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Hospital EHR interoperability still advances slowly


Researchers at Harvard, the University of California at San Francisco and a senior adviser at the Office of the National Coordinator for Health IT have found that health systems may be improving very slowly in searching, sending, receiving and integrating patient data via electronic health record systems.  24.5 percent of hospitals were engaged in all four domains in 2014, the researchers found. In 2015, that percentage had grown  to 29.7 percent.

Perhaps more troubling was that 37.2 percent of hospitals in 2015 said they “rarely” or “never” use outside data for patient care while only 18.7 percent reported that they used outside data “often.”

In what’s probably an understatement, lead study author Jay Holmgren,  a  Harvard Business School doctoral student, said: “What this means is there is potentially a significant amount of waste and inefficiency in hospitals”.

The researchers found that — no surprise! — that hospitals that are part of a larger system and had a comprehensive EHR, as compared with a “basic” EHR system were more likely to have information from outside sources available to them than.

Please hit this link to read more.


ACA exchanges’ navigators are hitting roadblocks


— Photo by HurwiczRocks


For Kaiser Health News

While healthcare uncertainty roils Washington, the rest of the country is coasting toward  signup season on the Affordable Care Act insurance exchanges.

Open enrollment is just about a month away. But the current landscape is marked by funding cuts and other White House efforts to pull back on ACA outreach, which has led some people to brace for what they foresee as the toughest season yet.

And the latest wrinkle? In states that use the federal marketplace,, many navigators — nonprofit groups and workers who receive federal funding to help consumers enroll — are hitting snags completing a mandatory certification course. Those credentials are required before they can formally advise consumers or organize educational events about getting coverage.

To be sure, the training — which involves buggy, not-so-user-friendly software — has never been a smooth process.

But this year, many say they’re experiencing more technical glitches and — in a critical shift — getting less help from the Centers for Medicare & Medicaid Services, the federal agency tasked with supporting them.

“It used to be … you got the impression they were trying to help you,” said Randal Serr, director of Take Care Utah, a navigator organization based in Salt Lake City. “Now it seems, passively, this is not their priority.” He reports that he has experienced firsthand the slow responses to these technical difficulties.

CMS did not provide comment for this story.CMS

Chief among the complaints are repeated error messages and lost or unsaved work after sections of the training are completed.

Based on interviews with navigators as well as advocates and experts who work with their organizations, when these problems arise, they compound an already uphill climb to sign people up for ACA health coverage.

“I don’t know how much icing we need on this cake, but it’s more icing on the cake,” said Shelli Quenga, director of programs for the Palmetto Project, in South Carolina, whose federal grant was cut by more than 50 percent.

Software problems are occurring more frequently than in the past at her organization, Quenga said. Meanwhile, she added, it can take weeks before CMS resolves the issue — a delay she didn’t recall experiencing in previous years. On top of the funding cuts and administration’s messages that undermine enrollment, it’s “a new circle of Dante’s hell,” she said.

But even as navigators from a number of states report problems, others say their experiences haven’t differed from other years.

Adam VanSpankeren, a Wisconsin-based navigator, said he faced a few bugs in completing his training, but nothing unusual. When he sought technical support, he added, he received quick and thorough help. Amalia Benvenutti, a Georgia-based insurer, reported a similar encounter.

“There has always been the occasional odd bug with a particular module not saving or the site crashing — the interface is a bit clunky — but nothing that I would describe as more restrictive or onerous than previous years,” VanSpankeren said.

Daniel Bouton, who organizes the marketplace program at a Dallas-based navigator group and has already experienced some of these problems, sees a larger pattern. He worries that will almost certainly affect how many consumers can both access information about their insurance options and how many actually get covered.

Together, these challenges underscore the impact of the Trump administration’s broader disinterest in maintaining much of Obamacare’s vast apparatus.

“Local organizations are feeling the cut on funding. Then you move to, ‘OK, I’m not going to have enough funds for a strong marketing campaign. I’ll utilize my navigators, and go back to grass roots, and do door-to-door marketing.’ But then you go back to, ‘I can’t send my navigators out because they’re not certified,’” Bouton said. “I have this feeling of having our hands tied.”

