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Physician use of EHRs growing, but health data exchange, patient engagement remain problematic
Adoption of electronic health records reached 78% of office-based physicians in 2013, but use of two key functions that are expected to help improve health outcomes and lower the cost of health care – health information exchange and patient engagement functions – lag behind from an uptake perspective.
Primary care physicians are adopting faster than other specialty providers, with 53% of primary care physicians adopting at least a basic EHR by the end of 2013, compared with 43% of physicians in other specialties, according to a recent study published online Aug. 8 on the Health Affairs website (doi:10.1377/hlthaff.2014.0445).
The size of a practice is a determining factor, with two-thirds of physicians in large practices using a basic EHR, compared with 37% of solo practitioners, Michael Furukawa of the Department of Health and Human Services and his associates reported.
But while adoption is growing, information is not being shared at an equally high rate. Thirty-nine percent of office-based physicians reported having any electronic health information exchange with other ambulatory providers or hospitals in 2013, with physicians in larger practices having 36%-99% higher odds of any electronic health information exchange (HIE), compared with solo practitioners. Physicians in practices owned by academic medical centers or health maintenance organizations had 146%-185% higher odds of any HIE relative to physician-owned practices, and multispecialty practices had 110% higher odds of any HIE, compared with single-specialty practices.
"There are many reasons why physicians may not be sharing clinical data with other providers, especially with those outside their organization," the authors wrote. "There are privacy concerns and technical barriers because of incompatible systems. ... Additionally, HIE often requires the redesign of work flow, which is inherently disruptive and may be difficult to justify in the absence of a clear business case for HIE."
On the patient engagement side, about two-thirds of office-based physicians had the capability to electronically provide patients with visit summaries or patient-specific educational resources, and about half were able to exchange secure messages with patients. About 40% had the capability to allow patients to view, download, or transmit their information electronically, but only half of these physicians did so. Similarly, only a third of physicians with secure message capabilities used it on a regular basis.
The authors cited several factors, including the low uptake of patient portals and lack of awareness of capabilities, as well as poor usability. Also, "physicians may worry that patient portals might generate a large volume of clinical issues that require responses (time for which the physician cannot bill). And finally, some providers are concerned that accessing these data might make patients confused or worried," the authors wrote.
Stage 2 meaningful use criteria require the adoption of computerized capabilities for patient engagement.
The analysis was based on the 2009 National Ambulatory Medical Care Survey and the 2009-2013 Electronic Health Record Surveys, conducted by the National Center for Health Statistics. No conflicts of interest were disclosed by the authors.
Adoption of electronic health records reached 78% of office-based physicians in 2013, but use of two key functions that are expected to help improve health outcomes and lower the cost of health care – health information exchange and patient engagement functions – lag behind from an uptake perspective.
Primary care physicians are adopting faster than other specialty providers, with 53% of primary care physicians adopting at least a basic EHR by the end of 2013, compared with 43% of physicians in other specialties, according to a recent study published online Aug. 8 on the Health Affairs website (doi:10.1377/hlthaff.2014.0445).
The size of a practice is a determining factor, with two-thirds of physicians in large practices using a basic EHR, compared with 37% of solo practitioners, Michael Furukawa of the Department of Health and Human Services and his associates reported.
But while adoption is growing, information is not being shared at an equally high rate. Thirty-nine percent of office-based physicians reported having any electronic health information exchange with other ambulatory providers or hospitals in 2013, with physicians in larger practices having 36%-99% higher odds of any electronic health information exchange (HIE), compared with solo practitioners. Physicians in practices owned by academic medical centers or health maintenance organizations had 146%-185% higher odds of any HIE relative to physician-owned practices, and multispecialty practices had 110% higher odds of any HIE, compared with single-specialty practices.
"There are many reasons why physicians may not be sharing clinical data with other providers, especially with those outside their organization," the authors wrote. "There are privacy concerns and technical barriers because of incompatible systems. ... Additionally, HIE often requires the redesign of work flow, which is inherently disruptive and may be difficult to justify in the absence of a clear business case for HIE."
On the patient engagement side, about two-thirds of office-based physicians had the capability to electronically provide patients with visit summaries or patient-specific educational resources, and about half were able to exchange secure messages with patients. About 40% had the capability to allow patients to view, download, or transmit their information electronically, but only half of these physicians did so. Similarly, only a third of physicians with secure message capabilities used it on a regular basis.
The authors cited several factors, including the low uptake of patient portals and lack of awareness of capabilities, as well as poor usability. Also, "physicians may worry that patient portals might generate a large volume of clinical issues that require responses (time for which the physician cannot bill). And finally, some providers are concerned that accessing these data might make patients confused or worried," the authors wrote.
Stage 2 meaningful use criteria require the adoption of computerized capabilities for patient engagement.
The analysis was based on the 2009 National Ambulatory Medical Care Survey and the 2009-2013 Electronic Health Record Surveys, conducted by the National Center for Health Statistics. No conflicts of interest were disclosed by the authors.
Adoption of electronic health records reached 78% of office-based physicians in 2013, but use of two key functions that are expected to help improve health outcomes and lower the cost of health care – health information exchange and patient engagement functions – lag behind from an uptake perspective.
Primary care physicians are adopting faster than other specialty providers, with 53% of primary care physicians adopting at least a basic EHR by the end of 2013, compared with 43% of physicians in other specialties, according to a recent study published online Aug. 8 on the Health Affairs website (doi:10.1377/hlthaff.2014.0445).
The size of a practice is a determining factor, with two-thirds of physicians in large practices using a basic EHR, compared with 37% of solo practitioners, Michael Furukawa of the Department of Health and Human Services and his associates reported.
But while adoption is growing, information is not being shared at an equally high rate. Thirty-nine percent of office-based physicians reported having any electronic health information exchange with other ambulatory providers or hospitals in 2013, with physicians in larger practices having 36%-99% higher odds of any electronic health information exchange (HIE), compared with solo practitioners. Physicians in practices owned by academic medical centers or health maintenance organizations had 146%-185% higher odds of any HIE relative to physician-owned practices, and multispecialty practices had 110% higher odds of any HIE, compared with single-specialty practices.
"There are many reasons why physicians may not be sharing clinical data with other providers, especially with those outside their organization," the authors wrote. "There are privacy concerns and technical barriers because of incompatible systems. ... Additionally, HIE often requires the redesign of work flow, which is inherently disruptive and may be difficult to justify in the absence of a clear business case for HIE."
On the patient engagement side, about two-thirds of office-based physicians had the capability to electronically provide patients with visit summaries or patient-specific educational resources, and about half were able to exchange secure messages with patients. About 40% had the capability to allow patients to view, download, or transmit their information electronically, but only half of these physicians did so. Similarly, only a third of physicians with secure message capabilities used it on a regular basis.
The authors cited several factors, including the low uptake of patient portals and lack of awareness of capabilities, as well as poor usability. Also, "physicians may worry that patient portals might generate a large volume of clinical issues that require responses (time for which the physician cannot bill). And finally, some providers are concerned that accessing these data might make patients confused or worried," the authors wrote.
Stage 2 meaningful use criteria require the adoption of computerized capabilities for patient engagement.
The analysis was based on the 2009 National Ambulatory Medical Care Survey and the 2009-2013 Electronic Health Record Surveys, conducted by the National Center for Health Statistics. No conflicts of interest were disclosed by the authors.
FROM HEALTH AFFAIRS
Comparative effectiveness research results alone don’t change clinical practices
Comparative effectiveness research results are not making their way into medical practices, even when guidelines are updated to include the insights.
Practice patterns shifted little in the 12 months following the publishing of study results and in the 12 months following incorporation into clinical practice guidelines, based on an analysis of four comparative effectiveness research case studies, funded by the National Pharmaceutical Council (NPC).
The case studies, published in the American Journal of Managed Care (Am. J. Manag. Care 2014;20:e208-e220), looked at practice changes after the 2004 PROVE-IT study on statin therapies, the 2004 Mammography With MRI study on breast cancer surveillance methods in women with BRCA1 or BRCA2 mutations, the 2006 SPORT study comparing standard open diskectomy versus nonoperative treatments for patients with intervertebal disk herniation, and the 2007 COURAGE trial comparing optimal medical therapy and percutaneous coronary intervention versus optimal medical therapy alone.
"In some cases, we might have expected an uptick or change in what was happening," said report author and NPC Director of Comparative Effectiveness Research Jennifer Graff, Pharm.D., speaking in an interview. "For instance, in the PROVE-IT study, we would have expected, based upon the results, that you would have seen many more providers and patients using intensive statin therapy, ... [but it took] 3 years after the study’s publication before you started to see the change in which types of statins were being used."
The report authors developed suggestions on how to get clinicians to more quickly incorporate the results of comparative effectiveness research.
Involve clinicians, payers, policy makers, and patients in the research design "to make sure we are asking the right questions," said Dr. Graff. This approach is now being taken at the Food and Drug Administration to spur drug development and at the Patient-Centered Outcomes Research Institute, a comparative effectiveness research body created as part of the Affordable Care Act.
Perform more confirmatory studies. "One single study probably won’t change the mind of a provider who is seeing many patients and has in their mind what treatments work," Dr. Graff said. "Similarly, we need to fund studies when clinical opinion is shifting."
Align financial incentives with study results. This can be accomplished through value-based insurance design or incentivized provider pay based on outcomes. Bundled payments as well as incentivizing the use of clinical pathways, such as WellPoint’s recently announced program to provide bonus payments in oncology, are examples of such options, Dr. Graff said.
The study was funded by the NPC. Authors Teresa Gibson, Emily Ehrlich, and Amanda Farr reported employment with Truven Health Analytics, which received consulting fees from NPC. Authors Dr. Robert Dubois and Dr. Jennifer Graff are employees of the NPC. The remaining authors reported no financial conflicts of interest.
Comparative effectiveness research results are not making their way into medical practices, even when guidelines are updated to include the insights.
Practice patterns shifted little in the 12 months following the publishing of study results and in the 12 months following incorporation into clinical practice guidelines, based on an analysis of four comparative effectiveness research case studies, funded by the National Pharmaceutical Council (NPC).
The case studies, published in the American Journal of Managed Care (Am. J. Manag. Care 2014;20:e208-e220), looked at practice changes after the 2004 PROVE-IT study on statin therapies, the 2004 Mammography With MRI study on breast cancer surveillance methods in women with BRCA1 or BRCA2 mutations, the 2006 SPORT study comparing standard open diskectomy versus nonoperative treatments for patients with intervertebal disk herniation, and the 2007 COURAGE trial comparing optimal medical therapy and percutaneous coronary intervention versus optimal medical therapy alone.
"In some cases, we might have expected an uptick or change in what was happening," said report author and NPC Director of Comparative Effectiveness Research Jennifer Graff, Pharm.D., speaking in an interview. "For instance, in the PROVE-IT study, we would have expected, based upon the results, that you would have seen many more providers and patients using intensive statin therapy, ... [but it took] 3 years after the study’s publication before you started to see the change in which types of statins were being used."
The report authors developed suggestions on how to get clinicians to more quickly incorporate the results of comparative effectiveness research.
Involve clinicians, payers, policy makers, and patients in the research design "to make sure we are asking the right questions," said Dr. Graff. This approach is now being taken at the Food and Drug Administration to spur drug development and at the Patient-Centered Outcomes Research Institute, a comparative effectiveness research body created as part of the Affordable Care Act.
