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Consumer Satisfaction with Healthcare Websites

December 22, 2011 in Healthcare IT | No comments

ForeSee released a study showing which kinds of healthcare-oriented websites do the best job satisfying customers. Their results show health insurance websites have dismal customer satisfaction compared to other kinds of healthcare sites (such as pharmaceutical sites, hospital websites, health information sites, etc.). A summary of the overall customer satisfaction rates are below.

  • Health Information Websites: 78
    • Public (federal government and nonprofit): 78
    • Private :79
    • Pharmaceuticals: 76
    • Products: 76
  • Hospital and Health System Websites :78
  • Health Insurance Websites: 51

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Medicare Physician Payment Adjustments

November 21, 2011 in Healthcare IT, Medicare, P4P, Physician Compensation, Quality | No comments

The Medicare billing system is complex.  There an alphabet soup of acronyms, (e.g., RVUs, CPT, HCPCS, GPCI) and each of these affects payments in different ways.  In addition to the standard payment terms, Medicare is also creating additional payment incentives.  These payment incentives fall into three broad categories:

  • Quality reporting
  • e-Prescribing (eRx)
  • Electronic Health Records (EHR)

CMS’s Physician Quality Reporting System (PQRS) allows physicians to report the quality of care their patients receive. Physicians can report PQRS measures through claims, registries, or EHR systems.  To incentivize physician participation in the PQRS, CMS has adopted incentive payments.  In 2012-2014, Physicians who meet the PQRS participation requirements will receive a 0.5 percent payment bonus.  In 2015 through 2017, however, who do not submit a sufficient number of PQRS measures actually will receive a payment reduction.

In addition to the PQRS incentive, beginning 2012, Medicare eligible professionals who are not successful electronic prescribers under the eRx Incentive Program to a payment adjustment. This payment adjustment applies to all of the eligible professional’s Part B-covered professional services under the Medicare Physician Fee Schedule (MPFS). From 2012 through 2014, the payment adjustment will increase with each new reporting period. Accordingly, for 2012, eligible professionals receiving a payment adjustment will be paid 1.0% less than the Medicare Physician Fee Schedule (MPFS) amount for that service. In 2013 and 2014, the payment adjustment increases to 1.5% and 2.0% respectively.

A table summarizing these incentive payments is below.

Year PQRS eRx
Incentive Payment MOC Incentive Sucessful
2011 1.0% 0.5% 1% N/A
2012 0.5% 0.5% 1% -1%
2013 0.5% 0.5% 0.5% -0.5%
2014 0.5% 0.5% N/A -2%
2015 -1.5% N/A N/A N/A
2016 -2.0% N/A N/A N/A
2017 -2.0% N/A N/A N/A

CMS also offers physicians incentive payments to adopt EHR.  Incentive payments can be as high as $18,000 per year or $44,000 over a five year period.

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Is your personal health data secure?

October 13, 2011 in Healthcare IT | No comments

In 2010, providers alone spent more than $88.6 billion on health IT initiatives in response to the US government’s “meaningful use” incentive program to drive widespread adoption of electronic health records (EHRs).  Is this data secure?

For many individuals, the answer is no.  In just the last year and a half, a breach of personal health information occurred, on average, every other day.  The HHS Office for Civil Rights even lists where and when these breaches occurred.

PWC lists four key factors that put your health data at risk.  These include:

  • Electronic Health Records (HER) and Health Information Exchanges (HIE)
  • Business Associates (e.g., vendors)
  • Use of health data as secondary data for clinical studies, outcome-based research, and post-market surveillance of drugs.
  • Social Media.

Quotations

“Our policy restricts employees and physicians from accessing their own medical records, but there have been cases where curiosity gets the best of them,” said Thomas J. Lewis, president and chief executive officer at Thomas Jefferson University Hospitals, Philadelphia.

