The Obama administration, acting in concert with the health insurance trade group America's Health Insurance Plans (AHIP), announced today an agreement to develop a standardized set of healthcare quality measures for physicians. In particular, the new quality measurement system will track care given by accountable care organizations, patient-centered medical homes, primary care physicians, cardiologists, gastroenterologists, HIV and hepatitis C care providers, medical oncologists, orthopedists, obstetricians and gynecologists.
As physician's pay from insurance plans is more and more tied to quality outcomes - did the patient get well, or will there be additional claims down the road? - a system for measuring outcomes has become necessary. In recent years, government and private health plans have been working separately, and a confusing array of different measures for different companies has been growing. The CMS/AHIP agreement will seek to create a single standard system of measurement, relieving much of the burden caused by separate systems. In their news release, acting CMS administrator Andy Slavitt stated that "this agreement today will reduce unnecessary burdens for physicians and accelerate the country's movement to better quality." Representatives of the American Medical Association and the Americal Academy of Family Physicians praised the effort.
Showing posts with label primary care. Show all posts
Showing posts with label primary care. Show all posts
February 16, 2016
June 30, 2012
Population Healthcare Is Health Reform
Michael Christopher
Chief Chigger, CarePrecise Technology
We have heard many people say that the Affordable Care Act is not health reform, but an attempt at health insurance reform. But a broad shift in the focus and delivery of healthcare has begun, shaped in part by the ACA, and poised to bring significant change to American healthcare. At the heart of that change is population-based healthcare.
"With the Supreme Court upholding the ACA, we all now understand that population healthcare is what we're all going to be doing going forward," says Dr. Steven Davidson, senior vice president and chief medical informatics officer for New York's Maimonides Medical Center in a June 28 Modern Healthcare article. What is "population healthcare," what does it have to do with the Affordable Care Act, and what does it mean to industry vendors?
The term refers to "the ability to assess the health needs of a specific population; implement and evaluate interventions to improve the health of that population; and provide care for individual patients in the context of the culture, health status, and health needs of the populations" according to the Association of American Medical Colleges. Population healthcare is a broadening of focus to see beyond the individual patient to the broad context of that patient's health issues, and to understand the issues of the patient's population to better serve both the individual patient and broader communities of patients.
This perspective becomes ever more critical when cost efficiencies are taken seriously into account, as they must be in an "affordable care" paradigm. In a Tufts Managed Care Institute's white paper on population health, we find
When viewed through the lens of health reform's quality focus, public health data collection and bringing the technologies that enable collection to every point of care, population healthcare is seen as a key - if not the key - strategy for both implementing the provider side of health reform, and rewiring its financial backbone of health insurance.
* Boland P., editor. Redesigning Heath Care
Delivery. Boland Health Care, Berkeley,
1996. pp. 159-163.
** Zeich R. Patient identification as a key to
population health management. New
Medicine. 1998;2:109-116.
Chief Chigger, CarePrecise Technology
We have heard many people say that the Affordable Care Act is not health reform, but an attempt at health insurance reform. But a broad shift in the focus and delivery of healthcare has begun, shaped in part by the ACA, and poised to bring significant change to American healthcare. At the heart of that change is population-based healthcare.
"With the Supreme Court upholding the ACA, we all now understand that population healthcare is what we're all going to be doing going forward," says Dr. Steven Davidson, senior vice president and chief medical informatics officer for New York's Maimonides Medical Center in a June 28 Modern Healthcare article. What is "population healthcare," what does it have to do with the Affordable Care Act, and what does it mean to industry vendors?
The term refers to "the ability to assess the health needs of a specific population; implement and evaluate interventions to improve the health of that population; and provide care for individual patients in the context of the culture, health status, and health needs of the populations" according to the Association of American Medical Colleges. Population healthcare is a broadening of focus to see beyond the individual patient to the broad context of that patient's health issues, and to understand the issues of the patient's population to better serve both the individual patient and broader communities of patients.
This perspective becomes ever more critical when cost efficiencies are taken seriously into account, as they must be in an "affordable care" paradigm. In a Tufts Managed Care Institute's white paper on population health, we find
"Population-based care involves a new way of seeing the masses of individuals seeking health care. It is a way of looking at patients not just as individuals but as members of groups with shared health care needs. This approach does not detract from individuality but rather adds another dimension, as individuals benefit from the guidelines developed for the populations to which they belong.* Members with a particular disease must be prioritized so that disease management interventions are targeted toward those members most likely to cost-effectively benefit.**"The Affordable Care Act package as it now stands places the emphasis on results, rather than on specific means to obtain results. Despite what has been said by opponents, providers are given wide freedom in achieving improved quality and reach of care, and are provided with new resources, such as advanced electronic health records, paid for in part by the taxpayer. Population healthcare is a strategy for deploying these resources and creative latitudes, in a package of practical tactics and achievable objectives, and at scale.
When viewed through the lens of health reform's quality focus, public health data collection and bringing the technologies that enable collection to every point of care, population healthcare is seen as a key - if not the key - strategy for both implementing the provider side of health reform, and rewiring its financial backbone of health insurance.