Perform more confirmatory studies. "One single study probably won’t change the mind of a provider who is seeing many patients and has in their mind what treatments work," Dr. Graff said. "Similarly, we need to fund studies when clinical opinion is shifting."
Align financial incentives with study results. This can be accomplished through value-based insurance design or incentivized provider pay based on outcomes. Bundled payments as well as incentivizing the use of clinical pathways, such as WellPoint’s recently announced program to provide bonus payments in oncology, are examples of such options, Dr. Graff said.
The study was funded by the NPC. Authors Teresa Gibson, Emily Ehrlich, and Amanda Farr reported employment with Truven Health Analytics, which received consulting fees from NPC. Authors Dr. Robert Dubois and Dr. Jennifer Graff are employees of the NPC. The remaining authors reported no financial conflicts of interest.
Comparative effectiveness research results are not making their way into medical practices, even when guidelines are updated to include the insights.
Practice patterns shifted little in the 12 months following the publishing of study results and in the 12 months following incorporation into clinical practice guidelines, based on an analysis of four comparative effectiveness research case studies, funded by the National Pharmaceutical Council (NPC).
The case studies, published in the American Journal of Managed Care (Am. J. Manag. Care 2014;20:e208-e220), looked at practice changes after the 2004 PROVE-IT study on statin therapies, the 2004 Mammography With MRI study on breast cancer surveillance methods in women with BRCA1 or BRCA2 mutations, the 2006 SPORT study comparing standard open diskectomy versus nonoperative treatments for patients with intervertebal disk herniation, and the 2007 COURAGE trial comparing optimal medical therapy and percutaneous coronary intervention versus optimal medical therapy alone.
"In some cases, we might have expected an uptick or change in what was happening," said report author and NPC Director of Comparative Effectiveness Research Jennifer Graff, Pharm.D., speaking in an interview. "For instance, in the PROVE-IT study, we would have expected, based upon the results, that you would have seen many more providers and patients using intensive statin therapy, ... [but it took] 3 years after the study’s publication before you started to see the change in which types of statins were being used."
The report authors developed suggestions on how to get clinicians to more quickly incorporate the results of comparative effectiveness research.
Involve clinicians, payers, policy makers, and patients in the research design "to make sure we are asking the right questions," said Dr. Graff. This approach is now being taken at the Food and Drug Administration to spur drug development and at the Patient-Centered Outcomes Research Institute, a comparative effectiveness research body created as part of the Affordable Care Act.
Perform more confirmatory studies. "One single study probably won’t change the mind of a provider who is seeing many patients and has in their mind what treatments work," Dr. Graff said. "Similarly, we need to fund studies when clinical opinion is shifting."
Align financial incentives with study results. This can be accomplished through value-based insurance design or incentivized provider pay based on outcomes. Bundled payments as well as incentivizing the use of clinical pathways, such as WellPoint’s recently announced program to provide bonus payments in oncology, are examples of such options, Dr. Graff said.
The study was funded by the NPC. Authors Teresa Gibson, Emily Ehrlich, and Amanda Farr reported employment with Truven Health Analytics, which received consulting fees from NPC. Authors Dr. Robert Dubois and Dr. Jennifer Graff are employees of the NPC. The remaining authors reported no financial conflicts of interest.
FROM THE AMERICAN JOURNAL OF MANAGED CARE
Big data destined for the bedside within 5 years
Big data shows the promise to transform how health care is delivered, utilizing real-time information to assist doctors and patients in making more informed decisions at the point of care, a transformation that could arrive in the next 5 years.
That time prediction was offered by Dr. Harlan Krumholz, a professor at Yale University, New Haven, Conn.
"We are on the cusp of dramatic change in the way in which we are thinking about leveraging data that’s being generated in everyday clinical practice and in everyday daily life," Dr. Krumholz said in an interview. "I think there’s this recognition that the current clinical scientific enterprise is inadequate to keep up with information needs."
But getting to that point is going to require a shift in the research culture and how that information is brought to doctors as they are treating patients.
"One of the biggest problems with our current research approach is it’s very reductionist," Dr. Krumholz observed. "We try to pursue the scientific method with testing hypotheses. We try to pull out all the complexity around the question we are trying to answer and simplify everything so we can cleanly look at a particular effect of one thing on patients. ... By the time [research results] come out, they are very anachronistic because medicine’s progressed and the patients that they’re studying aren’t exactly the people who are being seen in practice, so the studies aren’t necessarily having the effect they could have."
Dr. Krumholz also is a member of the Patient-Centered Outcomes Research Institute board of governors. The organization is building a research network that will facilitate the gathering and usage of big data to help inform patient decisions.
But it’s more than just health-specific data that need to be incorporated into big data analysis.
"It’s not just the pill, but it’s the pill for a specific patient who’s got a specific profile, who is in a certain social situation, who is taking other medication, maybe has certain access to physicians, and a lot of complicated issues coming together," Dr. Krumholz continued. "We need to be able to learn from everyday experience and we need to embrace the complexity, not reject it, so that our studies are taking into account the complex aspects of medicine, not trying to get rid of them so we have clean studies that may not well-relate back to the real-world situations doctors and patients face everyday."
The next step will be to find something that can truly demonstrate the power of big data.
"I think that once we break the dam open and allow the water to flow and turn the turbines of knowledge generation, people are going to demand better and better information in order to be in a stronger position to make decisions," he predicted. "I think the decision support enterprise, that community of people who are working on decision support tools, is going to start competing to develop and create these things that are going to be at the bedside, that is going to make a whole lot of difference from where we are now."
A number of pilots and areas where big data could have an immediate impact were highlighted in a recent article in the July issue of Health Affairs (doi: 10.1377/hlthaff.2014.0041). For example, Kaiser Permanente Northern California; Harvard University, Boston; and the University of California, San Francisco and Santa Cruz, are pilot testing a two-step protocol aimed at reducing antibiotic prescriptions for newborns by using objective maternal data to determine a preliminary probability for early-onset sepsis. The second step uses a set of clinical findings combined with the estimate based on maternal data to yield a new posterior probability for risk of sepsis following birth. Kaiser anticipates that the combination of these two steps could lead to as many as 240,000 fewer U.S. newborns being treated with systemic antibiotics each year.
Lead author Dr. David Bates, chief of the division of general medicine at Brigham and Women’s Hospital, Boston, and others identified several key areas where big data could have an effect at the point of care, including identifying high-cost patients to more efficiently care for them; helping to reduce readmissions; lowering the risk of complications when a patient is first admitted to a hospital; determining the risk that a patient’s condition will worsen; and understanding the risk of adverse events for patients.
"The better we are at getting to good information about options and consequences [regarding] who’s about to get into trouble, the more people are going to demand [the use of big data,] and the race will be on to create the products that are underneath the hood that are leveraging large data," Dr. Krumholz said.
Big data shows the promise to transform how health care is delivered, utilizing real-time information to assist doctors and patients in making more informed decisions at the point of care, a transformation that could arrive in the next 5 years.
That time prediction was offered by Dr. Harlan Krumholz, a professor at Yale University, New Haven, Conn.
"We are on the cusp of dramatic change in the way in which we are thinking about leveraging data that’s being generated in everyday clinical practice and in everyday daily life," Dr. Krumholz said in an interview. "I think there’s this recognition that the current clinical scientific enterprise is inadequate to keep up with information needs."
But getting to that point is going to require a shift in the research culture and how that information is brought to doctors as they are treating patients.
"One of the biggest problems with our current research approach is it’s very reductionist," Dr. Krumholz observed. "We try to pursue the scientific method with testing hypotheses. We try to pull out all the complexity around the question we are trying to answer and simplify everything so we can cleanly look at a particular effect of one thing on patients. ... By the time [research results] come out, they are very anachronistic because medicine’s progressed and the patients that they’re studying aren’t exactly the people who are being seen in practice, so the studies aren’t necessarily having the effect they could have."
Dr. Krumholz also is a member of the Patient-Centered Outcomes Research Institute board of governors. The organization is building a research network that will facilitate the gathering and usage of big data to help inform patient decisions.
But it’s more than just health-specific data that need to be incorporated into big data analysis.
"It’s not just the pill, but it’s the pill for a specific patient who’s got a specific profile, who is in a certain social situation, who is taking other medication, maybe has certain access to physicians, and a lot of complicated issues coming together," Dr. Krumholz continued. "We need to be able to learn from everyday experience and we need to embrace the complexity, not reject it, so that our studies are taking into account the complex aspects of medicine, not trying to get rid of them so we have clean studies that may not well-relate back to the real-world situations doctors and patients face everyday."
The next step will be to find something that can truly demonstrate the power of big data.
"I think that once we break the dam open and allow the water to flow and turn the turbines of knowledge generation, people are going to demand better and better information in order to be in a stronger position to make decisions," he predicted. "I think the decision support enterprise, that community of people who are working on decision support tools, is going to start competing to develop and create these things that are going to be at the bedside, that is going to make a whole lot of difference from where we are now."
A number of pilots and areas where big data could have an immediate impact were highlighted in a recent article in the July issue of Health Affairs (doi: 10.1377/hlthaff.2014.0041). For example, Kaiser Permanente Northern California; Harvard University, Boston; and the University of California, San Francisco and Santa Cruz, are pilot testing a two-step protocol aimed at reducing antibiotic prescriptions for newborns by using objective maternal data to determine a preliminary probability for early-onset sepsis. The second step uses a set of clinical findings combined with the estimate based on maternal data to yield a new posterior probability for risk of sepsis following birth. Kaiser anticipates that the combination of these two steps could lead to as many as 240,000 fewer U.S. newborns being treated with systemic antibiotics each year.
Lead author Dr. David Bates, chief of the division of general medicine at Brigham and Women’s Hospital, Boston, and others identified several key areas where big data could have an effect at the point of care, including identifying high-cost patients to more efficiently care for them; helping to reduce readmissions; lowering the risk of complications when a patient is first admitted to a hospital; determining the risk that a patient’s condition will worsen; and understanding the risk of adverse events for patients.
"The better we are at getting to good information about options and consequences [regarding] who’s about to get into trouble, the more people are going to demand [the use of big data,] and the race will be on to create the products that are underneath the hood that are leveraging large data," Dr. Krumholz said.
Big data shows the promise to transform how health care is delivered, utilizing real-time information to assist doctors and patients in making more informed decisions at the point of care, a transformation that could arrive in the next 5 years.
That time prediction was offered by Dr. Harlan Krumholz, a professor at Yale University, New Haven, Conn.
"We are on the cusp of dramatic change in the way in which we are thinking about leveraging data that’s being generated in everyday clinical practice and in everyday daily life," Dr. Krumholz said in an interview. "I think there’s this recognition that the current clinical scientific enterprise is inadequate to keep up with information needs."
But getting to that point is going to require a shift in the research culture and how that information is brought to doctors as they are treating patients.
"One of the biggest problems with our current research approach is it’s very reductionist," Dr. Krumholz observed. "We try to pursue the scientific method with testing hypotheses. We try to pull out all the complexity around the question we are trying to answer and simplify everything so we can cleanly look at a particular effect of one thing on patients. ... By the time [research results] come out, they are very anachronistic because medicine’s progressed and the patients that they’re studying aren’t exactly the people who are being seen in practice, so the studies aren’t necessarily having the effect they could have."
Dr. Krumholz also is a member of the Patient-Centered Outcomes Research Institute board of governors. The organization is building a research network that will facilitate the gathering and usage of big data to help inform patient decisions.
But it’s more than just health-specific data that need to be incorporated into big data analysis.