“We need to meet the physician and patient needs and demands for mobile health and social media, but we are still focusing on how we manage the security implications. There is a direct correlation between the level of mobility and our ability to protect that data,” said Luis Taveras, senior vice president of information technology services at Hartford HealthCare Corp., an 867-bed major teaching facility in Connecticut.

 

Source

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Kaiser Permanente’s EHR System

December 20, 2010 in Healthcare IT | No comments

As of 2009, only 9 percent of America’s hospitals were using even a basic form of electronic medical records (EHR) and as of 2008 only 13 percent of practicing doctors were doing so.  Yet one private health insurer has integrated EHR for hospitals, physicians, outpatient and other services.  I am of course talking about Kaiser Permanente.

Today I will review the book Connected for Health, which details how Kaiser implemented EHR in their system.  The book is not an objective evaluation in that it is written by the people who participated in Kaiser EHR implementation.  The lack of objectivity, however, is more than offset by the “insider” point of view the authors offer.  This is not a book for people interested in a fun read or general health policy.  However, if you are interested in implementing EHR in your organization, this book will likely prove invaluable.

Kaiser Overview

Kaiser Permanente is an enormous organization. It employs 14,000 physicians, 45,000 nurses, and thousands of other clinicians and staff.  It has nine regions: Northern California, Southern California, Colorado (Denver), Colorado (Southern), Georgia, Hawaii, DC/Maryland/Virginia, Ohio, Oregon/Washington.

Kaiser EHR Functionality

Kaiser’s electronic health records system, KP HealthConnect, is based primary on software from Epic Systems of Wisconsin. The KPHealthConect system has the following functionalities:

  • A personal health record,
  • Outpatient practice management
  • Outpatient clinicals (e.g., physician order entry, clinical documentation),
  • Inpatient billing,
  • Inpatient pharmacy,
  • Inpatient administrative systems,
  • Inpatient clinicals,
  • Non-Epic Systems and Pre-existing applications that integrate with KPHealth Connect.

Of particular interest is the personal health record.  Patients can view most parts of their medical record such as lab results, immunizations, past office visits, prescriptions, and more.  Patients can send secure messages to providers and view, schedule or cancel appointments.  Members can also view information on health risk assessments, drug encyclopedias, and use health insurance management tools.

Read the rest of this entry »

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EMR and Second Opinions

September 16, 2010 in Healthcare IT | No comments

Electronic medical records have been touted as producing large gains in efficiency.  In fact, Kaiser Permanente has invested $3 billion in EMR.  One drawback of EMR, however, is that the value of second opinions may fall.  Instead of coming to a new physician with a clean slate or at the least seeking a fresh interpretation of a test, ‘second-opinion physicians’ in the same physician network will have access to the original physician’s diagnosis.  This may bias the doctor towards agreeing with the original interpretation of the patient’s condition.

To what degree do ‘second-opinion physicians’ currently have access to the diagnosis of the referring physician?  If they already have access to the original doctors notes or frequently call this physician to consult with them, the advent of EMR may not change the bias of the second-opinion physicians.  In fact, access to better information may improve the quality of second opinions.  On the other hand, if the increased amount of information available to the second physician changes their thought process, then they may be more likely to agree with the original physician.

Is this one of the cases where more information is actually a bad thing?

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Who would trust Wikipedia for medical information?

August 3, 2009 in Healthcare IT | 3 comments

The New Scientist reports that “Sixty-one per cent of American adults seek out health advice online.”  Looking for medical advice online is okay as long as you don’t rely on a unreliable sites.  For instance, who would trust a user generated site like Wikipedia?  The answer to this question, is doctors.

According to a report in April by US healthcare consultancy Manhattan Research, fifty percent of U.S. doctors turn to Wikipedia for medical information.