* Boland P., editor. Redesigning Heath Care
Delivery. Boland Health Care, Berkeley,
1996. pp. 159-163.
** Zeich R. Patient identification as a key to
population health management. New
Medicine. 1998;2:109-116.
June 29, 2012
Now We Know: Time to implement the Affordable Care Act
As the Tennessee Medical Association puts it, there is now a "certain finality" to the Affordable Care Act following the Supreme Court decision upholding the law. A huge win for the Obama administration, the decision yesterday was like kicking a hornet's nest among conservatives. The Christian Medical Association said the decision "sounds an alarm across the country to people with faith-based and pro-life convictions" and called on Congress to repeal the law.
An article in Modern Physician characterizes the response among physicians as "mixed," but the vast majority of our MD, DO, PA and RN contacts have come down strongly in favor of the law, in one case saying "The government did something right... 50 million healthier Americans is going to look pretty good here in a few years."
Whichever political side one is on, it is now clear that work can move forward on implementing the law. The Tennessee Medical Association's statement concluded "Today's decision allows us to make more definitive plans regarding reforms to our healthcare system in Tennessee." The sentiment seems to be fairly widespread through the provider side of the industry.
Some states - among them our own Oklahoma - elected to refuse federal funding ($54 million in Oklahoma's case) to establish health insurance exchanges. The decision, taken on the part of Governor Mary Fallin, appears to have been politically motivated, but Oklahoma is, in fact, developing an exchange, without the federal dollars. An agency head, speaking with an Oklahoma radio station, said "It would have been good to have the money, so we could have a more user friendly and effective system, but we'll have something, anyway."
The justices struck down provisions in the law that would empower the federal government to force states to comply with the planned Medicaid expansion or lose all of their Medicaid funding. Now states will be eligible for basic Medicare funding even if they choose not to accept the additional dollars to provide expanded care. Numerous states have sworn to refuse expanded Medicaid funding, but it remains to be seen whether any will ultimately deny this added coverage for hundreds of thousands of their citizens. The federal dollars are being offered with no required match for three years. Medicaid is often one of the biggest lines in states' budgets, and that share is growing as healthcare costs continue to rise.
An article in Modern Physician characterizes the response among physicians as "mixed," but the vast majority of our MD, DO, PA and RN contacts have come down strongly in favor of the law, in one case saying "The government did something right... 50 million healthier Americans is going to look pretty good here in a few years."
Whichever political side one is on, it is now clear that work can move forward on implementing the law. The Tennessee Medical Association's statement concluded "Today's decision allows us to make more definitive plans regarding reforms to our healthcare system in Tennessee." The sentiment seems to be fairly widespread through the provider side of the industry.
Some states - among them our own Oklahoma - elected to refuse federal funding ($54 million in Oklahoma's case) to establish health insurance exchanges. The decision, taken on the part of Governor Mary Fallin, appears to have been politically motivated, but Oklahoma is, in fact, developing an exchange, without the federal dollars. An agency head, speaking with an Oklahoma radio station, said "It would have been good to have the money, so we could have a more user friendly and effective system, but we'll have something, anyway."
The justices struck down provisions in the law that would empower the federal government to force states to comply with the planned Medicaid expansion or lose all of their Medicaid funding. Now states will be eligible for basic Medicare funding even if they choose not to accept the additional dollars to provide expanded care. Numerous states have sworn to refuse expanded Medicaid funding, but it remains to be seen whether any will ultimately deny this added coverage for hundreds of thousands of their citizens. The federal dollars are being offered with no required match for three years. Medicaid is often one of the biggest lines in states' budgets, and that share is growing as healthcare costs continue to rise.
September 9, 2011
U.S. Doctors Earn Big, Drive Up Costs
According to a new study published in Health Affairs, America's approximately 1.1 million physicians are paid dramatically higher fees than those in all of the other more than 230 Organisation for Economic Co-Operation and Development countries. Per capita, our physicians are paid $1,599; other countries averaged significantly less than that -- about 81% less -- or about $310. The difference, nearly $1,300, is a major factor in driving up U.S. healthcare costs, and, according to the report, is the the main cause of higher overall spending in America on physicians' services.
The disparity comes into stark focus in the area of specialists' fees. While U.S. primary care docs earned significantly higher than their foreign counterparts -- averaging $186,582 annually -- orthopedic physicians earned $442,450. As an example, the study compared physicians’ fees paid by public and private payers for hip replacements in Australia, Canada, France, Germany, the United Kingdom, and the United States, finding that much higher fees were paid to U.S. orthopedic physicians for hip replacements (70 percent more for public payers, 120 percent more for private payers) than public and private payers paid these specialitsts in other countries. The study concludes that "the higher fees, rather than factors such as higher practice costs, volume of services, or tuition expenses, were the main drivers of higher U.S. spending, particularly in orthopedics."
According to August, 2011 CarePrecise data, of the approximately 1.1 million U.S. physicians, about 35,500 practice as orthopedists and orthopedic surgeons, with another 378,000 specialists practicing in the high fee taxonomies. Only about 160,000 U.S. physicians serve in family practice.