"It’s not just the pill, but it’s the pill for a specific patient who’s got a specific profile, who is in a certain social situation, who is taking other medication, maybe has certain access to physicians, and a lot of complicated issues coming together," Dr. Krumholz continued. "We need to be able to learn from everyday experience and we need to embrace the complexity, not reject it, so that our studies are taking into account the complex aspects of medicine, not trying to get rid of them so we have clean studies that may not well-relate back to the real-world situations doctors and patients face everyday."
The next step will be to find something that can truly demonstrate the power of big data.
"I think that once we break the dam open and allow the water to flow and turn the turbines of knowledge generation, people are going to demand better and better information in order to be in a stronger position to make decisions," he predicted. "I think the decision support enterprise, that community of people who are working on decision support tools, is going to start competing to develop and create these things that are going to be at the bedside, that is going to make a whole lot of difference from where we are now."
A number of pilots and areas where big data could have an immediate impact were highlighted in a recent article in the July issue of Health Affairs (doi: 10.1377/hlthaff.2014.0041). For example, Kaiser Permanente Northern California; Harvard University, Boston; and the University of California, San Francisco and Santa Cruz, are pilot testing a two-step protocol aimed at reducing antibiotic prescriptions for newborns by using objective maternal data to determine a preliminary probability for early-onset sepsis. The second step uses a set of clinical findings combined with the estimate based on maternal data to yield a new posterior probability for risk of sepsis following birth. Kaiser anticipates that the combination of these two steps could lead to as many as 240,000 fewer U.S. newborns being treated with systemic antibiotics each year.
Lead author Dr. David Bates, chief of the division of general medicine at Brigham and Women’s Hospital, Boston, and others identified several key areas where big data could have an effect at the point of care, including identifying high-cost patients to more efficiently care for them; helping to reduce readmissions; lowering the risk of complications when a patient is first admitted to a hospital; determining the risk that a patient’s condition will worsen; and understanding the risk of adverse events for patients.
"The better we are at getting to good information about options and consequences [regarding] who’s about to get into trouble, the more people are going to demand [the use of big data,] and the race will be on to create the products that are underneath the hood that are leveraging large data," Dr. Krumholz said.
Questions Surround EHR Security
Despite government efforts to certify otherwise, questions remain as to whether the Dept. of Health & Human Services Office of the National Coordinator for Health Information Technology is doing enough to ensure that commercially available electronic health record software programs are doing enough to secure patient information.
Concerns were raised by HHS Office of Inspector General (OIG) in a report released Aug. 4. The agency watchdog examined certification work conducted by authorized testing and certification bodies (ATCBs), which early on in the meaningful use program certified that electronic health records (EHRs) met established criteria that would allow doctors and hospitals to obtain Medicare or Medicaid incentive payments.
According to the report, as of Aug. 30, 2013, a total of 3,590 certified EHRs were available to health care providers, 95% of which were certified by ATCBs under a temporary certification program.
In examining the work done by ATCBs, the OIG found that oversight by the HHS Office of the National Coordinator for Health Information Technology (ONC) "did not fully ensure that test procedures and standards could adequately secure and protect patient information contained in EHRs," the report states. OIG claimed that the health IT office did not ensure that ATCBs "developed procedures to periodically evaluate whether certified EHRs continued to meet Federal standards and developed a training program to ensure that their personnel were competent to test and certify EHRs and to secure proprietary or sensitive information."
OIG notes that the ATCB standards and procedures met all National Institute of Standards and Technology (NIST) test procedure requirements that the ONC approved, but those procedures "were not sufficient to ensure that EHRs would adequately secure and protect patient health information; in particular, the procedures allowed ATCBs to certify EHRs that demonstrated the use of a single-character password during testing." NIST procedures also did not address common security issues, including password complexity and logging emergency access or user privilege changes.
In response to the draft, included as part of the report, ONC noted that ATCBs are no longer active in the certification. New certification criteria approved earlier this year have "strengthened test procedures for common security and privacy features for inclusion in EHRs." Additionally, ONC has "substantially revised the ‘auditable events and tamper resistance’ certification criterion, and we adopted a new ‘end-user device encryption’ criterion," as well as other security capabilities, according to a spokesperson. ONC will review the OIG’s comments before determining the appropriate next steps, the spokesperson added.
However, the OIG does not agree that the current certification regulations "sufficiently address our security concerns regarding the Temporary Program," such as multifactor authentication.
OIG also criticized the health IT office for not addressing the authority to remove EHRs from the market that are shown to have privacy and security flaws.
If an EHR "is exploited and used to conduct malicious activities, ONC is not able to remove the EHR, even temporarily, from the product list to prevent further purchases of it."
Despite government efforts to certify otherwise, questions remain as to whether the Dept. of Health & Human Services Office of the National Coordinator for Health Information Technology is doing enough to ensure that commercially available electronic health record software programs are doing enough to secure patient information.
Concerns were raised by HHS Office of Inspector General (OIG) in a report released Aug. 4. The agency watchdog examined certification work conducted by authorized testing and certification bodies (ATCBs), which early on in the meaningful use program certified that electronic health records (EHRs) met established criteria that would allow doctors and hospitals to obtain Medicare or Medicaid incentive payments.
According to the report, as of Aug. 30, 2013, a total of 3,590 certified EHRs were available to health care providers, 95% of which were certified by ATCBs under a temporary certification program.
In examining the work done by ATCBs, the OIG found that oversight by the HHS Office of the National Coordinator for Health Information Technology (ONC) "did not fully ensure that test procedures and standards could adequately secure and protect patient information contained in EHRs," the report states. OIG claimed that the health IT office did not ensure that ATCBs "developed procedures to periodically evaluate whether certified EHRs continued to meet Federal standards and developed a training program to ensure that their personnel were competent to test and certify EHRs and to secure proprietary or sensitive information."
OIG notes that the ATCB standards and procedures met all National Institute of Standards and Technology (NIST) test procedure requirements that the ONC approved, but those procedures "were not sufficient to ensure that EHRs would adequately secure and protect patient health information; in particular, the procedures allowed ATCBs to certify EHRs that demonstrated the use of a single-character password during testing." NIST procedures also did not address common security issues, including password complexity and logging emergency access or user privilege changes.
In response to the draft, included as part of the report, ONC noted that ATCBs are no longer active in the certification. New certification criteria approved earlier this year have "strengthened test procedures for common security and privacy features for inclusion in EHRs." Additionally, ONC has "substantially revised the ‘auditable events and tamper resistance’ certification criterion, and we adopted a new ‘end-user device encryption’ criterion," as well as other security capabilities, according to a spokesperson. ONC will review the OIG’s comments before determining the appropriate next steps, the spokesperson added.
However, the OIG does not agree that the current certification regulations "sufficiently address our security concerns regarding the Temporary Program," such as multifactor authentication.
OIG also criticized the health IT office for not addressing the authority to remove EHRs from the market that are shown to have privacy and security flaws.
If an EHR "is exploited and used to conduct malicious activities, ONC is not able to remove the EHR, even temporarily, from the product list to prevent further purchases of it."
Despite government efforts to certify otherwise, questions remain as to whether the Dept. of Health & Human Services Office of the National Coordinator for Health Information Technology is doing enough to ensure that commercially available electronic health record software programs are doing enough to secure patient information.
Concerns were raised by HHS Office of Inspector General (OIG) in a report released Aug. 4. The agency watchdog examined certification work conducted by authorized testing and certification bodies (ATCBs), which early on in the meaningful use program certified that electronic health records (EHRs) met established criteria that would allow doctors and hospitals to obtain Medicare or Medicaid incentive payments.
According to the report, as of Aug. 30, 2013, a total of 3,590 certified EHRs were available to health care providers, 95% of which were certified by ATCBs under a temporary certification program.
In examining the work done by ATCBs, the OIG found that oversight by the HHS Office of the National Coordinator for Health Information Technology (ONC) "did not fully ensure that test procedures and standards could adequately secure and protect patient information contained in EHRs," the report states. OIG claimed that the health IT office did not ensure that ATCBs "developed procedures to periodically evaluate whether certified EHRs continued to meet Federal standards and developed a training program to ensure that their personnel were competent to test and certify EHRs and to secure proprietary or sensitive information."
OIG notes that the ATCB standards and procedures met all National Institute of Standards and Technology (NIST) test procedure requirements that the ONC approved, but those procedures "were not sufficient to ensure that EHRs would adequately secure and protect patient health information; in particular, the procedures allowed ATCBs to certify EHRs that demonstrated the use of a single-character password during testing." NIST procedures also did not address common security issues, including password complexity and logging emergency access or user privilege changes.
In response to the draft, included as part of the report, ONC noted that ATCBs are no longer active in the certification. New certification criteria approved earlier this year have "strengthened test procedures for common security and privacy features for inclusion in EHRs." Additionally, ONC has "substantially revised the ‘auditable events and tamper resistance’ certification criterion, and we adopted a new ‘end-user device encryption’ criterion," as well as other security capabilities, according to a spokesperson. ONC will review the OIG’s comments before determining the appropriate next steps, the spokesperson added.
However, the OIG does not agree that the current certification regulations "sufficiently address our security concerns regarding the Temporary Program," such as multifactor authentication.
OIG also criticized the health IT office for not addressing the authority to remove EHRs from the market that are shown to have privacy and security flaws.
If an EHR "is exploited and used to conduct malicious activities, ONC is not able to remove the EHR, even temporarily, from the product list to prevent further purchases of it."
Questions surround EHR security
Despite government efforts to certify otherwise, questions remain as to whether the Dept. of Health & Human Services Office of the National Coordinator for Health Information Technology is doing enough to ensure that commercially available electronic health record software programs are doing enough to secure patient information.
Concerns were raised by HHS Office of Inspector General (OIG) in a report released Aug. 4. The agency watchdog examined certification work conducted by authorized testing and certification bodies (ATCBs), which early on in the meaningful use program certified that electronic health records (EHRs) met established criteria that would allow doctors and hospitals to obtain Medicare or Medicaid incentive payments.
According to the report, as of Aug. 30, 2013, a total of 3,590 certified EHRs were available to health care providers, 95% of which were certified by ATCBs under a temporary certification program.
In examining the work done by ATCBs, the OIG found that oversight by the HHS Office of the National Coordinator for Health Information Technology (ONC) "did not fully ensure that test procedures and standards could adequately secure and protect patient information contained in EHRs," the report states. OIG claimed that the health IT office did not ensure that ATCBs "developed procedures to periodically evaluate whether certified EHRs continued to meet Federal standards and developed a training program to ensure that their personnel were competent to test and certify EHRs and to secure proprietary or sensitive information."
OIG notes that the ATCB standards and procedures met all National Institute of Standards and Technology (NIST) test procedure requirements that the ONC approved, but those procedures "were not sufficient to ensure that EHRs would adequately secure and protect patient health information; in particular, the procedures allowed ATCBs to certify EHRs that demonstrated the use of a single-character password during testing." NIST procedures also did not address common security issues, including password complexity and logging emergency access or user privilege changes.
In response to the draft, included as part of the report, ONC noted that ATCBs are no longer active in the certification. New certification criteria approved earlier this year have "strengthened test procedures for common security and privacy features for inclusion in EHRs." Additionally, ONC has "substantially revised the ‘auditable events and tamper resistance’ certification criterion, and we adopted a new ‘end-user device encryption’ criterion," as well as other security capabilities, according to a spokesperson. ONC will review the OIG’s comments before determining the appropriate next steps, the spokesperson added.
