CMS Urged to Improve Efficiency
Medicare patients who see an “outlier generalist,” a physician who treats a disproportionate share of overly expensive patients, were more likely to have been hospitalized, more likely to have been hospitalized multiple times, and more likely to have used home health services than were other Medicare patients, the Government Accountability Office found in a report. Based on those findings, the GAO recommended that the Centers for Medicare and Medicaid Services develop a system that identifies individual physicians with inefficient practice patterns and uses the results to improve the efficiency of care in the Medicare system. Although CMS has discussed only using profiling results for educating physicians, the optimal system, according to the GAO, would include financial or other incentives to encourage efficiency.
Overcrowded Hospitals Riskier?
Hospitals that operate at or over their capacity might be at increased risk of adverse events that injure patients, according to a study led by investigators from Massachusetts General Hospital (MGH) and Brigham and Woman's Hospital, both in Boston. The report in the May issue of the journal Medical Care suggests that efforts to reduce costs and improve patient safety might work against each other. The researchers reviewed data from four hospitals in two states over 12 months and identified 1,530 preventable injuries not resulting from patients' underlying medical conditions. At three of the four hospitals, the rate of adverse events did not appear to increase at times of peak workload. But at the fourth—a major urban teaching hospital with consistently high occupancy rates that exceeded 100% for more than 3 months—workload increases and higher patient-to-nurse ratios were associated with more adverse events. “Our study suggests that pushing efficiency efforts to their limits could be a double-edged sword that may jeopardize patient safety,” said study lead author Dr. Joel Weissman of the MGH Institute of Public Policy in a statement.
N.H. Rx Law Struck Down
A federal judge in New Hampshire has struck down a state law banning commercial use of provider-identifiable prescription information, finding that it “unconstitutionally restricted speech.” Judge Paul Barbadoro ruled in favor of health information companies IMS Health and Verispan LLC, which jointly filed a lawsuit seeking to prevent the state from enforcing the statute, which went into effect last June. The law was the first in the nation to ban the commercial use of information on what medications individual physicians prescribe. New Hampshire argued that the law aimed to protect physicians' privacy, end inappropriate pharmaceutical marketing, and cut costs. The plaintiffs said that using physicians' prescription data is crucial to improving quality. “The free flow of health care information is central to evidence-based medicine and improved patient outcomes,” said IMS vice president Randolph Frankel in a statement.
IT Bill Would Aid Small Practices
Seeking to help physicians who might like to adopt health information technology (HIT) systems but cannot afford the investment, Reps. Charlie Gonzalez (D-Tex.) and Phil Gingrey (R-Ga.) have introduced legislation that would provide grants, loans, and tax incentives to small practices that implement computer systems. The bill is designed to facilitate the development and adoption of national standards, and to provide initial financial support and ongoing reimbursement incentives for physicians in smaller practices to adopt HIT to support quality improvement activities. The legislation is based in large part on ideas originally developed by the American College of Physicians (ACP), the physicians' group said. Studies have estimated that an electronic health records system averages $44,000 per physician initially, and $8,500 per physician annually to maintain. “The proposed financial incentives would make it possible for physicians in small practices to invest in the technology and encourage its continued use to improve patient care,” said Dr. Lynne Kirk, ACP president.
Debridement Restrictions Lifted
The American Academy of Family Physicians (AAFP) said it has succeeded in its drive to remove restrictive language from a Medicare carrier's draft local coverage determination on wound care. The restriction would have affected physicians in Delaware, Maryland, Texas, and Virginia. Last December, AAFP questioned TrailBlazer Health Enterprises' proposed debridement limits of three times for one wound. AAFP said that although repetitive debridement of one wound is uncommon, sometimes serial debridement is the only option. TrailBlazer removed the restrictions from its final policy, released in April.
Adults Disregard MDs' Orders
In a recent survey, 44% of U.S. adults said that they or an immediate family member have ignored a doctor's course of treatment or sought a second opinion because they felt the doctor's orders were unnecessary or overly aggressive. Most adults reported that they didn't view disregarding a doctor's recommendations as problematic or consequential. Only 1 in 10 adults who chose to disregard a physician's instructions at some time believes that he or she or a family member experienced problems because of this decision, with the most common consequence being lost time from work or school. The survey, conducted by Harris Interactive for the Wall Street Journal Online's health industry edition, also found that a large majority of adults think patients who have medical conditions often experience problems because of overtreatment as well as undertreatment by medical providers.