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5 Health Care Myths

January 12, 2009 in Healthcare IT, Obesity, Physician Compensation | No comments

Bob Laszewski has a great posts on 5 false  “solutions” to reduce health care costs.  These are:

  • EMR: Making electronic medical records universal will greatly improve health care quality, but the impact on cost will be minor.  Better quality care can reduce iatrogenic injuries and reduce cost, but the cost reduction–if any–will likely be small in magnitude.
  • Prevention.  From the CBO: any gains from reducing obesity would be concentrated in the short and intermediate period “because some of the savings will be offset by increased longevity and the cost of disease that are most prevalent during old age.”
  • Outcomes Research:  Laszewski claims that “inefficient use of technology is the key driver in health care spending accounting for an estimated 38% to 65% of spending growth.  The problem…with the suggestions that more outcomes research will save us money is that more than twenty years of outstanding outcomes research, Dartmouth for example, has not kept our health care costs under control.”  Outcomes research is important; it is imperative for physicians to prescribe cost effective treatment.  However, I agree with Laszewski that if financial incentives are not aligned to promote physician use of evidence-based medicine, then health outcomes research will have little impact.
  • P4P: Laszewski doesn’t like pay-for-performance because in order for it to save money, it must lead to a reduction in physician payment on average.  Another reason why P4P won’t work is that paying individuals to check a diabetic’s A1C level may increase the frequency the physician monitors this metric, but it also may compel the physician to substitute their time away from other necessary medical services.
  • Universal Coverage.  Universal coverage should reduce the percentage of individual who go to the emergency room for primary care needs;.  Nevertheless, providing universal health insurance coverage will certainly increase healthcare spending due to the moral hazard problem as well as supplier-induced demand.

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Word of the day: cyberchondriacs

December 1, 2008 in Healthcare IT, Miscellaneous | No comments

From the BBC:

“…researchers found Web searches for common symptoms such as headache and chest pain were just as likely or more likely to lead people to pages describing serious conditions as benign ones, even though the serious illnesses are much more rare.

Searching for ‘chest pain’ or ‘muscle twitches’ returned terrifying results with the same frequency as less serious ailments, even though the chances of having a heart attack or a fatal neurodegenerative condition is far lower than having simple indigestion or muscle strain, for example.“

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Flu Surveillance

November 13, 2008 in HC Statistics, Healthcare IT, Information, Vaccinations | No comments

Google searches as a public health resource:

Google.org has released Flu Trends, an online reporting tool for flu-related search activity. It’s long been theorized that Google’s search data would be useful to predict epidemics. This is the first time they’ve released a tool like this to the public. As they say on the main page:

We have found a close relationship between how many people search for flu-related topics and how many people actually have flu symptoms. Of course, not every person who searches for “flu” is actually sick, but a pattern emerges when all the flu-related search queries from each state and region are added together. We compared our query counts with data from a surveillance system managed by the U.S. Centers for Disease Control and Prevention (CDC) and discovered that some search queries tend to be popular exactly when flu season is happening. By counting how often we see these search queries, we can estimate how much flu is circulating in various regions of the United States.

This tool comes to us via Google.org’s Predict & Prevent initiative. You can download the data for your own analysis.

[Update, 14 May 2009: Google is refining their Flu Trends data by asking people questions about their flu searches.]

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Physicians who use DSS lose prestige in their patients eyes

November 12, 2008 in Healthcare IT | No comments

Is it better for a physician to have more information or less?  Should physicians utilize diagnostic support systems (DSS) which base their recommendations on hundreds or thousands of data points or should they trust their gut instinct?  Most rational people would say that physicians should use DSS–not blindly–but as a tool to guide their decisionmaking.  Would a rational physician ever refuse DSS?

It turns out that physicians may be wise to refuse DSS assistance to build their reputation.  A study by Arkes, Shaffer and Medow (2007) found that patients believed that physicians who did not use DSS were more capable doctors than those who did.  ”Patients may surmise that a physician who uses a DSS is not as capable as a physician who makes the diagnosis with no assistance from a DSS”

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