The Centers for Medicare & Medicaid Services (CMS) has announced a three-year demonstration program to examine whether allowing hospitals to provide financial incentives for physicians to support better care can improve patient outcomes without increasing costs. In the demonstration program, the hospital would be paid its usual inpatient rate for the patient’s care, but would pay to the physician a portion of the savings resulting from quality improvement and efficiency initiatives taken by the physician. Such incentive payments would only be allowed for documented, significant improvements in quality of care and savings in the overall costs of care. The program is known as the Physician-Hospital Collaboration Demonstration (PHCD). The program is intended to focus on the entire scope of health care for a surgical episode or other episode of illness involving hospital care. It will encompass physician groups and up to 72 hospitals in a limited number of geographic areas across the country, and will test whether financial incentives from hospital payments to their physicians for quality and efficiency improvement can increase quality while reducing hospitals’ and Medicare costs. For example, incentive payments to surgeons for achieving lower infection rates and fewer readmissions with complications could both improve patient outcomes and lower overall hospital and Medicare costs. The demonstration requires tracking patients for an entire episode of care, which generally extends well beyond a hospitalization, to determine the impact of hospital-physician collaborations on preventing short and longer-term complications, duplication of services, coordination of care across settings, and other quality improvements that hold great promise for eliminating preventable complications and unnecessary costs. This demonstration will examine the effects of the incentive payments system-wide, as hospitals and physicians within a geographic area collaborate on similar quality improvement initiatives and work together to assure that appropriate longer-term outcomes and other quality measures can be tracked appropriately. "We will give preference to proposals submitted by a healthcare group consortium, composed of healthcare groups and affiliated hospitals, because we need a sufficiently large demonstration size to reliably measure impacts on longer-term patient results and overall Medicare costs," CMS Administrator Dr. Mark McClellan said. "This is very different from traditional ‘gainsharing’ with its short-term focus. We are aiming to support the best efforts of physicians and hospitals to improve quality and efficiency in the overall care for their patients." CLICK HERE.

GAO reports on health IT  

The United States Government Accountability Office (GAO) released a report on health information technology, saying that Health and Human Services (HHS) is continuing efforts to define its national strategy. The use of information technology (IT) has enormous potential to improve the quality of healthcare and is critical to improving the performance of the U.S. healthcare system. Given the federal government’s role in providing healthcare in the U.S., it has been urged to take a leadership role in driving change to improve the quality and effectiveness of health care, including the adoption of IT. GAO was asked to identify progress made by HHS toward the development and implementation of a national health IT strategy. In late 2005, to help define the future direction of a national strategy, HHS awarded several health IT contracts and formed the American Health Information Community, a federal advisory committee made up of healthcare stakeholders from both the public and private sectors. Through the work of the these contracts and the community, HHS and its Office of the National Coordinator for Health IT have made progress in five major areas associated with the President’s goal of nationwide implementation of health IT. The five areas of progress and their supporting activities include: 1.) Advancing use of electronic health records: Defined initial certification criteria for certain electronic health records and certified 22 vendors’ products; Presented functional requirements for inclusion of patient information into electronic health records; Initiated work to advance the use of electronic health records to rebuild medical records following disasters. 2.) Establishing interoperability standards for a health information exchange: American National Standards Institute Health IT Standards Panel selected 90 interoperability standards for areas such as electronic health records and public health detection and reporting; Coordinated with the National Institute for Standards and Technology to align federal and private sector standards for interoperable health IT. 3.) Developing prototypes of a nationwide health information network: Awarded contracts for developing prototypes for a national network to four contractors. 4.) Addressing privacy and security issues associated with the nationwide exchange of health information: Contracted with 34 states and territories to perform assessments of the impact of policies and laws on security and privacy practices; Selected standards to help ensure privacy and confidentiality; Formed a new workgroup to specifically address privacy and security policy issues; Made recommendations covering topics that are central to challenges for protecting health information privacy in a national health information exchange environment. 5.) Integrating public health systems into a national network: Made recommendations to help support sharing of clinical care data with local, state, and federal biosurveillance programs, including the development of materials for public education on benefits to public health and national security, and the protection of patient confidentiality; Selected information exchange standards for sharing clinical health information with public health. Although HHS agreed with GAO’s prior recommendations and has made progress in these areas, it still lacks detailed plans, milestones, and performance measures for meeting the President’s goals. For more information, CLICK HERE.