However, the OIG does not agree that the current certification regulations "sufficiently address our security concerns regarding the Temporary Program," such as multifactor authentication.
OIG also criticized the health IT office for not addressing the authority to remove EHRs from the market that are shown to have privacy and security flaws.
If an EHR "is exploited and used to conduct malicious activities, ONC is not able to remove the EHR, even temporarily, from the product list to prevent further purchases of it."
Despite government efforts to certify otherwise, questions remain as to whether the Dept. of Health & Human Services Office of the National Coordinator for Health Information Technology is doing enough to ensure that commercially available electronic health record software programs are doing enough to secure patient information.
Concerns were raised by HHS Office of Inspector General (OIG) in a report released Aug. 4. The agency watchdog examined certification work conducted by authorized testing and certification bodies (ATCBs), which early on in the meaningful use program certified that electronic health records (EHRs) met established criteria that would allow doctors and hospitals to obtain Medicare or Medicaid incentive payments.
According to the report, as of Aug. 30, 2013, a total of 3,590 certified EHRs were available to health care providers, 95% of which were certified by ATCBs under a temporary certification program.
In examining the work done by ATCBs, the OIG found that oversight by the HHS Office of the National Coordinator for Health Information Technology (ONC) "did not fully ensure that test procedures and standards could adequately secure and protect patient information contained in EHRs," the report states. OIG claimed that the health IT office did not ensure that ATCBs "developed procedures to periodically evaluate whether certified EHRs continued to meet Federal standards and developed a training program to ensure that their personnel were competent to test and certify EHRs and to secure proprietary or sensitive information."
OIG notes that the ATCB standards and procedures met all National Institute of Standards and Technology (NIST) test procedure requirements that the ONC approved, but those procedures "were not sufficient to ensure that EHRs would adequately secure and protect patient health information; in particular, the procedures allowed ATCBs to certify EHRs that demonstrated the use of a single-character password during testing." NIST procedures also did not address common security issues, including password complexity and logging emergency access or user privilege changes.
In response to the draft, included as part of the report, ONC noted that ATCBs are no longer active in the certification. New certification criteria approved earlier this year have "strengthened test procedures for common security and privacy features for inclusion in EHRs." Additionally, ONC has "substantially revised the ‘auditable events and tamper resistance’ certification criterion, and we adopted a new ‘end-user device encryption’ criterion," as well as other security capabilities, according to a spokesperson. ONC will review the OIG’s comments before determining the appropriate next steps, the spokesperson added.
However, the OIG does not agree that the current certification regulations "sufficiently address our security concerns regarding the Temporary Program," such as multifactor authentication.
OIG also criticized the health IT office for not addressing the authority to remove EHRs from the market that are shown to have privacy and security flaws.
If an EHR "is exploited and used to conduct malicious activities, ONC is not able to remove the EHR, even temporarily, from the product list to prevent further purchases of it."
Despite government efforts to certify otherwise, questions remain as to whether the Dept. of Health & Human Services Office of the National Coordinator for Health Information Technology is doing enough to ensure that commercially available electronic health record software programs are doing enough to secure patient information.
Concerns were raised by HHS Office of Inspector General (OIG) in a report released Aug. 4. The agency watchdog examined certification work conducted by authorized testing and certification bodies (ATCBs), which early on in the meaningful use program certified that electronic health records (EHRs) met established criteria that would allow doctors and hospitals to obtain Medicare or Medicaid incentive payments.
According to the report, as of Aug. 30, 2013, a total of 3,590 certified EHRs were available to health care providers, 95% of which were certified by ATCBs under a temporary certification program.
In examining the work done by ATCBs, the OIG found that oversight by the HHS Office of the National Coordinator for Health Information Technology (ONC) "did not fully ensure that test procedures and standards could adequately secure and protect patient information contained in EHRs," the report states. OIG claimed that the health IT office did not ensure that ATCBs "developed procedures to periodically evaluate whether certified EHRs continued to meet Federal standards and developed a training program to ensure that their personnel were competent to test and certify EHRs and to secure proprietary or sensitive information."
OIG notes that the ATCB standards and procedures met all National Institute of Standards and Technology (NIST) test procedure requirements that the ONC approved, but those procedures "were not sufficient to ensure that EHRs would adequately secure and protect patient health information; in particular, the procedures allowed ATCBs to certify EHRs that demonstrated the use of a single-character password during testing." NIST procedures also did not address common security issues, including password complexity and logging emergency access or user privilege changes.
In response to the draft, included as part of the report, ONC noted that ATCBs are no longer active in the certification. New certification criteria approved earlier this year have "strengthened test procedures for common security and privacy features for inclusion in EHRs." Additionally, ONC has "substantially revised the ‘auditable events and tamper resistance’ certification criterion, and we adopted a new ‘end-user device encryption’ criterion," as well as other security capabilities, according to a spokesperson. ONC will review the OIG’s comments before determining the appropriate next steps, the spokesperson added.
However, the OIG does not agree that the current certification regulations "sufficiently address our security concerns regarding the Temporary Program," such as multifactor authentication.
OIG also criticized the health IT office for not addressing the authority to remove EHRs from the market that are shown to have privacy and security flaws.
If an EHR "is exploited and used to conduct malicious activities, ONC is not able to remove the EHR, even temporarily, from the product list to prevent further purchases of it."
New HCV drugs could boost Part D spending by up to $5.8 billion
New treatments for hepatitis C could boost federal spending for the Medicare Part D program by up to $5.8 billion in 2015 and lead to a 4.3%-8.6% premium increase for beneficiaries, according to a report by the actuarial firm Milliman, prepared for the Pharmaceutical Care Management Association.
Milliman examined the cost impact of sofosbuvir, marketed by Gilead Sciences as Sovaldi; the drug was approved by the Food and Drug Administration in December 2013 and carries an $84,000 price tag for a 12-week treatment regimen.
"Unlike some other high-cost specialty drugs, the new HCV [hepatitis C virus] drugs have a significant patient base, so their financial impact causes a meaningful and measurable increase in costs to beneficiaries and United States taxpayers," the report said. "No one knows for sure how many infected beneficiaries will ultimately receive the new treatment, but if for example, 50% of infected Medicare Part D beneficiaries were eventually treated with the $84,000 course of treatment, approximately $11 billion of new spending would enter the Part D system."
The report noted that hepatitis C is more prevalent among low-income individuals, placing an additional cost burden on the government, as these people are either covered by Medicaid or dually eligible for Medicare and Medicaid.
Milliman based its findings on the cost of taking sofosbuvir for 12 weeks, but noted that the "relative use pattern for these drugs is not well established." The analysis does not reflect any potential cost savings from reductions in other medical costs (such as treating chronic liver disease), which may result from using one of these new drugs.
New treatments for hepatitis C could boost federal spending for the Medicare Part D program by up to $5.8 billion in 2015 and lead to a 4.3%-8.6% premium increase for beneficiaries, according to a report by the actuarial firm Milliman, prepared for the Pharmaceutical Care Management Association.
Milliman examined the cost impact of sofosbuvir, marketed by Gilead Sciences as Sovaldi; the drug was approved by the Food and Drug Administration in December 2013 and carries an $84,000 price tag for a 12-week treatment regimen.
"Unlike some other high-cost specialty drugs, the new HCV [hepatitis C virus] drugs have a significant patient base, so their financial impact causes a meaningful and measurable increase in costs to beneficiaries and United States taxpayers," the report said. "No one knows for sure how many infected beneficiaries will ultimately receive the new treatment, but if for example, 50% of infected Medicare Part D beneficiaries were eventually treated with the $84,000 course of treatment, approximately $11 billion of new spending would enter the Part D system."
The report noted that hepatitis C is more prevalent among low-income individuals, placing an additional cost burden on the government, as these people are either covered by Medicaid or dually eligible for Medicare and Medicaid.
Milliman based its findings on the cost of taking sofosbuvir for 12 weeks, but noted that the "relative use pattern for these drugs is not well established." The analysis does not reflect any potential cost savings from reductions in other medical costs (such as treating chronic liver disease), which may result from using one of these new drugs.
New treatments for hepatitis C could boost federal spending for the Medicare Part D program by up to $5.8 billion in 2015 and lead to a 4.3%-8.6% premium increase for beneficiaries, according to a report by the actuarial firm Milliman, prepared for the Pharmaceutical Care Management Association.
Milliman examined the cost impact of sofosbuvir, marketed by Gilead Sciences as Sovaldi; the drug was approved by the Food and Drug Administration in December 2013 and carries an $84,000 price tag for a 12-week treatment regimen.
"Unlike some other high-cost specialty drugs, the new HCV [hepatitis C virus] drugs have a significant patient base, so their financial impact causes a meaningful and measurable increase in costs to beneficiaries and United States taxpayers," the report said. "No one knows for sure how many infected beneficiaries will ultimately receive the new treatment, but if for example, 50% of infected Medicare Part D beneficiaries were eventually treated with the $84,000 course of treatment, approximately $11 billion of new spending would enter the Part D system."
The report noted that hepatitis C is more prevalent among low-income individuals, placing an additional cost burden on the government, as these people are either covered by Medicaid or dually eligible for Medicare and Medicaid.
Milliman based its findings on the cost of taking sofosbuvir for 12 weeks, but noted that the "relative use pattern for these drugs is not well established." The analysis does not reflect any potential cost savings from reductions in other medical costs (such as treating chronic liver disease), which may result from using one of these new drugs.
New bill aims to decriminalize cannabidiol oil and therapeutic hemp
A new bill to decriminalize the use of cannabidiol oil and therapeutic hemp was introduced by Rep. Scott Perry (R-Pa.).
The bill, "Charlotte’s Web Medical Hemp Act of 2014" (H.R. 5226), would allow for access to cannabidiol (CBD) oil, which has anecdotally been shown to reduce the amount and duration of seizures in children suffering from epilepsy and other seizure disorders in children and adults. It would remove CBD oil and therapeutic hemp from the federal definition of marijuana in the Controlled Substances Act. Therapeutic hemp is defined as having no more than 0.3% THC, which means it has none of the hallucinogenic effects of traditional marijuana.
The bill is named for a strain of marijuana, "Charlotte’s Web," from which the CBD oil was derived to treat Colorado girl Charlotte Figi. Perry’s office said that more than 300,000 children in America suffer from some form of epilepsy, with many experiencing more than 100 seizures a day.
Perry’s office emphasized that this is not a bill that would federally legalize the recreational use of marijuana, nor would it legalize all forms of medical marijuana, but it permits access to CBD oil and therapeutic hemp for those who might benefit from them.
"We applaud Congressman Perry and his leadership in creating access to this treatment for Americans with epilepsy who have run out of options," Epilepsy Foundation president and CEO Philip M. Gattone said in a statement. "The Epilepsy Foundation has supported access to CBD oil – which is showing dramatic results for some patients. Access to a lifesaving treatment should not be determined or limited by a zip code. It is time for Congress to enact this sensible bill that could help save lives."
A new bill to decriminalize the use of cannabidiol oil and therapeutic hemp was introduced by Rep. Scott Perry (R-Pa.).
The bill, "Charlotte’s Web Medical Hemp Act of 2014" (H.R. 5226), would allow for access to cannabidiol (CBD) oil, which has anecdotally been shown to reduce the amount and duration of seizures in children suffering from epilepsy and other seizure disorders in children and adults. It would remove CBD oil and therapeutic hemp from the federal definition of marijuana in the Controlled Substances Act. Therapeutic hemp is defined as having no more than 0.3% THC, which means it has none of the hallucinogenic effects of traditional marijuana.
