01 Feb Secretary Leavitt announces federal funding, local groups may promote EMRs
Madison, Wis. – On a visit to Madison, Health and Human Services Secretary Michael Leavitt announced that a Wisconsin healthcare organization and the Madison community have been encouraged to apply for a pilot program in which local medical communities would receive larger Medicare reimbursements if they establish electronic medical records and measure and report quality.
Leavitt has become an admirer of what is going on in Wisconsin to promote the adoption of EMRs and the measuring and dissemination of healthcare quality information. He visited St. Mary’s Hospital, one of several hospitals in the process of adopting an electronic health record developed by Epic Systems, to recognize the launch of the Wisconsin Healthcare Value Exchange.
The Wisconsin Healthcare Value Exchange may apply to be part of a Medicare pilot program in 12 markets nationwide to provide financial incentives for 100 small and medium-sized medical practices to adopt EMRs that meet federal standards, and to measure and report on the quality of their care.
Leavitt has touted what the Bush Administration calls the four cornerstones of value-driven healthcare, starting with the adoption of interoperable health information technology. Initially, the 12 value exchange programs will divide $50 million in federal funds, and eventually Leavitt hopes that up to 1,200 small and medium-sized primary-care physician practices nationwide will receive higher Medicare payments in exchange for adopting certified EMRs.
Leavitt said standards for EMR adoption and quality reporting must be developed nationally and executed locally. In addition to financial incentives, HHS will provide local exchanges with Medicare data to populate their research.
Wisconsin, he indicated, already has a head start on most areas of the country. “With the Wisconsin Collaborative on Healthcare Quality, you have been inventing a system and collaborating to collect information so that local physicians can rely on those quality measures,” he said, “and in the future consumers will have good measure of quality and attach it to price and determine value, and we can begin to have competition based on value.”
Chris Queram, chief executive of the Wisconsin Collaborative for Healthcare Quality, will lead the Wisconsin Healthcare Value Exchange. The exchange will receive access to Medicare provider performance information for their communities and be part of a nationwide learning network that will provide peer-to-peer learning experiences and access to experts.
Queram has been an advocate of measuring and publishing healthcare quality information so that consumers can make better decisions about their providers and treatment options, which is one of the cornerstones of value-driven healthcare. The other pieces are the drive to measure and publish price information about healthcare procedures and to reward providers that offer quality, competitively priced healthcare. Queram said the objective is to improve how consumers select health providers and work with providers to manage their health.
According to Queram, the collaborative has continued add member medical groups and hospitals, which are located in every geographic region of the state. An estimated 50 percent of the primary care physicians in Wisconsin now are part of the collaborative, he said.
The collaborative also continues to grow in the number of quality measures reported. It now has more than 13 measures in the ambulatory practice, including chronic measures, prevention, and episodic measures, and the collaborative has plans to introduce several new measures in 2008 and 2009.
The measures are reported on the collaborative’s web site for consumers to examine. “What we’ve found is that the measures are both accurate and actionable, and as a result there is a genuine value that we are able to bring to our medical groups in terms of helping them identify how well their performance compares with other groups,” he said. “Equally important is being able to identify and make operational strategies to improve that care.”
Queram and others involved in the Wisconsin Healthcare Value Exchange have been invited to a launch meeting at the end of February, where they will learn more about expectations for the group. “I think the primary initial benefit is being involved in a network of organizations that are doing this work across the country,” Queram said. “The opportunity to benchmark ourselves against other states, the access to subject matter experts and technical expertise that will help inform us about how we can do this work even better will be a direct benefit.
“The Secretary [Leavitt] made mention to the fact there will also be access to comparative information that’s calculated for use in Medicare data, and because Medicare patients make up such a significant percentage of any average physician’s practice, that’s a significant benefit of being able to report that performance information.”
Setting the standard
Leavitt said the nation is broken down into hundreds of healthcare markets “doing their own thing to measure quality.” If chartered value exchanges are established in those markets, and they use the same standards, he predicted the emergence of a capacity to measure quality in Madison that is similar to what is used in Memphis, Tenn.
This gives people a relative sense of value and the basis of a consumer decision. “My view that healthcare isn’t really a system,” Leavitt said. “It’s a big sector, and what we have got to do is create a system out of this sector. In order to systemize, you need standards, and in order to have standards, you need the same ones.”
Each of the value exchanges will be non-profit organizations that will use national standards but be governed locally. A big part of those standards will be privacy standards, a prerequisite to the establishment of a network, to protect the integrity of the data that is electronically transmitted.