Physician burnout associated with increase in perceived medical errors  

Physicians who believe they have committed a major medical error in the previous three months are more likely to report symptoms of burnout and depression, which may also increase the risk of a future error, according to findings of a Mayo Clinic study published in the current issue of Journal of the American Medical Association (JAMA). Since the Institute of Medicine’s 1999 report that as many as 100,000 patients die each year because of preventable medical errors, several studies of physicians in medical and surgical residency programs have found that a significant proportion of medical trainees make medical errors. "In addition to the obvious negative effects of errors on patients, studies have shown that the physicians involved often experience guilt, shame, distress and depression," said Tait Shanafelt, M.D., the Mayo Clinic physician who led the current study. "Better understanding these effects on physicians, and how they may affect the care future patients receive, is the goal of our research." Previous studies asking residents about errors either had taken a single snapshot in time or asked residents to look back on their entire residency and recollect whether they had made a serious error. The Mayo study is the first to follow a group of residents prospectively, enabling researchers to examine the relationship between physician distress and the future likelihood of an error. "We knew from previous studies some of the effects on physicians of making an error," explains Dr. Shanafelt. "This new study takes it a step further, enabling us to see the time relationship between errors and burnout, and vice versa." On average, 14.7 percent of the participants reported making an error in the previous three months on each quarterly survey. Those who reported an error experienced substantially higher levels of burnout and were more than three times more likely to have a screening test indicate possible depression. The connection between errors and various measures of distress also operated in reverse; those who scored high on burnout measures were twice as likely to report an error in the next three months as those with low burnout. The study also found a trend toward increased future errors for physicians with symptoms of depression. "Not only are physicians who perceive they have made errors more likely to experience burnout and symptoms of depression, but those who are distressed appear more likely to make an error in the next three months," said Dr. Shanafelt. The researchers say additional study is needed to identify effective approaches to assist physicians who have made medical errors, and that residency programs, HMOs, and hospital administrators should also establish efforts to prevent, identify and treat burnout in physicians, for the benefit of their patients.

MedPAC reports on physician-owned heart hospitals

The Medicare Payment Advisory Commission (MedPAC) has released a report to Congress regarding their investigation of physician-owned cardiac hospitals. The report updates MedPAC’s March 2005 specialty hospital report that found that among other things, physician-owned specialty hospitals did not have lower costs per severity-adjusted discharge than competitor community hospitals in their markets, although their patients had shorter lengths of stay. The new findings were similar to the earlier report, however the statistical significance of some findings has increased due to having a larger number of specialty hospitals to examine, MedPAC reported. Specifically, MedPAC found: The number of physician-owned specialty hospitals roughly doubled from 2002 to 2004. Specialty hospitals continue to locate in areas that lack certificate-of-need laws and have above average population growth. The median heart hospital has 56 beds and a strong focus on Medicare inpatient services. The median orthopedic/surgical hospital has 14 beds, focuses on outpatient services, and receives a majority of its revenue from private payers. Both types of physician-owned hospitals tend to have lower shares of Medicaid patients than local competitors and nonlocal peer hospitals that specialize in cardiac or orthopedic care. As previously found, specialty hospitals’ inpatient services are not less costly than community hospitals’ services. But they do have some competitive advantages such as shorter lengths of stay. Physician-owned heart hospitals were associated with a statistically significant increase in the rate of cardiac surgeries in the market area. For a typical market, MedPAC estimates that entrance of a physician-owned cardiac hospital was associated with a 6 percent increase in the number of cardiac surgeries per 1,000 Medicare beneficiaries. The typical heart hospital had 26 percent of the cardiac surgery market in 2004 and obtained most of its market share by diverting patients from competitor community hospitals. MedPAC concluded that as physician-owned entities capture more profitable service lines, the effect on community hospitals may increase. However, MedPAC found that community hospitals’ profit margins appeared stable through 2004, even in markets where physician-owned hospitals captured more than 10 percent of all admissions. CLICK HERE.

Drug-eluting stent safety triggers special FDA advisory panel

The FDA said it will hold a special meeting of a device advisory committee to assess new data about "small but significant" increases in the rates of death and myocardial infarction among patients treated with drug-eluting coronary stents. The agency said that its Circulatory System Devices Advisory Panel will meet before the end of the year to consider the implications of a meta-analysis reported in Spain and earlier data that suggested late-stenosis safety concerns with the devices. The agency added that it has already discussed safety concerns with the makers of the two FDA-approved drug-eluting stents-Cypher, a sirolimus-eluting stent sold by Cordis, a Johnson & Johnson company, and Taxus, the paclitaxel-eluting stent sold by Boston Scientific. The FDA cited two recent studies, BASKET, first reported in March at the American College of Cardiology meeting, and the Camenzind metanalysis reported last month in Barcelona at the European Society of Cardiology meeting. The BASKET study found that at 18 months, the rate of death or myocardial infarction was 8.4% for patients treated with drug-eluting stents and 7.5% for bare-metal stents, but that difference was not statistically significant. By contrast, the Camenzind meta-analysis, which included three-year data, found a 2.4% increase in the incidence of death or MI in patients who received Cypher stents compared with patients treated with bare-metal stents. The FDA also signaled that it is seeking more information about the possible mechanism of the excess mortality and MI in patients with drug-eluting stents. The hypothesis is that the events are caused by late stent thrombosis due to a failure of the stent to re-endothelialize, but that has yet to be proven. The FDA statement said the agency is continuing to evaluate information related to the duration of dual antiplatelet therapy with aspirin and Plavix. The FDA said it "believes that coronary [drug-eluting stents] remain safe and effective when used in patients having clinical and coronary anatomic features similar to those treated in the pivotal trials conducted by the manufacturers for FDA approval." (MedPage Today)