And there are other potential delays. Many navigator groups saw their federal funding cut this year — a change that required them to submit new working budget proposals to CMS by last Wednesday. It’s unclear if or when they will receive federal approval, which some said could further cut into planning and outreach efforts.

Meanwhile, these challenges come as open enrollment — which starts Nov. 1 — for the first time lasts only six weeks compared with three months in previous seasons. CMS also indicated it will for the first time be shutting down the website on most Sundays of open enrollment, which officials say is for maintenance. Sundays, though, have typically been a prime time for consumers to sign up.

And at the same time, the learning curve is steeper. Many consumers aren’t aware that the enrollment period is shorter, Quenga said. Because of congressional back-and-forth, she added, some aren’t even sure if Obamacare is still in effect.

“People need that in-person assistance to understand the subtleties and nuances of a very complicated system,” she said. “You’re cutting these people off at the knees.”

Fitch sees Feds as greatest threat to for-profit hospitals’ earnings

Steward becomes largest for-profit hospital chain


Boston-based Steward Health has become America’s largest for-profit hospital operator. It now owns and operates a total of 36 hospitals in 10 states, with 1,400 physicians and 4,700 physicians in an integrated network.

It reached this status with the completion of  its acquisition of ISASIS Healthcare last week.

Steward Health didn’t disclose the cost of the deal, but Boston Business Journal reported that Medical Properties Trust contributed $1.4 billion of the $1.9 billion purchase of the acquired hospital’s real estate that was in the agreement.

T0 read more, please hit this link.



Senate bill would extend telehealth benefits to several Medicare populations battling chronic illnesses

Telehealth blood-pressure monitor.

Lawmakers and telehealth advocates have lauded  the  U.S. Senate’s passage of bipartisan legislation to extend telehealth benefits to several patient populations battling chronic illnesses.

After another failed attempt to repeal the Affordable Care Act, the Senate has unanimously passed the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017.

The measure would let Medicare Accountable Care Organizations expand the use of telehealth, build broader telehealth benefits into Medicare Advantage plans and expand virtual care for stroke and dialysis patients.

“The CHRONIC Care Act will mean more care at home and less in institutions. It will expand the use of lifesaving technology,” Sen. Ron Wyden (D-Ore.), said on the Senate floor before the vote. “It places a stronger focus on primary care. It gives seniors, however they get Medicare, more tools and options to receive care specifically targeted to address their chronic illnesses and keep them healthy. Those are all important steps forward in updating the Medicare guarantee.”

To read more, please hit this link.


Community health centers anxiously await congressional rescue



For Kaiser Health News

One community health center in New York has frozen hiring. Another in Missouri can’t get a bank loan to expand.

The nation’s 1,400 community health centers are carefully watching expenses in case the financial rescue they hope Congress delivers very soon doesn’t arrive. With four days left in the government’s fiscal year, Congress has not voted on reauthorizing billions of dollars now going to community health centers and other health programs for the 2018 budget year that starts Sunday.

“The anxiety level is increasing on almost a daily basis,” said Dan Hawkins, senior vice president of the National Association of Community Health Centers (NACHC) in Washington, D.C. “There is broad support and agreement in Congress that it should get done, but we are working against a ticking clock and a crowded legislative calendar.”

For the past two weeks, the GOP’s scramble to repeal the Affordable Care Act before the month ends pushed other healthcare matters off the congressional agenda. That effort ended Tuesday when Senate Republicans said they would not seek a vote this week because they lacked enough support to pass the bill.

It’s not clear if lawmakers’ lighter agenda will now leave room for funding health centers or deciding other issues, such as renewing the Children’s Health Insurance Program (CHIP), which also expires Sept. 30. At a hearing Sept. 25,  Senate Finance Committee Chairman Orrin Hatch (R.-Utah) urged his colleagues to work with the Senate’s health committee to settle the matter. NACHC officials privately express optimism that a deal might come later in October if not by Sunday.

Community health centers operate in more than 9,500 locations, serving 27 million people, according to the NACHC. They are the main source of healthcare for many low-income Americans — and the only source of primary care in many underserved areas.

