30% of all non e-Prescriptions require pharmacy callbacks, e-Prescribing will reduce pharmacy callbacks by 80%.

• Hewlett Packard – Estimated 2 hours per day per Physician reduction in time spent with prescribing and Rx issues

More about our mission in Virginia:

CommonwealthRx is established to meet the immediate need of promoting state efforts to bring about the coordination for successful electronic prescribing adoption by all stakeholders in the Virginia healthcare industry. Specifically, our mission is to:
• Create a forum that encourages the necessary dialog among the state health care implementers for the benefits and adoption of electronic prescribing.

• Identify cross-industry coordination and electronic prescribing best practices and identification of requirements for electronic prescribing solutions and established standards-based electronic prescribing capability.

• Serve as the primary conduit to address health care opportunities associated with the successful implementation of e-prescribing.

• Educate the health care community about best practices through our internet website, conferences and industry outreach programs and facilitate the distribution of educational and implementation tools.

• Establish outreach approaches for state-level initiatives by developing recommendations to address the coordination that must exist within the state to accelerate the adoption and successful implementation for electronic prescribing stakeholders.

• Coordinate with other regional and national electronic prescribing initiatives evaluating other initiative’s recommendations and findings and identify additional barriers and opportunities for accelerating electronic prescribing.

Lastly, I chair the vendor solutions workgroup of this committee. The Vendor Solutions Workgroup provides all stakeholders access to information and tools that support the evaluation of electronic prescribing solutions consistent with the goals of CommonwealthRx. If you are interested in joining this workgroup, please email me at ck@DIVURGENT.com.

ck
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Ok, back to the future of healthcare. I’ve been distracted for some time by the ARRA. If personal genetic testing isn’t the future, I don’t know what is. In any case, the future is now the present.

I recently sent in a DNA sample to one of the industry leaders in personal genetic testing. Once I learned of the service through a colleague, I had to see it for myself. The company is called 23andMe, and is one of the industry leaders in personal genetic testing. They are dedicated to helping individuals understand their own genetic information through DNA analysis technologies and they utilize some pretty cool web-based interactive tools. The company’s Personal Genome Service™ enables individuals like me and you, to gain deeper insights into our ancestry and inherited traits, as well as giving us the opportunity to advance genetic research through participation in 23andMe’s research studies.

As you may have guessed, the name 23andMe refers to the 23 pairs of chromosomes that make up each individual’s genome. 23andMe connects individuals to their unique, paired set of 23 chromosomes.

How does it work? Joining 23andMe was easy. I logged in, read through the online consent form and purchased the service (~$400). Within a few days I received a sample collection kit in the mail, with instructions on how to provide a DNA sample (ok, spit). The kit included a pre-paid, pre-addressed envelope into which I placed the bar coded tube containing my saliva.

They received my sample and I’m told that laboratory personnel extracted DNA from cells in my saliva. My DNA was then processed on an Illumina® BeadChip, which reads more than 550,000 SNPs (single nucleotide polymorphisms) plus a custom designed set that analyzes more than 50,000 additional SNPs, chosen by 23andMe scientists for their scientific relevance. Ok, I’m not really sure what all of that means, but I’m interested in seeing the results.

As promised 4-6 weeks after mailing back the sample, I received an email notification that my 23andMe genome profile was ready. Currently, I am exploring my genome and determining if I want to opt-in and learn of my potential for Parkinson’s disease. It’s only one click, but I hesitated for some reason. In any case, I’ll let the group know of anything interesting I find! I can tell you that I don’t have to worry much about male pattern baldness, what a relief.

You can see for yourself at www.23andMe.com

ck
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There are basically four factors involved in the incentive payment to hospitals. The base amount, additional incentive payments based upon the quantity of annual discharges, a Medicare share, and a transition factor.

The base amount specified in the legislation is $2,000,000.

The discharge related amount specified in the legislation is estimated based upon total discharges for the eligible hospital (regardless of any source of payment) for the period, for each discharge up to the 23,000th discharge

The Medicare share is based on inpatient bed days paid under Medicare Part A or through a Medicare Advantage organization.

The transition factor where total incentive payments are reduced over a period of four years.

There is additionally a “phase down” factor applied to hospitals who are not meaningful users after 2013. This phase down factor is based on the transition factor discussed above.

