Weekly Healthcare Reform Update from Healthcare Information and Management Systems Society

Healthcare Reform Update – This Week’s View From Washington, D.C.

from  www.himss.org/ASP/ContentRedirector.asp?ContentID=69003&type=HIMSSNewsItem

Originally, it was estimated that $19.2 billion in health IT was included in ARRA ($2 billion for the Office of the National Coordinator and $17.2 billion for incentives through Medicare and Medicaid).

The Congressional Budget Office (CBO) now indicates that approximately $23 billion is included for health IT through the legislation ($2 billion for the Office of the National Coordinator and $20.819 billion for incentives through Medicare and Medicaid). A new CBO report estimates that enacting the ARRA legislation would increase federal budget deficits by $787 billion over the 2009 – 2019 period. ARRA authorizes and appropriates $2 billion for the Office of the National Coordinator for Health IT. Of the $2 billion, the CBO projects that $300 million will be spent in fiscal year 2009, $1.28 billion in fiscal year 2010, $360 million in fiscal year 2011, and $40 million in fiscal year 2012. (See page 5 of the PDF.) In addition, the CBO now estimates higher projections for eligible providers that demonstrate a meaningful use of certified EHR technology at a new net cost of $20.819 billion. $20.819 is derived from the sum of the total costs of the incentives in fiscal year 2009 – fiscal year 2015 ($36.368 billion) and the total savings that are achieved in fiscal year 2016 – fiscal year 2019 through the incentives ($15.549 billion).

NYTimes: Bad medical imaging is a growing problem

www.nytimes.com/2009/03/02/health/02scans.html?ref=health

Many factors contribute. Insurers pay the same for a scan done on a 10-year-old machine as one on the latest model, though the differences in the images can be significant.

Insurers do not distinguish between scans that are done poorly or done well or read by less- or more-qualified doctors. Aside from mammography, whose standards were established by a law that went into effect more than a decade ago, the field is largely unregulated. And increasingly, doctors refer patients to scanning centers they own and profit from.

Ten years ago, the age of a scanner might not have mattered so much. Now, said Dr. Gary Glazer, the chairman of radiology at Stanford, technology has advanced so much that the older scanner “is not the same machine.”

“I can tell you from my experience that between those extremes the gap is huge,” Dr. Glazer said.

Yet, he added, many scanning machines used today are a decade old.

Imaging centers can, if they choose, become accredited by the American College of Radiology. That requires, among other things, scanning a phantom, a device that simulates a body part. Technologists must also be certified, and there are standards for supervising physicians. And the scanners must be regularly assessed to ensure they are properly functioning.

But many centers are not accredited, although the percentage is not known because there is no national registry of imaging centers.

Accrediting will be partly addressed by a little noticed aspect of a wide-ranging Medicare law passed last year. After it goes into effect in 2012, Medicare will pay only for scans done at accredited centers. But imaging experts say the law fixes only part of the problem. High-tech scanning is complicated, and there is no consensus on objective measures to ensure quality. Even with the new law, there is still little assurance that scans will be appropriately ordered and interpreted or that a scanner will be up to date.

Radiologists are struck by the wide variation in the quality of scans, and they say there is little patients can do other than to ask why the scan is necessary and, if it is, to ask about accreditation, the credentials of the person reading the scan and the age of the scanner.

“The studies I see coming from the outside vary from marginal quality to very good quality,” said Dr. Chris Beaulieu, a Stanford radiology professor. “Some of it is related to equipment, and some is related to people with very good equipment who don’t know how to use it right. And on the interpretation side, there is also a very wide range of quality or accuracy, in my opinion.”

Interpretation can be crucial, Dr. Beaulieu added. “A good radiologist can sometimes accurately read scans off of a lower-quality scanner,” he said. “I see that all the time. A good radiologist and a lower-quality scan could be better than a bad radiologist and a good scan.”

But logical as it might seem to pay more for a better scan, there are problems. Health insurers have no way of knowing whether scans are good, said Susan Pisano, a spokeswoman for America’s Health Insurance Plans, a trade group. Doctors, not insurers, receive the images and reports, and all insurers can do is notice if there are frequent requests to redo scans from a particular center.

Physicians to receive incentives for EHR, penalties

from www.healthcarefinancenews.com/news/physicians-receive-incentives-ehr-use

The American Recovery and Reinvestment Act of 2009 provides financial incentives to physicians who adopt and use Electronic Health Record (EHR) technology. However, physicians who haven’t adopted certified EHR systems by 2014 will have their Medicare reimbursements reduced by up to 3 percent beginning in 2015.

The act provides $20 billion in health information technology funding, divided between $2 billion in discretionary funds and $18 billion in investments and incentives through Medicare and Medicaid, to ensure widespread adoption and use of interoperable healthcare IT systems.

“In one stroke, Congress has all but removed the biggest stumbling block to EHR adoption – cost,” said James R. Morrow, MD, a physician at North Fulton Family Medicine in Alpharetta, Ga., who was named “Physician IT Leader of the Year” by the Health Information and Management Systems Society (HIMSS). “It’s time for doctors to stop complaining about the cost of an EHR and take the ball and run with it toward the goal of better medicine with better records and information sharing across the healthcare team.”

With the stimulus, the Centers for Medicare and Medicaid Services will pay physicians $44,000 to $64,000 over five years, beginning in 2011, for deploying and using a certified EHR. The stimulus package is expected to ignite significant job growth in the information technology sector and, according to a Congressional Budget Office review, drive up to 90 percent of U.S. physicians to EHRs in the next decade.

A recent Allscripts survey of 1,888 healthcare professionals revealed that 98 percent of physician practices would take advantage of the incentives or would be closely evaluating the opportunity.

hat-tip-www.fiercehealthcare.com