The bill is named for a strain of marijuana, "Charlotte’s Web," from which the CBD oil was derived to treat Colorado girl Charlotte Figi. Perry’s office said that more than 300,000 children in America suffer from some form of epilepsy, with many experiencing more than 100 seizures a day.
Perry’s office emphasized that this is not a bill that would federally legalize the recreational use of marijuana, nor would it legalize all forms of medical marijuana, but it permits access to CBD oil and therapeutic hemp for those who might benefit from them.
"We applaud Congressman Perry and his leadership in creating access to this treatment for Americans with epilepsy who have run out of options," Epilepsy Foundation president and CEO Philip M. Gattone said in a statement. "The Epilepsy Foundation has supported access to CBD oil – which is showing dramatic results for some patients. Access to a lifesaving treatment should not be determined or limited by a zip code. It is time for Congress to enact this sensible bill that could help save lives."
A new bill to decriminalize the use of cannabidiol oil and therapeutic hemp was introduced by Rep. Scott Perry (R-Pa.).
The bill, "Charlotte’s Web Medical Hemp Act of 2014" (H.R. 5226), would allow for access to cannabidiol (CBD) oil, which has anecdotally been shown to reduce the amount and duration of seizures in children suffering from epilepsy and other seizure disorders in children and adults. It would remove CBD oil and therapeutic hemp from the federal definition of marijuana in the Controlled Substances Act. Therapeutic hemp is defined as having no more than 0.3% THC, which means it has none of the hallucinogenic effects of traditional marijuana.
The bill is named for a strain of marijuana, "Charlotte’s Web," from which the CBD oil was derived to treat Colorado girl Charlotte Figi. Perry’s office said that more than 300,000 children in America suffer from some form of epilepsy, with many experiencing more than 100 seizures a day.
Perry’s office emphasized that this is not a bill that would federally legalize the recreational use of marijuana, nor would it legalize all forms of medical marijuana, but it permits access to CBD oil and therapeutic hemp for those who might benefit from them.
"We applaud Congressman Perry and his leadership in creating access to this treatment for Americans with epilepsy who have run out of options," Epilepsy Foundation president and CEO Philip M. Gattone said in a statement. "The Epilepsy Foundation has supported access to CBD oil – which is showing dramatic results for some patients. Access to a lifesaving treatment should not be determined or limited by a zip code. It is time for Congress to enact this sensible bill that could help save lives."
Doctors disgruntled about gun-discussion ban
Primary care organizations are booing a July 25 ruling by the 11th Circuit Court of Appeals to uphold a Florida law that prevents physicians from asking patients about firearms in the home.
The 2-1 ruling reverses a June 2012 decision by U.S. District Court Judge Marcia Cooke of the Southern District of Florida-Miami, who ruled in favor of the Florida chapters of the American Academy of Pediatrics, American Academy of Family Physicians, and the American College of Physicians and individual plaintiff physicians who sought an injunction to prevent the enforcement of the 2011 Florida law.
The plaintiffs will seek a rehearing by the full 11th Circuit Court of Appeals. The injunction against the law’s enforcement remains in place until the court renders a decision on rehearing the case.
"This dangerous decision gives state legislatures free license to restrict physicians from asking important questions about health and safety that are vital to providing the best medical care to patients," Dr. Mobeen H. Rathore, president of the Florida chapter of the American Academy of Pediatrics, said in a statement.
Florida Gov. Rick Scott (R) signed the law that forbids licensed health care providers from asking about gun ownership unless he or she believes "in good faith" that the information is relevant to patients’ and family members’ medical care or safety. Under the law, physicians and other providers cannot record information on firearms in patients’ medical records.
In the ruling, Circuit Court Judge Gerald B. Tjoflat wrote that the original law "seeks to protect patient’s privacy by restricting irrelevant inquiry and record-keeping by physicians regarding firearms. The act recognizes that when a patient enters a physician’s examination room, the patient is in a position of relative powerlessness. The patient must place his or her trust in the physician’s guidance, and submit to the physician’s authority. In order to protect patients, physicians have for millennia been subject to codes of conduct that define the practice of good medicine and affirm the responsibility physicians bear. In keeping with these traditional codes of conduct – which almost universally mandate respect for patient privacy – the Act simply acknowledges that the practice of good medicine does not require interrogation about irrelevant, private matters. As such, we find that the Act is a legitimate regulation of professional conduct."
The AAP called the decision a violation of pediatricians’ First Amendment rights and said that it "threatens their ability to counsel parents about how best to protect children from unintentional injury and death."
"This law has a chilling effect on life-saving conversations that take place in the physician’s office," Dr. James Perrin, AAP president, said in a statement. "More than 4,000 children are killed by guns every year. Parents who own firearms must keep them locked, with ammunition locked away separately. In this case, a simple conversation can prevent a tragedy."
In a statement, ACP President Dr. David Fleming called the ruling "destructive to the patient-physician relationship. Many doctors ask about gun ownership as a normal part of screening patients, including it on a long list of health questions about drug and alcohol use, smoking, exercise, and eating habits."
Dr. Fleming also noted a broader problem with the ruling, calling it "much bigger than guns. We believe it addresses whether the government or any other body should be allowed to tell physicians what they can and can’t discuss with their patients, consistent with evidence-based standards of care."
AAFP President Dr. Reid Blackwelder echoed those comments: "Make no mistake – this issue is much bigger than guns or gun ownership. This is about governmental intrusion on the patient/physician relationship. Laws that infringe on this relationship put the patient and their family’s health at risk. Physicians should not be prohibited by law or regulation from discussing with or asking their patients about risk factors that may negatively impact their health."
Primary care organizations are booing a July 25 ruling by the 11th Circuit Court of Appeals to uphold a Florida law that prevents physicians from asking patients about firearms in the home.
The 2-1 ruling reverses a June 2012 decision by U.S. District Court Judge Marcia Cooke of the Southern District of Florida-Miami, who ruled in favor of the Florida chapters of the American Academy of Pediatrics, American Academy of Family Physicians, and the American College of Physicians and individual plaintiff physicians who sought an injunction to prevent the enforcement of the 2011 Florida law.
The plaintiffs will seek a rehearing by the full 11th Circuit Court of Appeals. The injunction against the law’s enforcement remains in place until the court renders a decision on rehearing the case.
"This dangerous decision gives state legislatures free license to restrict physicians from asking important questions about health and safety that are vital to providing the best medical care to patients," Dr. Mobeen H. Rathore, president of the Florida chapter of the American Academy of Pediatrics, said in a statement.
Florida Gov. Rick Scott (R) signed the law that forbids licensed health care providers from asking about gun ownership unless he or she believes "in good faith" that the information is relevant to patients’ and family members’ medical care or safety. Under the law, physicians and other providers cannot record information on firearms in patients’ medical records.
In the ruling, Circuit Court Judge Gerald B. Tjoflat wrote that the original law "seeks to protect patient’s privacy by restricting irrelevant inquiry and record-keeping by physicians regarding firearms. The act recognizes that when a patient enters a physician’s examination room, the patient is in a position of relative powerlessness. The patient must place his or her trust in the physician’s guidance, and submit to the physician’s authority. In order to protect patients, physicians have for millennia been subject to codes of conduct that define the practice of good medicine and affirm the responsibility physicians bear. In keeping with these traditional codes of conduct – which almost universally mandate respect for patient privacy – the Act simply acknowledges that the practice of good medicine does not require interrogation about irrelevant, private matters. As such, we find that the Act is a legitimate regulation of professional conduct."
The AAP called the decision a violation of pediatricians’ First Amendment rights and said that it "threatens their ability to counsel parents about how best to protect children from unintentional injury and death."
"This law has a chilling effect on life-saving conversations that take place in the physician’s office," Dr. James Perrin, AAP president, said in a statement. "More than 4,000 children are killed by guns every year. Parents who own firearms must keep them locked, with ammunition locked away separately. In this case, a simple conversation can prevent a tragedy."
In a statement, ACP President Dr. David Fleming called the ruling "destructive to the patient-physician relationship. Many doctors ask about gun ownership as a normal part of screening patients, including it on a long list of health questions about drug and alcohol use, smoking, exercise, and eating habits."
Dr. Fleming also noted a broader problem with the ruling, calling it "much bigger than guns. We believe it addresses whether the government or any other body should be allowed to tell physicians what they can and can’t discuss with their patients, consistent with evidence-based standards of care."
AAFP President Dr. Reid Blackwelder echoed those comments: "Make no mistake – this issue is much bigger than guns or gun ownership. This is about governmental intrusion on the patient/physician relationship. Laws that infringe on this relationship put the patient and their family’s health at risk. Physicians should not be prohibited by law or regulation from discussing with or asking their patients about risk factors that may negatively impact their health."
Primary care organizations are booing a July 25 ruling by the 11th Circuit Court of Appeals to uphold a Florida law that prevents physicians from asking patients about firearms in the home.
The 2-1 ruling reverses a June 2012 decision by U.S. District Court Judge Marcia Cooke of the Southern District of Florida-Miami, who ruled in favor of the Florida chapters of the American Academy of Pediatrics, American Academy of Family Physicians, and the American College of Physicians and individual plaintiff physicians who sought an injunction to prevent the enforcement of the 2011 Florida law.
The plaintiffs will seek a rehearing by the full 11th Circuit Court of Appeals. The injunction against the law’s enforcement remains in place until the court renders a decision on rehearing the case.
"This dangerous decision gives state legislatures free license to restrict physicians from asking important questions about health and safety that are vital to providing the best medical care to patients," Dr. Mobeen H. Rathore, president of the Florida chapter of the American Academy of Pediatrics, said in a statement.
Florida Gov. Rick Scott (R) signed the law that forbids licensed health care providers from asking about gun ownership unless he or she believes "in good faith" that the information is relevant to patients’ and family members’ medical care or safety. Under the law, physicians and other providers cannot record information on firearms in patients’ medical records.
In the ruling, Circuit Court Judge Gerald B. Tjoflat wrote that the original law "seeks to protect patient’s privacy by restricting irrelevant inquiry and record-keeping by physicians regarding firearms. The act recognizes that when a patient enters a physician’s examination room, the patient is in a position of relative powerlessness. The patient must place his or her trust in the physician’s guidance, and submit to the physician’s authority. In order to protect patients, physicians have for millennia been subject to codes of conduct that define the practice of good medicine and affirm the responsibility physicians bear. In keeping with these traditional codes of conduct – which almost universally mandate respect for patient privacy – the Act simply acknowledges that the practice of good medicine does not require interrogation about irrelevant, private matters. As such, we find that the Act is a legitimate regulation of professional conduct."
The AAP called the decision a violation of pediatricians’ First Amendment rights and said that it "threatens their ability to counsel parents about how best to protect children from unintentional injury and death."
"This law has a chilling effect on life-saving conversations that take place in the physician’s office," Dr. James Perrin, AAP president, said in a statement. "More than 4,000 children are killed by guns every year. Parents who own firearms must keep them locked, with ammunition locked away separately. In this case, a simple conversation can prevent a tragedy."
In a statement, ACP President Dr. David Fleming called the ruling "destructive to the patient-physician relationship. Many doctors ask about gun ownership as a normal part of screening patients, including it on a long list of health questions about drug and alcohol use, smoking, exercise, and eating habits."
Dr. Fleming also noted a broader problem with the ruling, calling it "much bigger than guns. We believe it addresses whether the government or any other body should be allowed to tell physicians what they can and can’t discuss with their patients, consistent with evidence-based standards of care."