The disparity comes into stark focus in the area of specialists' fees. While U.S. primary care docs earned significantly higher than their foreign counterparts -- averaging $186,582 annually -- orthopedic physicians earned $442,450. As an example, the study compared physicians’ fees paid by public and private payers for hip replacements in Australia, Canada, France, Germany, the United Kingdom, and the United States, finding that much higher fees were paid to U.S. orthopedic physicians for hip replacements (70 percent more for public payers, 120 percent more for private payers) than public and private payers paid these specialitsts in other countries. The study concludes that "the higher fees, rather than factors such as higher practice costs, volume of services, or tuition expenses, were the main drivers of higher U.S. spending, particularly in orthopedics."
According to August, 2011 CarePrecise data, of the approximately 1.1 million U.S. physicians, about 35,500 practice as orthopedists and orthopedic surgeons, with another 378,000 specialists practicing in the high fee taxonomies. Only about 160,000 U.S. physicians serve in family practice.
March 8, 2011
Patients Want Their Providers Online
The second-annual study from Intuit Health, the Health Care Check-Up Survey, found that 73% of Americans surveyed would use secure online tools to access lab results, request appointments, pay medical bills, and communicate with their doctor's office. CarePrecise began building web portals for healthcare providers a few years ago, and has seen a rise in interest from providers, who want to be able to point patients to written information in the controlled environment of their websites. Providers are also looking at adding scheduling applications, and some are participating in PHRs (patient health record portals). Read the Information Week article.
November 2, 2010
Federal Physician Comparison Website Coming
CMS has until January 1 to create the new PhysicianCompare.hhs.gov site, intended to make it possible to lookup info on your doctor and compare her quality to that of others. Like HospitalCompare.hhs.gov launched recently, the notion is that these sites will create the incentive for providers to give better care, ultimately helping to control healthcare costs. As required by the Affordable Care Act, CMS has two years to get the site serving up quality data on docs.
Not only must quality data be available to help patients make smarter healthcare purchasing decisions, but the Act requires that the site help physicians to actively use the information to improve quality.
At a five-hour-long Town Hall last week, CMS gathered doctors, hospitals, employers and anyone else who wanted to participate with the goal of getting input on what the site should contain. The outspoken participants told them, among many other things:
And here's a big one: Should physicians' charges be disclosed? How can you make a value decision without prices? Doctors who charge more might offer additional services; what about house calls, or no-wait appointments, or a Personal Health Record (PHR) portal -- should this information be available?
Naturally, the AMA is pushing back a bit. AMA president James Rohack, M.D. told HealthLeaders Media last week that the AMA's concern is that "individual doctor-level data right now is not ready for prime time, especially in complex situations. The attribution of who's really responsible for that care is not worked out." Dr. Rohack said that doctors aren't particularly afraid of being graded: "The reason we became doctors was because we got good grades."
These and many more questions remain to be resolved even before determining exactly what data will be collected -- a step that is mandated to begin in January of 2012. But pulling away the veil of mystery surrounding the work of the physician is long overdue and worthy of the gargantuan task facing CMS. Unless a wing nut Congress repeals or guts the law within the next two years, we will finally be able to look under the hood before making some of the most important and most costly buying decisions of our lives.
Not only must quality data be available to help patients make smarter healthcare purchasing decisions, but the Act requires that the site help physicians to actively use the information to improve quality.
At a five-hour-long Town Hall last week, CMS gathered doctors, hospitals, employers and anyone else who wanted to participate with the goal of getting input on what the site should contain. The outspoken participants told them, among many other things:
- Physician's sex, race and age
- Languages spoken
- Office hours
- Medical degrees and schools
- Hospitals where they have privileges
- How long in practice
- Health networks they belong to
- Awards received
- Community service work/care for the poor
And here's a big one: Should physicians' charges be disclosed? How can you make a value decision without prices? Doctors who charge more might offer additional services; what about house calls, or no-wait appointments, or a Personal Health Record (PHR) portal -- should this information be available?
Naturally, the AMA is pushing back a bit. AMA president James Rohack, M.D. told HealthLeaders Media last week that the AMA's concern is that "individual doctor-level data right now is not ready for prime time, especially in complex situations. The attribution of who's really responsible for that care is not worked out." Dr. Rohack said that doctors aren't particularly afraid of being graded: "The reason we became doctors was because we got good grades."
These and many more questions remain to be resolved even before determining exactly what data will be collected -- a step that is mandated to begin in January of 2012. But pulling away the veil of mystery surrounding the work of the physician is long overdue and worthy of the gargantuan task facing CMS. Unless a wing nut Congress repeals or guts the law within the next two years, we will finally be able to look under the hood before making some of the most important and most costly buying decisions of our lives.
October 8, 2010
Primary Care Providers' Role in Mental Health Increases
Reaching the mental heathcare provider may mean casting a wider net. The Center for American Progress published a study last month finding that more than 50% of patients treated for a mental illness are being treated for part of their condition by a primary care provider. The study, reported by the Associated Press, shows that more than a third of mentally ill patients in the health system are going only to primary care providers. Read the article...
Subscribe to:
Posts (Atom)