The Week in Review - April 16, 2009

National Association of Community Health Centers (NACHC) reports that 60 million lack access to care. NACHC links the "growth of the 'medically disenfranchised' population to a host of factors that include a worsening shortage of primary care doctors in needy communities and a growing scarcity of providers willing to treat the uninsured or publicly insured."

Blue Cross Blue Shield of Minnesota initiates a pilot virtual clinic - 10 minute consultations with a doctor over the web.

Ownership of electronic health information is not clear, as the nation gears up to put this information on-line nationally by 2014.

Using genomics to assess risk of various diseases will improve over the next several years. While it's premature to test for many diseases today, "the situation may be very different in just 2 or 3 years. Appropriate guidelines are urgently needed to help physicians advise patients who are considering this form of genetic testing as to how to interpret, and when to act on, the results as they become more stable."

Health Research Insights sends letters to a physician threatening to turn him over to the feds, if he doesn't pay $347 for up-coding on 4 occasions, the earliest dating back to 2005. American Medical News reports that companies operating under ERISA are not time limited in making such claims.

The Preident and CEO of Catholic IPA Western New York argues that the national "investment in health information technology has the great potential to improve the functioning of our health care system."

Medicare's Transitions Project aims to reduce hospital re-admissions and fragmentation of care in a pilot running in 14 communities.

Washington Hospital Center in Washington DC are piloting an ethical checklist, which includes the following items to progress notes and reports:

• "Patient's wishes unclear/refusal of treatment
• Questionable capacity to consent to, or refuse, treatment
• Disagreement involving relatives/surrogates/caregivers
• End-of-life (advance directive/power of attorney, do not resuscitate/allow natural death, withdraw/withhold Rx)
• Confidentiality/disclosure issue
• Resource or fairness issue
• Other (please note)
• No notable ethical issues"

According to the New England Journal of Medicine, "only 1.5% of U.S. hospitals have a comprehensive electronic-records system (i.e., present in all clinical units), and an additional 7.6% have a basic system (i.e., present in at least one clinical unit). Computerized provider-order entry for medications has been implemented in only 17% of hospitals. Larger hospitals, those located in urban areas, and teaching hospitals were more likely to have electronic-records systems. Respondents cited capital requirements and high maintenance costs as the primary barriers to implementation, although hospitals with electronic-records systems were less likely to cite these barriers than hospitals without such systems."

The AMA launches an e-prescribing learning center for physicians.

The State Health Access Data Assistance Center and the Robert Wood Johnson Foundation "At the Brink" reports on the demographics of the uninsured broken down by state.

The Uninsured Crisis

Health Care Reform is a critical and central topic to our national financial well-being, the health of the population at large and the health of our industry. As such, Healthcare Technology News will cover news on Health Care Reform

The Institute of Medicine has released the pre-publication version of America's Uninsured Crisis: Consequences for Health and Health Care. The IOM Committee on Health Insurance Status and Its Consequences found that the country is "caught in a downward spiral: health insurance coverage is declining and will continue to decline."

Some of the committee's key findings include that

• "Health insurance coverage in the US is declining and the situation will get worse. The crisis is engulfing employer-sponsored insurance, the cornerstone of private health coverage, and also threatens expansion in public coverage.
  
• Despite the availability of some safety net services, there is a chasm between health care needs and access to effective health care services for uninsured children and adults. Health insurance coverage in the United States is integral to individuals' personal well-being and health.
• Local health care delivery appears to be vulnerable to the financial pressures associated with high community-level uninsurance rates. Analyses commissioned by the committee and other recent research strongly suggest that when community-level insurance rates are relatively high, insured adults are more likely to have difficulties obtaining needed health care."

This last finding is counter-intuitive and the process by which this occurs is not well understood by the committee. Nevertheless the committee found that "higher community uninsurance is negatively associated with several well-validated indicators of access to and satisfaction with health care for privately insured adults including having a place to go when sick, having a doctor's visit, visiting a doctor for routine preventive care and seeing a specialist when needed..."

The report also refers to the Center for Studying Health System Change which found that "problems in local health care delivery - not necessarily attributable to uninsurance - can be intensified by higher uninsurance rates. For example, providers and capital investment tend to locate ... away from communities with high uninsurance...", among other factors.

The committee concludes that the US must work "on an urgent basis to achieve health insurance coverage for everyone and, in order to make that coverage sustainable, to reduce the costs of health care and the rate of increase in per capita health care spending."

Link here to IOM's report brief on "America's Uninsured Crisis".