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Leavitt Pitches Financial Transparency

Staff Reporters

According to Diana Manor, Senior Editor for Healthcare Finance News, the Department of Health and Human Services [HHS] Secretary Michael Leavitt was reported to say that he has no intention of slacking off in efforts to drive transparency into the US healthcare system, despite the winding down of the Bush Administration.  

World Health Care Congress

At the Fifth Annual World Health Care Congress, held last week in Washington, DC, Leavitt reported that in his 272 days left as HHS secretary, he has “a continued sense of urgency” and plans on picking up the pace to drive much-needed change. “I am among those who believe our unbridled healthcare costs will bring our economic system to its knees.”

Among initiatives in the works, Leavitt said HHS is consolidating all healthcare quality standards used across its agencies and will publish them in an effort to boost their market-wide use.

Competitive Bidding

HHS is also experimenting with competitive bidding for bundled services, beginning with a Medicaid demo that HHS officials hope to expand in the future.

The Bush value-driven healthcare plan relies on healthcare IT adoption to record quality measures and aggregate and provide cost and quality information to consumers, but adoption by small physician practices remains at, or below, 10 percent. HHS plans in June to push Congress to tie physician Medicare payment incentives to the use of healthcare IT.

Assessment

Apparently, many HIT standards have been developed over the past few years, but are not being developed fast enough. Leavitt pushed for these HIT initiative back in December 2008, without success.

Conclusion

And so, do you think the next HIT push will be successful or not; and please comment why?

Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Financial Planning: http://www.jbpub.com/catalog/0763745790

Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Administrative Terms: www.HealthDictionarySeries.com

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New Four Part Standards

[By Staff Writers]

The Centers for Medicare & Medicaid Services [CMS] finally published regulations which establish Part D electronic prescribing standards for four types of information: 

• formulary and benefits,
• medication history,
• fill status notification, and
• identification of individual health care providers.

All Need Not Comply

Drug prescribers, dispensers and plan sponsors are not required to implement e­-prescribing under Part D.

But, those who do must comply with the new Medicare standards when using e-prescribing to send prescriptions and prescription related information for covered drugs prescribed for Part D eligible individuals.

Assessment

These new standards supplement the 2006 “foundation” standards that first addressed the exchange of Part D information related to eligibility inquiries and responses; new prescriptions; and changes, renewals, and cancellations of existing prescriptions; according to the Health Industry Watch, in Washington, DC.

Conclusion

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Power to the Patients?

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

A common rallying cry of the turbulent sixties was “power to the people”. It embodied the zeitgeist of a generation that never seemed content until the democratizing electronic era emerged. In the healthcare space however, power still seems to rest in control of a select few; medical providers, employers, insurance companies, the government and other third-party intermediaries. Everyone, but the patient, until now!

And so, as a doctor, medical and nurse executive, health economists and scions of that era, the recent founding of Dossia.org, is particularly gratifying. Why? Because Dossia is an independent and nonprofit internet based platform that is personally controlled by patients, and patients alone? It is a voluntary, private, portable, secure, lifelong and decentralized repository of electronic medical information archived from many sources.

Early Adopters

Of course, as with any new technology, we wonder if patients and stakeholders are ready for it? Unfortunately, most are not; but increasingly more are. And, supporters of consumer directed healthcare, concierge medicine, marketplace competition, medical price transparency, retail clinics and the like, often respond in the affirmative. Therefore, allow us to ask if your clinic, facility, hospital or healthcare organization is aware and ready forDossia.org?

Inevitable

Ready or not, the promise of Dossia [or similar] is complete information about your patient’s medical history — information that they alone control — that will become available whenever needed: for routine office visits, away from home, in an emergency, for hospital admission or after a disaster that could destroy paper records. Dossia enables patients to become your active partner in their healthcare management. In short, it will allow them to:

• Share information with  doctors, clinics, outpatient centers, hospitals and healthcare systems
• Avoid delays, mistakes and miscommunication when more than one doctor is involved
• Help reduce medical communication errors and eliminate waste, costs and redundancy
• Help track, manage and treat chronic illnesses and enhance evidence-based best practices
• More effectively utilize physician and patient-provider face-time
• Help family members manage their health care; and more!