AAFP President Dr. Reid Blackwelder echoed those comments: "Make no mistake – this issue is much bigger than guns or gun ownership. This is about governmental intrusion on the patient/physician relationship. Laws that infringe on this relationship put the patient and their family’s health at risk. Physicians should not be prohibited by law or regulation from discussing with or asking their patients about risk factors that may negatively impact their health."
Bundled payment pilot shows promise for reducing cost of cancer care
Bundling payments for cancer care that modify payment from current fee-for-service payments to one that rewards outcomes and cost efficiency can provide significant total cost-of-care reductions, results from a recent UnitedHealthcare pilot suggest.
"This study challenges the assumption that any reduction of resources results in worse outcomes for cancer," a report on the pilot states.
But while the total cost of care in this pilot showed reductions, looking just at the cost of chemotherapy drugs revealed an unexpected increase, reported Dr. Lee Newcomer, senior vice president of oncology at UnitedHealthcare, and his associates online in the Journal of Oncology Practice (2014 July 8 [doi: 10.1200/JOP.2014.001488]).
UnitedHealthcare built the pilot around five volunteer medical groups, including Northwest Georgia Oncology of Atlanta, Ga.; Center for Cancer and Blood Disorders of Fort Worth, Tex.; Kansas University in Kansas City, Kansas; Dayton Physicians of Dayton, Ohio; West Clinic of Memphis, Tenn.; and Advanced Medical Specialties of Miami, Fla. One group dropped out after it was acquired by an academic medical center and was replaced, but the article did not identify which one dropped out.
The pilot looked at breast, colon, and lung cancer treatments. UnitedHealthcare modified the standard fee-for-service (FFS) payment in four areas. First, chemotherapy drugs were reimbursed at the average sales price with no modifier (FFS has a contracted percentage modifier). Physician hospital care, hospice management, and case management all received an episode of care payment (the standard model offers FFS for physician hospital care, FFS or nothing for hospice management, and nothing for case management). The study sites also collected clinical and outcomes data. Medical groups were free to change their preferred drug regimen at any time, and new drugs added were paid at their respective rates, but a change did not cause a change with the episodic payments.
Predicted FFS total cost for the episode cohort was $98.1 million, but the actual total medical cost was $64.8 million. The predicted FFS chemotherapy drug cost was $7.5 million, but the actual cost was $21.0 million. The study was not designed to determine the expenses that drove the differences in cost, although a subset analysis showed a statistically valid decrease in hospitalization and therapeutic radiology usage in the episode arm.
Most quality outcomes had "insufficient numbers for statistical analysis," the report notes, though lung cancer survivors "were the only evaluable subgroup, and there was no significant survival difference between the episode and registry patients. ... Overall, multiple quality measures were monitored, and none of them provided an early signal that quality of care was different than controls."
Regarding the chemotherapy drug costs, the report’s authors noted that the increased costs were "not expected," considering the fact that the episodic payment scheme included several incentives to keep drug costs down, with no payment benefit for using more expensive drugs.
The authors suggested that the study be replicated to determine its generalization, which they say is possible with the automation of many of the claims-adjudication functions that were done manually for the study. They added that the work "proves the essential concept that the cost of care for future generations can be reduced without sacrificing quality."
Three of the article’s authors, including lead author Dr. Newcomer, are employed by UnitedHealthcare and have stock ownership in the company.
I am excited and encouraged to see the article by Dr. Newcomer and his colleagues in the Journal of Oncology Practice, demonstrating a reduction in the cost of cancer care by restructuring the revenue model to doctors and practices by removing the financial incentive to prescribe chemotherapy. It is also reassuring that they are following process measures of quality as well as outcome measures of survival in the population in the bundled payment model, in addition to their comparator population. We should all seek to reduce cost appropriately, but need to be certain that we continue to provide high-quality care to give our patients the best possible outcome.
Oncology care represents a high cost of subspecialty care in the adult population, and the oncology market is growing (as the age distribution of the population changes and people are more likely to survive their cancers and undergo chronic treatments). We as practitioners need to be able to control costs and provide high-value and high-quality care. Removing financial incentives for chemotherapy prescribing is one important part of that cost control. Bundled payment models in oncology can be another potential solution to address the cost concern. However, bundled payment systems in oncology are complex, and an outlier in cost to a practice could be financially devastating to a smaller practice. In addition, United has had other bundled pilots in oncology that have not been successful.
There are other structures of cost control that seek to align incentives with providers. WellPoint aligned with AIM to pay providers a monthly management fee for utilization of preferential pathways designed by Eviti as a prior authorization system. Dr. John Sprandio and Dr. Linda Bosserman have piloted medical oncology home projects for their smaller practices with a high level of physician oversight, seeking to reduce costs and align incentives. The US Oncology Network has Innovent Oncology, a program that aligns incentives with evidence-based Value Pathways powered by the National Comprehensive Cancer Network, advance care planning, and a nursing management system. Additionally, in order to allow physicians to access transparent, evidence-based clinical content at the point of care (which has been a major limitation for any of the pathway initiatives), Clear Value Plus was developed, which is a first of its kind clinical quality and regimen support system that’s fully embedded into McKesson Specialty Health’s iKnowMed Generation 2electronic health record (EHR), and is being developed for use in other EHRs.
I think all of these initiatives represent some progress in how we consider cost control and improve or sustain quality in oncology care, but it will always be important to continue to measure both. To measure both cost and quality, these programs need to have the informatics infrastructure in place to understand all of the long-term consequences of these measures in patient outcomes. Dr. Newcomer’s innovation in this space is an important and exciting step, but we still have a long way to go.
Dr. Debra Patt serves as the principal investigator for health economics and outcomes research for retrospective trials, as well as prospective clinical trials in breast cancer, within the US Oncology Network and leads the strategic development team for her local practice. She advocates for policies that support improving cancer care for Texas Oncology. Dr. Patt also is the director of health care informatics at McKesson Specialty Health and the US Oncology Network.
I am excited and encouraged to see the article by Dr. Newcomer and his colleagues in the Journal of Oncology Practice, demonstrating a reduction in the cost of cancer care by restructuring the revenue model to doctors and practices by removing the financial incentive to prescribe chemotherapy. It is also reassuring that they are following process measures of quality as well as outcome measures of survival in the population in the bundled payment model, in addition to their comparator population. We should all seek to reduce cost appropriately, but need to be certain that we continue to provide high-quality care to give our patients the best possible outcome.
Oncology care represents a high cost of subspecialty care in the adult population, and the oncology market is growing (as the age distribution of the population changes and people are more likely to survive their cancers and undergo chronic treatments). We as practitioners need to be able to control costs and provide high-value and high-quality care. Removing financial incentives for chemotherapy prescribing is one important part of that cost control. Bundled payment models in oncology can be another potential solution to address the cost concern. However, bundled payment systems in oncology are complex, and an outlier in cost to a practice could be financially devastating to a smaller practice. In addition, United has had other bundled pilots in oncology that have not been successful.
There are other structures of cost control that seek to align incentives with providers. WellPoint aligned with AIM to pay providers a monthly management fee for utilization of preferential pathways designed by Eviti as a prior authorization system. Dr. John Sprandio and Dr. Linda Bosserman have piloted medical oncology home projects for their smaller practices with a high level of physician oversight, seeking to reduce costs and align incentives. The US Oncology Network has Innovent Oncology, a program that aligns incentives with evidence-based Value Pathways powered by the National Comprehensive Cancer Network, advance care planning, and a nursing management system. Additionally, in order to allow physicians to access transparent, evidence-based clinical content at the point of care (which has been a major limitation for any of the pathway initiatives), Clear Value Plus was developed, which is a first of its kind clinical quality and regimen support system that’s fully embedded into McKesson Specialty Health’s iKnowMed Generation 2electronic health record (EHR), and is being developed for use in other EHRs.
I think all of these initiatives represent some progress in how we consider cost control and improve or sustain quality in oncology care, but it will always be important to continue to measure both. To measure both cost and quality, these programs need to have the informatics infrastructure in place to understand all of the long-term consequences of these measures in patient outcomes. Dr. Newcomer’s innovation in this space is an important and exciting step, but we still have a long way to go.
Dr. Debra Patt serves as the principal investigator for health economics and outcomes research for retrospective trials, as well as prospective clinical trials in breast cancer, within the US Oncology Network and leads the strategic development team for her local practice. She advocates for policies that support improving cancer care for Texas Oncology. Dr. Patt also is the director of health care informatics at McKesson Specialty Health and the US Oncology Network.
I am excited and encouraged to see the article by Dr. Newcomer and his colleagues in the Journal of Oncology Practice, demonstrating a reduction in the cost of cancer care by restructuring the revenue model to doctors and practices by removing the financial incentive to prescribe chemotherapy. It is also reassuring that they are following process measures of quality as well as outcome measures of survival in the population in the bundled payment model, in addition to their comparator population. We should all seek to reduce cost appropriately, but need to be certain that we continue to provide high-quality care to give our patients the best possible outcome.
Oncology care represents a high cost of subspecialty care in the adult population, and the oncology market is growing (as the age distribution of the population changes and people are more likely to survive their cancers and undergo chronic treatments). We as practitioners need to be able to control costs and provide high-value and high-quality care. Removing financial incentives for chemotherapy prescribing is one important part of that cost control. Bundled payment models in oncology can be another potential solution to address the cost concern. However, bundled payment systems in oncology are complex, and an outlier in cost to a practice could be financially devastating to a smaller practice. In addition, United has had other bundled pilots in oncology that have not been successful.
There are other structures of cost control that seek to align incentives with providers. WellPoint aligned with AIM to pay providers a monthly management fee for utilization of preferential pathways designed by Eviti as a prior authorization system. Dr. John Sprandio and Dr. Linda Bosserman have piloted medical oncology home projects for their smaller practices with a high level of physician oversight, seeking to reduce costs and align incentives. The US Oncology Network has Innovent Oncology, a program that aligns incentives with evidence-based Value Pathways powered by the National Comprehensive Cancer Network, advance care planning, and a nursing management system. Additionally, in order to allow physicians to access transparent, evidence-based clinical content at the point of care (which has been a major limitation for any of the pathway initiatives), Clear Value Plus was developed, which is a first of its kind clinical quality and regimen support system that’s fully embedded into McKesson Specialty Health’s iKnowMed Generation 2electronic health record (EHR), and is being developed for use in other EHRs.
I think all of these initiatives represent some progress in how we consider cost control and improve or sustain quality in oncology care, but it will always be important to continue to measure both. To measure both cost and quality, these programs need to have the informatics infrastructure in place to understand all of the long-term consequences of these measures in patient outcomes. Dr. Newcomer’s innovation in this space is an important and exciting step, but we still have a long way to go.
Dr. Debra Patt serves as the principal investigator for health economics and outcomes research for retrospective trials, as well as prospective clinical trials in breast cancer, within the US Oncology Network and leads the strategic development team for her local practice. She advocates for policies that support improving cancer care for Texas Oncology. Dr. Patt also is the director of health care informatics at McKesson Specialty Health and the US Oncology Network.
Bundling payments for cancer care that modify payment from current fee-for-service payments to one that rewards outcomes and cost efficiency can provide significant total cost-of-care reductions, results from a recent UnitedHealthcare pilot suggest.
"This study challenges the assumption that any reduction of resources results in worse outcomes for cancer," a report on the pilot states.