Health centers provide preventive care, counseling, dentistry and primary care to everyone, whether or not they can pay. A sliding fee scale based on income and family size is available to patients without insurance.

In 2015, nearly 1 in 6 Medicaid beneficiaries received health-center services, the Kaiser Family Foundation reported this year. (Kaiser Health News is an editorially independent program of the foundation.)

“The end result is these are people who will be locked out of health care” without new funding, Hawkins said.

Community health centers gained billions of dollars in federal revenue under the ACA, which created a special trust fund to support them from 2011 through 2015. The Community Health Center Fund was extended in 2015 for two years with an additional $3.6 billion annually.

That money represents 70 percent of all federal grants to health centers and about a fifth of their annual revenue. Medicaid reimbursements account for the largest share, about 40 percent.

One beneficiary is Pamela Richardson, a 60-year-old patient of Valley Community Healthcare,in North Hollywood, Calif., who suffers from an iron- absorption disorder called hereditary hemochromatosis. She was unable to get health insurance before Obamacare prohibited insurers from excluding people with preexisting medical conditions. The clinic helped her sign up for coverage through the Medi-Cal expansion.

Once Richardson was covered, she received long-delayed primary care, which revealed she had “scary high” blood pressure and a lump in one breast (which proved benign). “When you don’t have insurance you don’t get breast exams. You don’t have Pap smears,” she told a KHN reporter earlier this year. “I wish people had a little more patience with Obamacare. Once you get what’s wrong with you under control, the cost would come down.”

California has by far the most federally funded health centers and they serve 6.2 million Californians, according to CaliforniaHealth+ Advocates, which represents state clinics. They have received over $1.6 billion from 2011 through 2016 from the Community Health Center Fund, more than any other state, the Congressional Research Service reported in January.

If health centers receive no new funds for 2018, the ensuing financial crunch would cost 51,000 jobs, force the centers to close 2,800 locations and cause 9 million people to lose healthcare services, according to a budget document that the Health and Human Services Department gave Congress in July.

Uncertainty about what Congress will do now is already causing problems. Hawkins said his members call him and his staff every day, fretting about employment contracts, lease agreements and equipment rentals that run past Oct. 1.

Neighborhood Health in Nashville, Tenn., has federal grant money that will carry it through Jan. 31, but CEO Mary Bufwack said some of her 180 staff members live paycheck to paycheck and are getting nervous about Neighborhood’s stability.

Bufwack is worried the health center won’t receive money it needs to replace a clinic, a project now being planned.

She fears that a new doctor she recruited to join Neighborhood next June will take another job before she can get his signature on an employment contract. And she doesn’t want to do that until she’s sure about her budget.

Mostly, she worries that whatever Congress gives her will be only for one year.

“We’re already worried about next Sept. 30,” Bufwack said.

Future hospitals to go to patients


Photo by Oxyman

Anders Wold,  CEO of GE Healthcare Clinical Care Solutions,  writes in Med City News about how the hospital of the future will go to patients. Among his observations:

“{H}ealthcare is breaking down traditional hospital walls, and it’s not just the developed world leading this disruption. Indeed, the healthcare model for billions of people in the developing world has always been different. Lacking the massive and complicated hospital infrastructure of other regions, medical care in many parts of the world travels to the patient in the form of a visit from a local doctor or a stop at a rural clinic.

“This ‘last mile of care’ – where the hospital finds the patient, not the other way around – is made possible as medical innovation across the globe becomes increasingly mobile, digital, personal and accessible.”

“While most acute care will continue to take place inside brick-and-mortar medical facilities, future generations will likely receive care virtually, and participate in their own care to greater degrees. For instance, subtle stick-on monitors that look like digital Band-Aids are being developed right now to help doctors remotely monitor key vital signs, from heart rate and blood pressure to sweat and oxygen levels.”

To read his full essay, please hit this link.