The key feature of Dossia is its personal and private nature. Only the patient is allowed to include or exclude information in a health record, and determine what parts will be shared with others. The patient will choose how much data is collected and how the record is shared – with whom – and in what form.

And, while we recommended patients share a complete medical history with their providers, the decision will always rest with them. Others can not access information without permission, including employers and insurance companies. 

Assessment

In brief, the mission of Dossia is nothing less than the complete transformation of health information technology, to reduce costs and improve quality, by developing a lifelong personal health record [LPHR].

Of course, the Dossia Founders Group is highly suited for this Herculean task. Thus far it includes: AT&T, Applied Materials, BP America, Inc., Cardinal Health, Intel Corporation, Pitney Bowes, sanofi-aventis and Wal-Mart. It is growing and has been endorsed by the American Academy of Pediatrics, the American Academy of Family Physicians, the Centers for Disease Control and Prevention [CDC] and the National Association of Manufacturers. Initially, Founders will work with Children’s Hospital in Boston, and other qualified experienced vendors to develop and implement the Dossia Network infrastructure.  

Conclusion

And so, your thoughts on patient controlled eMRS are appreciated. Of course, regular readers of the Executive-Post know that according to the HIPAA statutes, patients have had similar medical records power for more than a decade now.

It’s just that the electronic platform seems to make it so much more appealing, doesn’t it; or is it the anytime-anywhere instantaneous nature of it all? Please opine.

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Overview of System Architectures

By Dr. Richard J. Mata; MS, CIS, CMP™ (Hon)

Hospitals can use a variety of configurations for Health Information System [HIS] implementation depending on business needs and budgetary constraints.

Staffing needed for these systems can range from a few full-time equivalents (FTEs) per 100 beds for very basic off-site processing systems to 15 or more FTEs per 100 beds for sophisticated systems that attempt to combine several architectures into one system (e.g., combination of client-server systems with mainframe processing).

Resource use and customizability tends to vary in tandem; the greater the flexibility of the system to meet unique user needs, the greater the cost outlay for capital and/or additional FTEs.  

Relationship of Resource Use and Customizability Based on System Architecture Selected

The basic system architecture possibilities are as follows:

• Off-site (remote) processing: In this case the hospital contracts with a vendor external to the hospital. The hospital sends data over to the vendor site where the actual processing takes place. When processing is complete, the vendor sends the data back to the hospital, usually in electronic form.
• Turnkey systems: A vendor provides the hospital with systems that are “pre-packaged” so that hospital-based system development is minimal. Limited customization of the system is possible using systems analysts or programmers.
• Mainframe systems: Most applicable to large hospitals, this configuration is highly centralized. A large and powerful computer performs basically all the information processing for the institution and connects to multiple terminals that communicate with the mainframe to display the information at the user sites. Hospital Information Technology (IT) departments usually use programmers to modify the core operating systems or applications programs such as billing and scheduling programs.
• Client-server systems: In this configuration one or more “repository” computers exist, known as “servers,” that store large amounts of data and perform limited processing. Communicating with the server(s) are client workstations that perform much of the data processing and often have graphical user interfaces (GUIs) for ease of use. Both customizability and resource use is high, depending on the desired sophistication. Many clinical information systems that process data directly related to patient care use this configuration.

Assessment

The above architectures are broad categories. Modifications and combinations of the above also exist, such as the use of client-server technology with mainframe systems and the addition of wireless technology and personal digital assistants (PDAs) to supplement the core computing functionality. In considering the optimal architecture for a hospital, management needs to take into account factors such as size of the institution, desired sophistication of the application, IT budget, and anticipated level of user community involvement.

Can you improve on the basic system architecture outlined above; or does your institutional have a different HIS architecture?

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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• Dictionary of Health Economics and Finance
• Dictionary of Health Information Technology and Security
• Dictionary of Health Insurance and Managed Care

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