Leavitt said it’s very important that quality be measured locally based on national standards, so the HHS mantra is “national standards and local control.”
“If I were proposing to measure quality in Washington, D.C. so that a physician was dependent on some faceless bureaucrat, there would be big pushback,” he said.
In the development of standards, HHS will provide guidance on security for healthcare IT and for how providers can and cannot use patient data.
Leavitt said the future medical community will be operating in two different worlds – consumer and clinical – and they will be melded together, but personal identifiers that could accidentally be transmitted or stolen won’t be as necessary in the consumer realm.
In the consumer world, patients will increasingly use personal health records. At the moment, Leavitt said five percent of all searches on search engines are healthcare related, and all the major technology players are beginning to formulate approaches to consumer health. “If I were a Google customer, I would set up a Google personal health record, or my health plan might provide it to me,” he said. “We will all, in the future, have personal health records, so if I make a purchase at health store, I would want my medical record to capture that.”
In this consumer world, with personal health records maintained by consumers, an identifier isn’t as worrisome. In the clinical setting, where the medical community manages an EMR and will want to reach robust research conclusions, providers may have to develop new ways to identify patients. In large integrated health systems, the kind so prevalent in Wisconsin, “you probably have way around that,” Leavitt said. “Frankly, we don’t have a [national] solution for this yet. The political dynamics are such that it may take a while.”
While Wisconsin has large practices where EMRs are a bigger part of the medical culture, the picture is somewhat different nationally. A small percentage of small and medium-sized medical practices have an EMR, in part because physicians would make all the investments and consumers would derive most of the benefits.
In developing its 12-member Medicare pilot, HHS is establishing participation incentives. The local healthcare value exchanges would be paid progressively more each year if they adopt EMRs, then report certain quality measures, and then use the measures to improve quality.
Is there enough money to connect?
Jeff Thompson, CEO of Gunderson Lutheran Health System in La Crosse, said the $50 million allocation is enough money if the system is quickly deployed and used a learning tool, but everyone in the medical community has the responsibility to step up and become better connected.
“The industry that sells healthcare technology has to get it’s act together and say, `We’re going to make interoperability a part of what we’re doing.’ The healthcare organizations involved have to say, `If we’re really interested in best patient care, there is a ton of evidence that says this is where it is, and this has to be a priority for us.’
“Government has to lead in making the best pathway to move forward, both for business and for healthcare.”
Jeff Grossman, president and CEO of the University of Wisconsin Medical Foundation and senior associate dean of clinical affairs at the UW School of Medicine and Public Health, is enthusiastic about the potential benefits of EMRs, but he said the burden for funding EMRs and other healthcare IT has fallen disproportionately on healthcare providers. He said there must be greater cost sharing among insurance companies, technology vendors, the federal and state governments, and healthcare providers.
“We are committed to doing the right thing, but there still is not a very crisp business case that is driving this for providers,” Grossman said.
Dr. Barry P. Chaiken, chief medical officer for DocsNetwork, Ltd., said unless some fundamental changes are made, it’s wishful thinking to believe that vendors, providers, and insurers (payers) will come together toward the common goal of deploying electronic medical records. Chaiken, who chairs WTN Media’s Digital Health Conference Board, said there is an 800-pound gorilla in the room that cannot be ignored – an unworkable incentive structure.
“The current incentives of healthcare delivery in the U.S. are such that investment in such items as healthcare IT and preventive services deliver most benefits to stakeholders other than the entity making the investment,” he said. “The U.S. must first embrace a broad-based, all-inclusive approach to providing healthcare such that every insurer, provider, and vendor is required to provide a basic level of care so that the investment in health IT offers the accrual of benefits to everyone, irrespective of who makes the investment.
“Without some process, standard, or requirement that ensures that every entity make such investment, there is a moral hazard where some individuals or organizations will fail to make the necessary investment while accruing the benefits of someone else’s investment.”
Meet the new boss
Some concern was expressed about how a new presidential administration would view the path that has been established, and even Leavitt acknowledged there is no guarantee the next secretary of HHS will find this project as appealing as he does. But no matter what philosophy the next administration adopts, Leavitt said it would need “a system like ours to get it to work.”
Kevin Hayden, secretary of the Wisconsin Department of Health and Family Services, agreed. “If you look in the state of Wisconsin and look at the support on both sides of the aisle, and then you model that to the federal level, I think so,” he said. “I think this is not a political issue, it’s a practical issue.
“The point I think we also need to realize is that as the young generation becomes older patients, our expectations for technology will be there. I’ve sensed great support for this regardless of political opinion.”
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