Chad Hayes, M.D., looks at what he thinks it would look like if auto mechanics were paid like physicians. And many people think they should ne paid like mechanics in the exciting new world of healthcare-payment reform.
Chad Hayes, M.D., looks at what he thinks it would look like if auto mechanics were paid like physicians. And many people think they should ne paid like mechanics in the exciting new world of healthcare-payment reform.
The article notes:
“There is no single pathway through which all states will be able to achieve integrated behavioral and physical healthcare; the best strategy or combination of strategies will depend on a state’s political and healthcare environment. However, regardless of the approach, states will succeed only if they put in place a cohesive framework that enables providers to deliver integrated care to Medicaid patients with comorbid physical and behavioral health needs.”
The article addresses:
”Who should have the difficult discussion of the goals of care with Anne {the patient}? With whom does this responsibility lie? What course of action should you take?
Here are three options:
”1. As the primary care physician, discuss the goals of care with the patient yourself.
”2. Recommend that the oncology team discuss the goals of care with the patient.
”3. Refer the patient to a palliative care physician who will discuss the goals of care with the patient.”
Starting immediately, the federal government is making it harder for nursing homes to get top grades on a public report card, in part by increasing scrutiny of their use of anti-psychotic drugs and raising the bar on an array of quality measures.
Those grades – in the form of one- to five-star ratings – are part of Nursing Home Compare, a government Web site to help consumers evaluate nursing homes. While the star ratings, which debuted in December 2008, are lauded as an important tool, critics say they rely too heavily on self-reported data and allow a majority of homes to score high ratings.
The Web site rates more than 15,000 nursing homes in three broad categories: government inspections, quality measures and staffing levels. An overall score is a fourth category.
The system has come under recent criticism with complaints that some highly rated nursing homes have numerous problems and face fines and other enforcement actions. On Thursday, the federal government said it would require nursing homes to do more to get higher quality scores.
Among the better-known measures that go into quality scores are the percentages of residents who develop bed sores or are injured in falls. The scores will now count the percentage of residents given anti-psychotic drugs, reflecting concern that too many are unnecessarily drugged to make them easier to manage. All of those measures will continue to be reported by the homes themselves, however.
The changes mean many homes could drop a star or more from their January levels, even though nothing may have changed, said officials from the Center for Medicare & Medicaid Services. They declined to say how many might see a ratings drop.
Consumer advocates welcomed the adjustments, but industry officials said the new rules may confuse patients and their families if scores change suddenly.
“If centers across the country start losing star ratings overnight, it sends a signal to families and residents that quality is on the decline, ” said Mark Parkinson, president and CEO of the American Healthcare Association, the industry lobby.
But Brian Lee with Families for Better Care, a Florida-based advocacy group for nursing-home residents and their families, said the shift was necessary. More information is always better, he said. He and other advocates had raised concerns that high rates were too easy to achieve.
Lee said about 55 percent of the nation’s nursing homes had overall scores of either four or five stars on Nursing Home Compare in January. Drilling down, Lee said only about one-third of them got four or five stars on the website for inspections, which he calls the most objective measure because it is based on government, rather than self-reported data. “But when you look at the quality scores portion, 80 percent of homes are four- or five-star rated,” Lee said. “Something is not coming out in the wash.”
The new ratings will be reflected on the website as of Feb. 20. Nursing home administrators will be able to see their scores under the new system starting Friday.
The changes follow others announced in October that require additional verification of self-reported staffing levels and other efforts to confirm quality data submitted by the homes.
Anyway, Messrs. Ubi and Nexon assert in HealthAffairs that the medical- innovation ”eco-system” is “severely stressed” and they say that policy improvements are essential.
They write that the biggest problems include: reduced investment; reduced revenue growth; flight of clinical trials and first-product introduction out of the United States; increasing difficulty in getting public and private insurers to cover patient costs to use new medical devices and diagnostics, and disincentives for providers to adopt new technology.
*”The FDA and the Centers for Medicare and Medicaid Services (CMS) should adopt a seamless, accelerated process for approval of breakthrough products that offer the promise of significant improvements in treatment or diagnosis of serious illnesses.”
*”The FDA needs to continue to progress toward the goal articulated in the device center’s recent vision statement that patients in the U.S. will have first in the world access to new medical devices.”
*”CMS needs to view encouraging medical innovation as part of its mission and review all its policies with this goal in mind.”
* “U.S. tax policy needs to be reformed to put knowledge-based, high- value-added industries on a level playing field with competitor countries. Prior to the enactment of the medical-device tax, medical technology companies paid an effective federal tax rate of 31 percent on activities …taxed in the U.S., but an average effective rate of 14 percent on activities located and taxed abroad.”
* “Engage your board of directors with the chief information security officer.”
* “Use as many layers of protection as you can. Yes, this means encryption–of data at rest and of backups….”
* “Make penetration and application vulnerability testing an ongoing priority. You can do this by incorporating them these processes into operational analysis.”
* “Hire third parties to conduct your HIPAA risk assessment.” .
* ”Don’t use the cloud to store data from applications that require strict security standards. Store this data on company-owned storage.”
* “Follow Open Web Application Security Project (OWASP) standards if you develop applications.”
www.hospitalimpact.org/index.php/2015/02/11/8_best_practices_for_payer_data_security