As with Physicians, hospitals must show meaningful use as early as possible (in year one) in order to maximize incentive payments.

Critical Access Hospitals (CAH) have a unique payment formula that is the same as the formula that is calculated for eligible hospitals, with the exception of how the Medicare Share is calculated. After the Medicare Share is derived, 20 percentage points must be added to that amount. In addition, the Medicare Share cannot be larger than 100% for CAH’s.
HIMSS has developed a very good calculator to calculate incentive payments for both non-critical access hospitals and critical access hospitals. Providers can click the following link access the calculators:

http://www.himss.org/EconomicStimulus/

You can find the entire ARRA legislation at:

http://www.thomas.gov/home/approp/app09.html#h1

ck
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The Department of Health and Human Services today announced the
selection of David Blumenthal, M.D., M.P.P. as the Obama
Administration’s choice for National Coordinator for Health Information
Technology. As the National Coordinator, Dr. Blumenthal will lead the
implementation of a nationwide interoperable, privacy-protected health
information technology infrastructure as called for in the American
Recovery and Reinvestment Act.

Dr. Blumenthal most recently served as a physician and director of the
Institute for Health Policy at The Massachusetts General
Hospital/Partners HealthCare System in Boston, Mass. He was also Samuel
O. Thier Professor of Medicine and Professor of Health Care Policy at
Harvard Medical School. There, he also served as director of the Harvard
University Interfaculty Program for Health Systems Improvement. Prior to
that, he was senior vice president at Boston’s Brigham and Women’s
Hospital and served as executive director of the Center for Health
Policy and Management and as a lecturer on Public Policy at the John F.
Kennedy School of Government.

ck
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As part of the Stimulus package, non hospital based Physicians can receive up to $44,000 in incentives if they are able to demonstrate “meaningful use” of an electronic health record (EHR) by 2011. Incentives are based on a Physician’s Medicare and Medicaid charges and are capped based on when the Physician is a meaningful user of an EHR.

Overall, if Physicians demonstrate meaningful use by 2011, they can maximize the incentive program and receive the full $44,000. For each year that goes by without meaningful use, incentive quantities are reduced and eventually a Physician’s Medicare payment rates will be reduced if meaningful use is not demonstrated by 2015. For example, if a physician does not demonstrate meaningful use by 2015 their Medicare payments will be reduced by 1%. If not by 2016, their Medicare payments may be reduced by 2% and possibly so on (as years post 2016 have not been outlined).

Below is a summary of how incentives can be maximized if meaningful use is demonstrated in a given year:

Payment Year Incentive
First Payment Year
$18,000 if the first payment year is 2011 or 2012
$15,000 if the first payment year is 2013
$12,000 if the first payment year is 2014
Second Payment Year $12,000
Third Payment Year $8,000
Fourth Payment Year $4,000
Fifth Payment Year $2,000

The funding outlined above has been summarized by HIMSS and does not include additional opportunities which may be made available by the States through grants and loans.

You can find the entire legislation at:

http://www.thomas.gov/home/approp/app09.html#h1

ck
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As we have read, Stimulus incentives will be based on a Physician’s or Hospital’s ability to demonstrate “meaningful use” of an electronic health record. What do we know so far about the government’s definition of “meaningful use”? Overall, meaningful use is based on the following:

- Utilizing certified EHR technology. Who certifies? The easy money is on CCHIT.
- Reporting on clinical quality measures which will be identified at a later date.
- Conforming to interoperability standards, which will be identified at a later date.
- For physicians, utilizing ePrescribing.

For Physicians to receive Medicare Incentives they must use certified EHR technology that includes electronic prescribing; and, to the satisfaction of the Secretary of HHS, demonstrate that the certified EHR technology is connected in a manner that provides for the e-exchange of health information to improve the quality of health care.

For Hospitals to receive Medicare Incentives they must be using certified EHR technology and to the satisfaction of the Secretary of HHS, demonstrate that the certified EHR technology is connected in a manner that provides for the e-exchange of health information to improve the quality of health care, such as care coordination; and the hospital submits information on such clinical quality measures and such other measures as selected by the Secretary.

That’s what we know for now.

You can find the entire legislation at:

http://www.thomas.gov/home/approp/app09.html#h1