Jul 17, 2009 | Laboratory News, Laboratory Pathology
Goal is to improve patient safety and health outcomes, but who is going to pay?
Pathologists are aware of the ongoing debate about the overwork of medical residents, who traditionally worked 100 or more hours per week. Medical experts regularly point out how overworking medical residents may result in fatigue-related adverse events that negatively affect patient safety. These adverse events cost teaching hospitals money in additional care and/or malpractice claims. Now comes a new report published in the New England Journal of Medicine (NEJM) which determined that it remains more profitable to continue this practice than to hire extra help.
The study, Cost Implications of Reduced Work Hours and Workloads for Resident Physicians, was conducted by researchers from UCLA and the RAND Corp, a nonprofit research facility in Los Angeles. The study was initiated in response to recommendations from the Institute of Medicine (IOM) to limit medical resident work hours.
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Oct 13, 2008 | Laboratory Management and Operations, Laboratory Pathology
It’s tough to get an accurate picture of EMR (electronic medical record) adoption by office-based physicians. That’s important information for clinical laboratories because they must often provide an electronic gateway interface with physicians’ EMR systems for laboratory test ordering and results reporting.
Now comes help for clinical laboratories and pathology groups seeking to understand the pace of EMR adoption by physicians. This summer, The Institute for Health Policy published the results of a six-month study on the use of electronic health records (EHRs) in physicians’ offices in the New England Journal of Medicine. “This is the best data that there has ever been on the adoption of electronic health records by physicians,” said William Jessee, M.D., the physician president and chief executive officer of the Medical Group Management Association.
According to the abstract of the NEJM article, 4% of physicians reported having an extensive, fully-functional electronic-records system, and 13% reported having a basic system. Another finding was that the physicians most likely to be currently using EMRs were: 1) primary care physicians; 2) those physicians practicing in large groups, in hospitals or medical centers; and, 3) physicians practicing in the western region of the United States. Physicians reported positive effects of these systems on several dimensions of quality of care, as well as high levels of satisfaction in how their system performed. Financial barriers were viewed as having the greatest effect on decisions about the adoption of electronic health records.
The survey was conducted between September 2007 and March 2008 at the 902-bed Massachusetts General Hospital, Boston; the Harvard School of Public Health; George Washington University; and RTI International, working under a contract with the Office of the National Coordinator for Health Information Technology at HHS and grants from the Robert Wood Johnson Foundation.
Despite the fact that the survey revealed that 83% of physicians don’t have an EHR, the NEJM authors pointed out some good news. They noted that 16% of physicians with no EHR responded that their medical practice had purchased an EHR at the time of the survey, but it had yet to be implemented. Another 26 % of surveyed physicians said their practice was planning on implementing an EMR system in the next two years.
The conclusions of the report were that “Physicians who use electronic health records believe such systems improve the quality of care and are generally satisfied with the systems. However, as of early 2008, electronic systems had been adopted by only a small minority of U.S. physicians, who may differ from later adopters of these systems.”
The pace and nature of physician adoption and use of EHRs are important issues for medical laboratories and pathology labs. Lab managers and pathologists will want to be ahead of physician EHR adoption curve by preparing their laboratory information system (LIS) to interface with these EHRS to accept electronic test orders and directly download lab test results into the physician’s HER system.
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Oct 16, 2006 | Laboratory Management and Operations, Laboratory Pathology
Pay-for-Performance programs are not limited to the United States. In 2004, the National Health Service (NHS) of the United Kingdom introduced a pay-for-performance program for family practitioners with much acclaim. A study called Pay for-Performance Programs in Family Practices in the United Kingdom published in the New England Journal of Medicine in July of this year reported findings on the success of the program in its first year.
The National Health Service in the UK committed £1.8 billion ($3.2 billion) in additional funding over a period of three years for the pay-for-performance program for family practitioners. The program would increase practitioners’ income by up to 25%. Incentives were based on practitioners’ performance with respect to 146 indicators covering clinical care for 10 chronic diseases, organization of care, and patient experiences.
It was reported that in the first year of the new pay-for-performance program, 95.5% of practices scored highly, earning them an average of £76,200 ($133,200) each. The pay-for-performance program increased the gross income of the average family practitioner by £23,000 ($40,200), but this was partially offset by the fact that practitioners were responsible for both the nursing and the administrative costs of meeting the targets.
It cannot be denied that the UK pay-for-performance program improved quality of patient care in its first year. Doctors in the UK were awarded a significant bonus and could justify the cost of improving their practices with equipment, training, and additional staff to achieve high quality scores. Unfortunately, this may not be the case with Medicare and Medicaid pay-for-performance programs in the United States.
Federal legislation directed the pay-for-performance model to be adopted in the U.S. by mid-2006. The Centers for Medicare and Medicaid (CMS) will then begin rewarding high-performing doctors, hospitals, health plans, and other providers. Unfortunately, according to another study in the New England Journal of Medicine – Paying for Performance in the United States and Abroad – the U.S. budget will only allow for bonuses of 1 to 2%, while the United Kingdom was able to provide 5 to 10%. These smaller bonuses might not be enough incentive for US physicians to meet high performance standards because the cost of upgrading their practices may eat up the entire bonus.
Already the number of pay-for-performance programs offered by private payers is increasing each year. As grades and rewards are directed to doctors based on their performance, it increases the likelihood is high that they will select labs based on reputation and quality. Furthermore, the CMS may adopt pay-for-performance programs for laboratories that provide them with incentives based on their turnaround time, the accuracy of their results, and other performance factors. Laboratories should be tracking the pay-for-performance trend to understand what indicators are likely to be used to evaluate and reward clinical labs.
