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Teaching Hospital Update - November 5-9, 2012


Email Alert

November 9, 2012

By Allison Cohen*

NAHQ Encourages Modifications to Incident-Reporting Systems

American Medical News (11/5) reports that the National Association for Healthcare Quality is urging hospitals to emphasize that they will protect health professionals who report quality and safety problems from retribution or intimidation. Hospital executives and clinical leaders should respond by investigating reported problems further and promptly initiating effective improvement plans. These changes will help foster a "safety culture" in hospitals, which is needed to address problems with hospital adverse event reporting. This issue has gained more attention as quality data and reporting becomes increasingly important since more payors are linking quality measures to reimbursement.

Study Finds a Correlation Between Doctors' Experience Levels and Cost Profiles

MedPage Today (11/5) reports that findings from a recent Health Affairs study suggest that, on average, less-experienced physicians will more likely experience negative adjustments to reimbursement under Medicare's new value-based payment modifier. This study of private insurance claims found that less-experienced doctors generally have higher healthcare cost profiles than their peers with more experience. The researchers cited several possible reasons for this correlation, including the fact that doctors with less experience may have to treat patients who are sicker and have more complicated conditions. The authors suggested there is a need to understand why the cost-profile scores differ. This is particularly true because of the potential impact that higher-cost profiles could have on younger doctors since, under the Affordable Care Act, Medicare's value-based purchasing program will go into effect in 2015.

Next Challenge for the President--the "Fiscal Cliff"

The Washington Post (11/7) reports that now that President Barack Obama has secured a second term, he will come back to face a battle over taxes and spending. Automatic sequestration cuts are slated to take place in January under legislation passed to solve the debt ceiling crisis. Congress will have only forty-nine days to reach a consensus on how to prevent these across-the-board spending cuts and $500 billion in tax increases that will occur when the Bush-era tax breaks expire. The Obama Administration is expected to promote the President's budget plan which calls for a "balanced approach" to debt reduction. Obama's most recent budget request proposed about $360 billion in cuts to spending on federal healthcare programs. It is likely that these modest cuts will be opposed by Republicans who favor larger cuts to spending on federal healthcare programs, such as Medicare, in order to preserve lower tax rates for a broader population. If lawmakers do not reach a deal, they will again have to face the challenge of raising the federal debt ceiling.

New Acute Heart Failure Drug Could Transform Clinical Practice

MedPage Today (11/6) reports that the RELAX-AHF (RELAXin in Acute Heart Failure Trial), suggests that the drug being tested, serelaxin, has a significant mortality benefit. If this proves to be true, it could change clinical practice related to addressing acute heart failure. The trial outcomes are getting attention due to the substantial decrease in cardiovascular death and all cause death through 180 days for the participants taking serelaxin. If it can be confirmed that the mortality benefit is real and is based upon starting the drug early, this would be transformative. Some are skeptical about the interpretation of the data because there was no benefit on heart failure and rehospitalization. Yet, it was noted that an imbalance in treatment groups in terms of previous rehospitalization favors the placebo and makes the data hard to interpret. Larger trials need to be performed to further confirm the mortality benefit before these promising outcomes result in a change in the standard of care.

CMS EHR Incentive Program Data Shows that Exchanging EHRs and Patient Engagement are Challenges for Stage 2

American Medical News (11/5) reports that two of the objectives that most physicians put off in the first stage of the Centers for Medicare & Medicaid Services' (CMS') electronic health records (EHR) incentive program were: exchanging data and getting patients to review their electronic records. This means that in order to get stage two bonuses, many doctors will have to focus on these tasks. Physicians participating in the EHR incentives program could defer five of the ten menu objectives in stage one. Eighty-four percent of the program participants decided that providing a summary of care to patients when they transition to other physicians and hospitals would be one of the objectives they waited until stage two to implement. Overall, the objectives that did not require transferring information to outside parties were the tasks that were deferred the least. Interoperability has already been identified as a challenge for electronic initiatives, and the recently released CMS data seem to support this conclusion. Stage two is likely to be more difficult since many physicians waited on the tasks that require upgrading their systems, increasing patient engagement, and enabling different EHR systems to exchange information.

*We would like to thank Allison M. Cohen, Esquire (Arlington, VA), for providing this week's update.

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