Mary Ellen Schneider

As physicians and hospitals begin to implement electronic health record systems in the hopes of earning financial incentives from the federal government, experts are considering how to ensure patient safety when working with health information technology.

The Health IT Policy Committee, which makes recommendations to the federal National Coordinator for Health Information Technology, met this Spring to discuss some of the areas where potential patient safety hazards exist. Topping the list were technology issues, such as software bugs, interoperability problems, and implementation and training deficiencies. Another major area of concern is the interaction of people and technology.

According to Paul Egerman, who co-chairs the Certification/Adoption Workgroup of the Health IT Policy Committee, straightforward problems with technology are actually the minority when it comes to safety issues. While these problems can be difficult to uncover, once they are discovered they can usually be easily and rapidly fixed.

The majority of safety issues surrounding health IT involve multiple factors. That complicates things, Mr. Egerman said, because that means that even if the technology worked perfectly, there could still be problems. “There are tons of issues that are completely independent of technology,” said Mr. Egerman, who is CEO of eScription, a computer-aided medical transcription company.

Also of concern is that many of the health IT-related safety issues are local. Marc Probst, who co-chairs the Certification/Adoption Workgroup, said that each health care organization is unique, and relies on very different operating systems, security and privacy protocols, and even different types of monitoring. That puts the onus on individual organizations to stay on top of safety issues raised by their health IT systems, he said.

“Every organization is going to be unique, so there is a local responsibility to HIT safety that our vendors simply aren't going to be able to keep up with,” Mr. Probst, who is the chief information officer at Intermountain Healthcare in Salt Lake City, Utah, said.

The Certification/Adoption workgroup previewed some of its ideas for gathering more data on the HIT-related safety issues and the need for more training. The workgroup released a set of preliminary recommendations that call for patients to play a greater role in identifying errors. In the physician office, for example, patients should ideally be able to observe as physicians enter information into an electronic record so they can call attention to mistakes. On the inpatient side, patients and family members should be encouraged to look at medication lists.

To gain more data on the scope of safety issues, the workgroup also called for establishing a national database and reporting system that would allow patients and health care providers to make confidential reports about incidents and potential hazards. This could be used for evaluation and analysis, but also for dissemination of potential problems, Mr. Egerman said.

As physicians and hospitals begin to implement electronic health record systems in the hopes of earning financial incentives from the federal government, experts are considering how to ensure patient safety when working with health information technology.

The Health IT Policy Committee, which makes recommendations to the federal National Coordinator for Health Information Technology, met this Spring to discuss some of the areas where potential patient safety hazards exist. Topping the list were technology issues, such as software bugs, interoperability problems, and implementation and training deficiencies. Another major area of concern is the interaction of people and technology.

According to Paul Egerman, who co-chairs the Certification/Adoption Workgroup of the Health IT Policy Committee, straightforward problems with technology are actually the minority when it comes to safety issues. While these problems can be difficult to uncover, once they are discovered they can usually be easily and rapidly fixed.

The majority of safety issues surrounding health IT involve multiple factors. That complicates things, Mr. Egerman said, because that means that even if the technology worked perfectly, there could still be problems. “There are tons of issues that are completely independent of technology,” said Mr. Egerman, who is CEO of eScription, a computer-aided medical transcription company.

Also of concern is that many of the health IT-related safety issues are local. Marc Probst, who co-chairs the Certification/Adoption Workgroup, said that each health care organization is unique, and relies on very different operating systems, security and privacy protocols, and even different types of monitoring. That puts the onus on individual organizations to stay on top of safety issues raised by their health IT systems, he said.

“Every organization is going to be unique, so there is a local responsibility to HIT safety that our vendors simply aren't going to be able to keep up with,” Mr. Probst, who is the chief information officer at Intermountain Healthcare in Salt Lake City, Utah, said.