Progressives, conservatives on future healthcare steps

Kent Bottles, M.D., talks with healthcare analysts to see what might next, afterthe collapse of the Graham-Cassidy. Dr. Bottles is a lecturer at the Thomas Jefferson University School of Population Health, in Philadelphia, and chief medical officer of PYA Analytics.  He writes that Congress is unlikely to take on healthcare in the next few months. But it’s worth  looking at the healthcare agendas of progressives and conservatives going forward.

He writes in Hospital Impact:

“Progressives are committed to protecting the Affordable Care Act and extending healthcare coverage to all Americans. There is not consensus about how to accomplish this goal:

  • “Some are advocating for ‘Midlife Medicare,’ which would be open to citizens ages 50 to 64.”
  • “Sen. Brian Schatz (D.-Hawaii), has proposed a bill that would extend the Medicaid program to all who wanted to seek coverage under that program.”
  • “Sen. Bernie Sanders (I.-Vt.)  has garnered support from many mainstream Democratic senators for a ‘Medicare for all’ measure.”
  • “Others think that expanding Medicaid, providing coverage for immigrants, fixing the ACA family glitch and extending CHIP are the best ways to go.”

“Since many conservatives do not think the federal government should play any role in healthcare, opposition to the ACA is easier than coming up with a replacement solution. Leading conservative experts do not agree on what to do next:

  • “Michael Cannon of the Cato Institute still thinks repealing the ACA is the only way to go.”
  • “Avik Roy of the Foundation for Research on Equal Opportunity would favor a system similar to Switzerland’s with universal coverage through private insurance and subsidization, but no individual mandate, per the article.”
  • “Doug Holtz-Eakin of the American Action Forum would focus on changing the delivery system to decrease cost and not concentrate on insurance coverage.”
  • “Sen. Ted Cruz (R.-Texas) has proposed allowing insurers to sell non-ACA-compliant plans in any given state as long as they sell at least one ACA-compliant plan there.”

To read more, please hit this link.




New EHR system lets rural health system boost population-health oversight


Hospitals & Health Networks reports on how Coteau des Prairies Health Care System, in South Dakota,  improved its population-health capabilities by fixing its EHR system

The 25-bed acute care system, based in Sisseton, had  “limited staff, burdensome administrative tasks and low satisfaction among providers and patients,” H&HN reported. But a new CEO, Michael Coyle,  started by bringing on a new leadership team and looking at various departments.

“His team asked staff and one another a number of questions: Are there standard operational procedures? Did patients trust the staff? What was the culture like at Coteau des Prairies? And did everyone in the system smile?

“During their review, Coyle and his team heard concerns again and again about the electronic health record system in place. One member of the staff went as far as to describe it as a ‘rock pile,’ Coyle said. He discovered that the EHR wasn’t set up correctly and wasn’t being used by any providers, and that the data didn’t exist.”

Within six months, Coteau des Prairies had a new EHR.

“Coteau des Prairies now has 100 percent physician usage of its EHR, a percentage that Coyle says he has not achieved in any system he’s worked at before. Provider trust has also improved. Many of the clinicians travel to multiple clinics, and the new system allows for records to be readily accessed across locations.

“The data collected by the new EHR have created a picture of the health needs of the population served by Coteau des Prairies. If any condition is 30 percent higher than the system’s average, Coyle and his team re-evaluate how they’re allocating physician hours across the system.”

To read more, please hit this link.

How some poor communities improved healthcare


The Commonwealth Fund looked at a few U.S. communities that have made progress on a majority of healthcare indicators included in the Commonwealth Fund’s latest “Scorecard on Local Health System Performance.  Interestingly, half were in regions where poverty rates exceed the national average.

It looked at how, for example:

  • “Stockton, the northern California city that filed for bankruptcy after the 2008 housing crash, managed to reduce avoidable hospitalizations, emergency department visits, and readmissions.
  • “Pueblo, a Colorado city where nearly half of the population lives below the poverty line, promotes shared accountability for solving problems.
  • “Paducah, in rural western Kentucky, leveraged Medicaid expansion to meet the primary care needs of newly insured low-income residents.
  • “Akron, Ohio, in the nation’s Rust Belt, has been tackling obesity, infant mortality, and opioid addiction.”

To read more, please hit this link.

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