But while the total cost of care in this pilot showed reductions, looking just at the cost of chemotherapy drugs revealed an unexpected increase, reported Dr. Lee Newcomer, senior vice president of oncology at UnitedHealthcare, and his associates online in the Journal of Oncology Practice (2014 July 8 [doi: 10.1200/JOP.2014.001488]).
UnitedHealthcare built the pilot around five volunteer medical groups, including Northwest Georgia Oncology of Atlanta, Ga.; Center for Cancer and Blood Disorders of Fort Worth, Tex.; Kansas University in Kansas City, Kansas; Dayton Physicians of Dayton, Ohio; West Clinic of Memphis, Tenn.; and Advanced Medical Specialties of Miami, Fla. One group dropped out after it was acquired by an academic medical center and was replaced, but the article did not identify which one dropped out.
The pilot looked at breast, colon, and lung cancer treatments. UnitedHealthcare modified the standard fee-for-service (FFS) payment in four areas. First, chemotherapy drugs were reimbursed at the average sales price with no modifier (FFS has a contracted percentage modifier). Physician hospital care, hospice management, and case management all received an episode of care payment (the standard model offers FFS for physician hospital care, FFS or nothing for hospice management, and nothing for case management). The study sites also collected clinical and outcomes data. Medical groups were free to change their preferred drug regimen at any time, and new drugs added were paid at their respective rates, but a change did not cause a change with the episodic payments.
Predicted FFS total cost for the episode cohort was $98.1 million, but the actual total medical cost was $64.8 million. The predicted FFS chemotherapy drug cost was $7.5 million, but the actual cost was $21.0 million. The study was not designed to determine the expenses that drove the differences in cost, although a subset analysis showed a statistically valid decrease in hospitalization and therapeutic radiology usage in the episode arm.
Most quality outcomes had "insufficient numbers for statistical analysis," the report notes, though lung cancer survivors "were the only evaluable subgroup, and there was no significant survival difference between the episode and registry patients. ... Overall, multiple quality measures were monitored, and none of them provided an early signal that quality of care was different than controls."
Regarding the chemotherapy drug costs, the report’s authors noted that the increased costs were "not expected," considering the fact that the episodic payment scheme included several incentives to keep drug costs down, with no payment benefit for using more expensive drugs.
The authors suggested that the study be replicated to determine its generalization, which they say is possible with the automation of many of the claims-adjudication functions that were done manually for the study. They added that the work "proves the essential concept that the cost of care for future generations can be reduced without sacrificing quality."
Three of the article’s authors, including lead author Dr. Newcomer, are employed by UnitedHealthcare and have stock ownership in the company.
Bundling payments for cancer care that modify payment from current fee-for-service payments to one that rewards outcomes and cost efficiency can provide significant total cost-of-care reductions, results from a recent UnitedHealthcare pilot suggest.
"This study challenges the assumption that any reduction of resources results in worse outcomes for cancer," a report on the pilot states.
But while the total cost of care in this pilot showed reductions, looking just at the cost of chemotherapy drugs revealed an unexpected increase, reported Dr. Lee Newcomer, senior vice president of oncology at UnitedHealthcare, and his associates online in the Journal of Oncology Practice (2014 July 8 [doi: 10.1200/JOP.2014.001488]).
UnitedHealthcare built the pilot around five volunteer medical groups, including Northwest Georgia Oncology of Atlanta, Ga.; Center for Cancer and Blood Disorders of Fort Worth, Tex.; Kansas University in Kansas City, Kansas; Dayton Physicians of Dayton, Ohio; West Clinic of Memphis, Tenn.; and Advanced Medical Specialties of Miami, Fla. One group dropped out after it was acquired by an academic medical center and was replaced, but the article did not identify which one dropped out.
The pilot looked at breast, colon, and lung cancer treatments. UnitedHealthcare modified the standard fee-for-service (FFS) payment in four areas. First, chemotherapy drugs were reimbursed at the average sales price with no modifier (FFS has a contracted percentage modifier). Physician hospital care, hospice management, and case management all received an episode of care payment (the standard model offers FFS for physician hospital care, FFS or nothing for hospice management, and nothing for case management). The study sites also collected clinical and outcomes data. Medical groups were free to change their preferred drug regimen at any time, and new drugs added were paid at their respective rates, but a change did not cause a change with the episodic payments.
Predicted FFS total cost for the episode cohort was $98.1 million, but the actual total medical cost was $64.8 million. The predicted FFS chemotherapy drug cost was $7.5 million, but the actual cost was $21.0 million. The study was not designed to determine the expenses that drove the differences in cost, although a subset analysis showed a statistically valid decrease in hospitalization and therapeutic radiology usage in the episode arm.
Most quality outcomes had "insufficient numbers for statistical analysis," the report notes, though lung cancer survivors "were the only evaluable subgroup, and there was no significant survival difference between the episode and registry patients. ... Overall, multiple quality measures were monitored, and none of them provided an early signal that quality of care was different than controls."
Regarding the chemotherapy drug costs, the report’s authors noted that the increased costs were "not expected," considering the fact that the episodic payment scheme included several incentives to keep drug costs down, with no payment benefit for using more expensive drugs.
The authors suggested that the study be replicated to determine its generalization, which they say is possible with the automation of many of the claims-adjudication functions that were done manually for the study. They added that the work "proves the essential concept that the cost of care for future generations can be reduced without sacrificing quality."
Three of the article’s authors, including lead author Dr. Newcomer, are employed by UnitedHealthcare and have stock ownership in the company.
FROM THE JOURNAL OF ONCOLOGY PRACTICE
Key clinical point: Bundling physician payments for cancer care does not appear to affect quality of patient care or patient outcomes.
Major finding: Total cost of cancer care was lower when portions of payment were bundled, compared with traditional fee-for-service.
Data source: The study modified four payment elements for lung, breast, and colon cancer at five volunteer community cancer settings, with cost of care and outcome measures of those receiving care under the bundled payment scheme compared to usual fee-for-service.
Disclosures: Three of the article’s authors, including lead author Dr. Newcomer, are employed by UnitedHealthcare and have stock ownership in the company.
Bundled payment pilot shows promise for reducing cost of cancer care
Bundling payments for cancer care that modify payment from current fee-for-service payments to one that rewards outcomes and cost efficiency can provide significant total cost-of-care reductions, results from a recent UnitedHealthcare pilot suggest.
"This study challenges the assumption that any reduction of resources results in worse outcomes for cancer," a report on the pilot states.
But while the total cost of care in this pilot showed reductions, looking just at the cost of chemotherapy drugs revealed an unexpected increase, reported Dr. Lee Newcomer, senior vice president of oncology at UnitedHealthcare, and his associates online in the Journal of Oncology Practice (2014 July 8 [doi: 10.1200/JOP.2014.001488]).
UnitedHealthcare built the pilot around five volunteer medical groups, including Northwest Georgia Oncology of Atlanta, Ga.; Center for Cancer and Blood Disorders of Fort Worth, Tex.; Kansas University in Kansas City, Kansas; Dayton Physicians of Dayton, Ohio; West Clinic of Memphis, Tenn.; and Advanced Medical Specialties of Miami, Fla. One group dropped out after it was acquired by an academic medical center and was replaced, but the article did not identify which one dropped out.
The pilot looked at breast, colon, and lung cancer treatments. UnitedHealthcare modified the standard fee-for-service (FFS) payment in four areas. First, chemotherapy drugs were reimbursed at the average sales price with no modifier (FFS has a contracted percentage modifier). Physician hospital care, hospice management, and case management all received an episode of care payment (the standard model offers FFS for physician hospital care, FFS or nothing for hospice management, and nothing for case management). The study sites also collected clinical and outcomes data. Medical groups were free to change their preferred drug regimen at any time, and new drugs added were paid at their respective rates, but a change did not cause a change with the episodic payments.
Predicted FFS total cost for the episode cohort was $98.1 million, but the actual total medical cost was $64.8 million. The predicted FFS chemotherapy drug cost was $7.5 million, but the actual cost was $21.0 million. The study was not designed to determine the expenses that drove the differences in cost, although a subset analysis showed a statistically valid decrease in hospitalization and therapeutic radiology usage in the episode arm.
Most quality outcomes had "insufficient numbers for statistical analysis," the report notes, though lung cancer survivors "were the only evaluable subgroup, and there was no significant survival difference between the episode and registry patients. ... Overall, multiple quality measures were monitored, and none of them provided an early signal that quality of care was different than controls."
Regarding the chemotherapy drug costs, the report’s authors noted that the increased costs were "not expected," considering the fact that the episodic payment scheme included several incentives to keep drug costs down, with no payment benefit for using more expensive drugs.
The authors suggested that the study be replicated to determine its generalization, which they say is possible with the automation of many of the claims-adjudication functions that were done manually for the study. They added that the work "proves the essential concept that the cost of care for future generations can be reduced without sacrificing quality."
Three of the article’s authors, including lead author Dr. Newcomer, are employed by UnitedHealthcare and have stock ownership in the company.
I am excited and encouraged to see the article by Dr. Newcomer and his colleagues in the Journal of Oncology Practice, demonstrating a reduction in the cost of cancer care by restructuring the revenue model to doctors and practices by removing the financial incentive to prescribe chemotherapy. It is also reassuring that they are following process measures of quality as well as outcome measures of survival in the population in the bundled payment model, in addition to their comparator population. We should all seek to reduce cost appropriately, but need to be certain that we continue to provide high-quality care to give our patients the best possible outcome.
Oncology care represents a high cost of subspecialty care in the adult population, and the oncology market is growing (as the age distribution of the population changes and people are more likely to survive their cancers and undergo chronic treatments). We as practitioners need to be able to control costs and provide high-value and high-quality care. Removing financial incentives for chemotherapy prescribing is one important part of that cost control. Bundled payment models in oncology can be another potential solution to address the cost concern. However, bundled payment systems in oncology are complex, and an outlier in cost to a practice could be financially devastating to a smaller practice. In addition, United has had other bundled pilots in oncology that have not been successful.
There are other structures of cost control that seek to align incentives with providers. WellPoint aligned with AIM to pay providers a monthly management fee for utilization of preferential pathways designed by Eviti as a prior authorization system. Dr. John Sprandio and Dr. Linda Bosserman have piloted medical oncology home projects for their smaller practices with a high level of physician oversight, seeking to reduce costs and align incentives. The US Oncology Network has Innovent Oncology, a program that aligns incentives with evidence-based Value Pathways powered by the National Comprehensive Cancer Network, advance care planning, and a nursing management system. Additionally, in order to allow physicians to access transparent, evidence-based clinical content at the point of care (which has been a major limitation for any of the pathway initiatives), Clear Value Plus was developed, which is a first of its kind clinical quality and regimen support system that’s fully embedded into McKesson Specialty Health’s iKnowMed Generation 2electronic health record (EHR), and is being developed for use in other EHRs.
I think all of these initiatives represent some progress in how we consider cost control and improve or sustain quality in oncology care, but it will always be important to continue to measure both. To measure both cost and quality, these programs need to have the informatics infrastructure in place to understand all of the long-term consequences of these measures in patient outcomes. Dr. Newcomer’s innovation in this space is an important and exciting step, but we still have a long way to go.
Dr. Debra Patt serves as the principal investigator for health economics and outcomes research for retrospective trials, as well as prospective clinical trials in breast cancer, within the US Oncology Network and leads the strategic development team for her local practice. She advocates for policies that support improving cancer care for Texas Oncology. Dr. Patt also is the director of health care informatics at McKesson Specialty Health and the US Oncology Network.
I am excited and encouraged to see the article by Dr. Newcomer and his colleagues in the Journal of Oncology Practice, demonstrating a reduction in the cost of cancer care by restructuring the revenue model to doctors and practices by removing the financial incentive to prescribe chemotherapy. It is also reassuring that they are following process measures of quality as well as outcome measures of survival in the population in the bundled payment model, in addition to their comparator population. We should all seek to reduce cost appropriately, but need to be certain that we continue to provide high-quality care to give our patients the best possible outcome.
Oncology care represents a high cost of subspecialty care in the adult population, and the oncology market is growing (as the age distribution of the population changes and people are more likely to survive their cancers and undergo chronic treatments). We as practitioners need to be able to control costs and provide high-value and high-quality care. Removing financial incentives for chemotherapy prescribing is one important part of that cost control. Bundled payment models in oncology can be another potential solution to address the cost concern. However, bundled payment systems in oncology are complex, and an outlier in cost to a practice could be financially devastating to a smaller practice. In addition, United has had other bundled pilots in oncology that have not been successful.
There are other structures of cost control that seek to align incentives with providers. WellPoint aligned with AIM to pay providers a monthly management fee for utilization of preferential pathways designed by Eviti as a prior authorization system. Dr. John Sprandio and Dr. Linda Bosserman have piloted medical oncology home projects for their smaller practices with a high level of physician oversight, seeking to reduce costs and align incentives. The US Oncology Network has Innovent Oncology, a program that aligns incentives with evidence-based Value Pathways powered by the National Comprehensive Cancer Network, advance care planning, and a nursing management system. Additionally, in order to allow physicians to access transparent, evidence-based clinical content at the point of care (which has been a major limitation for any of the pathway initiatives), Clear Value Plus was developed, which is a first of its kind clinical quality and regimen support system that’s fully embedded into McKesson Specialty Health’s iKnowMed Generation 2electronic health record (EHR), and is being developed for use in other EHRs.
I think all of these initiatives represent some progress in how we consider cost control and improve or sustain quality in oncology care, but it will always be important to continue to measure both. To measure both cost and quality, these programs need to have the informatics infrastructure in place to understand all of the long-term consequences of these measures in patient outcomes. Dr. Newcomer’s innovation in this space is an important and exciting step, but we still have a long way to go.
Dr. Debra Patt serves as the principal investigator for health economics and outcomes research for retrospective trials, as well as prospective clinical trials in breast cancer, within the US Oncology Network and leads the strategic development team for her local practice. She advocates for policies that support improving cancer care for Texas Oncology. Dr. Patt also is the director of health care informatics at McKesson Specialty Health and the US Oncology Network.
I am excited and encouraged to see the article by Dr. Newcomer and his colleagues in the Journal of Oncology Practice, demonstrating a reduction in the cost of cancer care by restructuring the revenue model to doctors and practices by removing the financial incentive to prescribe chemotherapy. It is also reassuring that they are following process measures of quality as well as outcome measures of survival in the population in the bundled payment model, in addition to their comparator population. We should all seek to reduce cost appropriately, but need to be certain that we continue to provide high-quality care to give our patients the best possible outcome.
Oncology care represents a high cost of subspecialty care in the adult population, and the oncology market is growing (as the age distribution of the population changes and people are more likely to survive their cancers and undergo chronic treatments). We as practitioners need to be able to control costs and provide high-value and high-quality care. Removing financial incentives for chemotherapy prescribing is one important part of that cost control. Bundled payment models in oncology can be another potential solution to address the cost concern. However, bundled payment systems in oncology are complex, and an outlier in cost to a practice could be financially devastating to a smaller practice. In addition, United has had other bundled pilots in oncology that have not been successful.
There are other structures of cost control that seek to align incentives with providers. WellPoint aligned with AIM to pay providers a monthly management fee for utilization of preferential pathways designed by Eviti as a prior authorization system. Dr. John Sprandio and Dr. Linda Bosserman have piloted medical oncology home projects for their smaller practices with a high level of physician oversight, seeking to reduce costs and align incentives. The US Oncology Network has Innovent Oncology, a program that aligns incentives with evidence-based Value Pathways powered by the National Comprehensive Cancer Network, advance care planning, and a nursing management system. Additionally, in order to allow physicians to access transparent, evidence-based clinical content at the point of care (which has been a major limitation for any of the pathway initiatives), Clear Value Plus was developed, which is a first of its kind clinical quality and regimen support system that’s fully embedded into McKesson Specialty Health’s iKnowMed Generation 2electronic health record (EHR), and is being developed for use in other EHRs.
I think all of these initiatives represent some progress in how we consider cost control and improve or sustain quality in oncology care, but it will always be important to continue to measure both. To measure both cost and quality, these programs need to have the informatics infrastructure in place to understand all of the long-term consequences of these measures in patient outcomes. Dr. Newcomer’s innovation in this space is an important and exciting step, but we still have a long way to go.
Dr. Debra Patt serves as the principal investigator for health economics and outcomes research for retrospective trials, as well as prospective clinical trials in breast cancer, within the US Oncology Network and leads the strategic development team for her local practice. She advocates for policies that support improving cancer care for Texas Oncology. Dr. Patt also is the director of health care informatics at McKesson Specialty Health and the US Oncology Network.
Bundling payments for cancer care that modify payment from current fee-for-service payments to one that rewards outcomes and cost efficiency can provide significant total cost-of-care reductions, results from a recent UnitedHealthcare pilot suggest.
"This study challenges the assumption that any reduction of resources results in worse outcomes for cancer," a report on the pilot states.
But while the total cost of care in this pilot showed reductions, looking just at the cost of chemotherapy drugs revealed an unexpected increase, reported Dr. Lee Newcomer, senior vice president of oncology at UnitedHealthcare, and his associates online in the Journal of Oncology Practice (2014 July 8 [doi: 10.1200/JOP.2014.001488]).
UnitedHealthcare built the pilot around five volunteer medical groups, including Northwest Georgia Oncology of Atlanta, Ga.; Center for Cancer and Blood Disorders of Fort Worth, Tex.; Kansas University in Kansas City, Kansas; Dayton Physicians of Dayton, Ohio; West Clinic of Memphis, Tenn.; and Advanced Medical Specialties of Miami, Fla. One group dropped out after it was acquired by an academic medical center and was replaced, but the article did not identify which one dropped out.
The pilot looked at breast, colon, and lung cancer treatments. UnitedHealthcare modified the standard fee-for-service (FFS) payment in four areas. First, chemotherapy drugs were reimbursed at the average sales price with no modifier (FFS has a contracted percentage modifier). Physician hospital care, hospice management, and case management all received an episode of care payment (the standard model offers FFS for physician hospital care, FFS or nothing for hospice management, and nothing for case management). The study sites also collected clinical and outcomes data. Medical groups were free to change their preferred drug regimen at any time, and new drugs added were paid at their respective rates, but a change did not cause a change with the episodic payments.
Predicted FFS total cost for the episode cohort was $98.1 million, but the actual total medical cost was $64.8 million. The predicted FFS chemotherapy drug cost was $7.5 million, but the actual cost was $21.0 million. The study was not designed to determine the expenses that drove the differences in cost, although a subset analysis showed a statistically valid decrease in hospitalization and therapeutic radiology usage in the episode arm.
Most quality outcomes had "insufficient numbers for statistical analysis," the report notes, though lung cancer survivors "were the only evaluable subgroup, and there was no significant survival difference between the episode and registry patients. ... Overall, multiple quality measures were monitored, and none of them provided an early signal that quality of care was different than controls."
Regarding the chemotherapy drug costs, the report’s authors noted that the increased costs were "not expected," considering the fact that the episodic payment scheme included several incentives to keep drug costs down, with no payment benefit for using more expensive drugs.
The authors suggested that the study be replicated to determine its generalization, which they say is possible with the automation of many of the claims-adjudication functions that were done manually for the study. They added that the work "proves the essential concept that the cost of care for future generations can be reduced without sacrificing quality."
Three of the article’s authors, including lead author Dr. Newcomer, are employed by UnitedHealthcare and have stock ownership in the company.
Bundling payments for cancer care that modify payment from current fee-for-service payments to one that rewards outcomes and cost efficiency can provide significant total cost-of-care reductions, results from a recent UnitedHealthcare pilot suggest.
"This study challenges the assumption that any reduction of resources results in worse outcomes for cancer," a report on the pilot states.
But while the total cost of care in this pilot showed reductions, looking just at the cost of chemotherapy drugs revealed an unexpected increase, reported Dr. Lee Newcomer, senior vice president of oncology at UnitedHealthcare, and his associates online in the Journal of Oncology Practice (2014 July 8 [doi: 10.1200/JOP.2014.001488]).
UnitedHealthcare built the pilot around five volunteer medical groups, including Northwest Georgia Oncology of Atlanta, Ga.; Center for Cancer and Blood Disorders of Fort Worth, Tex.; Kansas University in Kansas City, Kansas; Dayton Physicians of Dayton, Ohio; West Clinic of Memphis, Tenn.; and Advanced Medical Specialties of Miami, Fla. One group dropped out after it was acquired by an academic medical center and was replaced, but the article did not identify which one dropped out.
The pilot looked at breast, colon, and lung cancer treatments. UnitedHealthcare modified the standard fee-for-service (FFS) payment in four areas. First, chemotherapy drugs were reimbursed at the average sales price with no modifier (FFS has a contracted percentage modifier). Physician hospital care, hospice management, and case management all received an episode of care payment (the standard model offers FFS for physician hospital care, FFS or nothing for hospice management, and nothing for case management). The study sites also collected clinical and outcomes data. Medical groups were free to change their preferred drug regimen at any time, and new drugs added were paid at their respective rates, but a change did not cause a change with the episodic payments.
Predicted FFS total cost for the episode cohort was $98.1 million, but the actual total medical cost was $64.8 million. The predicted FFS chemotherapy drug cost was $7.5 million, but the actual cost was $21.0 million. The study was not designed to determine the expenses that drove the differences in cost, although a subset analysis showed a statistically valid decrease in hospitalization and therapeutic radiology usage in the episode arm.
Most quality outcomes had "insufficient numbers for statistical analysis," the report notes, though lung cancer survivors "were the only evaluable subgroup, and there was no significant survival difference between the episode and registry patients. ... Overall, multiple quality measures were monitored, and none of them provided an early signal that quality of care was different than controls."
Regarding the chemotherapy drug costs, the report’s authors noted that the increased costs were "not expected," considering the fact that the episodic payment scheme included several incentives to keep drug costs down, with no payment benefit for using more expensive drugs.
The authors suggested that the study be replicated to determine its generalization, which they say is possible with the automation of many of the claims-adjudication functions that were done manually for the study. They added that the work "proves the essential concept that the cost of care for future generations can be reduced without sacrificing quality."
Three of the article’s authors, including lead author Dr. Newcomer, are employed by UnitedHealthcare and have stock ownership in the company.
FROM THE JOURNAL OF ONCOLOGY PRACTICE
Key clinical point: Bundling physician payments for cancer care does not appear to affect quality of patient care or patient outcomes.
Major finding: Total cost of cancer care was lower when portions of payment were bundled, compared with traditional fee-for-service.
Data source: The study modified four payment elements for lung, breast, and colon cancer at five volunteer community cancer settings, with cost of care and outcome measures of those receiving care under the bundled payment scheme compared to usual fee-for-service.
Disclosures: Three of the article’s authors, including lead author Dr. Newcomer, are employed by UnitedHealthcare and have stock ownership in the company.