The Certification/Adoption workgroup previewed some of its ideas for gathering more data on the HIT-related safety issues and the need for more training. The workgroup released a set of preliminary recommendations that call for patients to play a greater role in identifying errors. In the physician office, for example, patients should ideally be able to observe as physicians enter information into an electronic record so they can call attention to mistakes. On the inpatient side, patients and family members should be encouraged to look at medication lists.

To gain more data on the scope of safety issues, the workgroup also called for establishing a national database and reporting system that would allow patients and health care providers to make confidential reports about incidents and potential hazards. This could be used for evaluation and analysis, but also for dissemination of potential problems, Mr. Egerman said.

As physicians and hospitals begin to implement electronic health record systems in the hopes of earning financial incentives from the federal government, experts are considering how to ensure patient safety when working with health information technology.

The Health IT Policy Committee, which makes recommendations to the federal National Coordinator for Health Information Technology, met this Spring to discuss some of the areas where potential patient safety hazards exist. Topping the list were technology issues, such as software bugs, interoperability problems, and implementation and training deficiencies. Another major area of concern is the interaction of people and technology.

According to Paul Egerman, who co-chairs the Certification/Adoption Workgroup of the Health IT Policy Committee, straightforward problems with technology are actually the minority when it comes to safety issues. While these problems can be difficult to uncover, once they are discovered they can usually be easily and rapidly fixed.

The majority of safety issues surrounding health IT involve multiple factors. That complicates things, Mr. Egerman said, because that means that even if the technology worked perfectly, there could still be problems. “There are tons of issues that are completely independent of technology,” said Mr. Egerman, who is CEO of eScription, a computer-aided medical transcription company.

Also of concern is that many of the health IT-related safety issues are local. Marc Probst, who co-chairs the Certification/Adoption Workgroup, said that each health care organization is unique, and relies on very different operating systems, security and privacy protocols, and even different types of monitoring. That puts the onus on individual organizations to stay on top of safety issues raised by their health IT systems, he said.

“Every organization is going to be unique, so there is a local responsibility to HIT safety that our vendors simply aren't going to be able to keep up with,” Mr. Probst, who is the chief information officer at Intermountain Healthcare in Salt Lake City, Utah, said.

The Certification/Adoption workgroup previewed some of its ideas for gathering more data on the HIT-related safety issues and the need for more training. The workgroup released a set of preliminary recommendations that call for patients to play a greater role in identifying errors. In the physician office, for example, patients should ideally be able to observe as physicians enter information into an electronic record so they can call attention to mistakes. On the inpatient side, patients and family members should be encouraged to look at medication lists.

To gain more data on the scope of safety issues, the workgroup also called for establishing a national database and reporting system that would allow patients and health care providers to make confidential reports about incidents and potential hazards. This could be used for evaluation and analysis, but also for dissemination of potential problems, Mr. Egerman said.

The federal government has awarded $162 million in grants to states to aid in the secure exchange of health information across different proprietary systems.

The grants will go to 16 states and qualified state-designated entities. The money was set aside under the American Recovery and Reinvestment Act of 2009. This final round of grants follows the release of $385 million to 40 states and qualified state-designed entities in February.

“What these awards will do is strengthen our health care system and speed our economic recovery,” Kathleen Sebelius, Health and Human Services Secretary, said during a press briefing to announce the grants. “They help to unleash the power of health information technology to cut costs, eliminate paperwork, and best of all help doctors deliver higher-quality, coordinated care.”

Despite the benefits of adopting electronic health records (EHRs), only about 20% of physicians and 10% of hospitals have implemented even a basic EHR system, Ms. Sebelius said. The goal in awarding these grants is that the states will be able to develop policies and frameworks based on nationally approved technical standards, which will allow physicians and hospitals to securely share information regardless of what type of EHR system they have.

States will need to begin by bringing all the parties to the table—from physicians and hospitals to health insurers and lawyers, said Dr. David Blumenthal, the national coordinator for health information technology. These groups will need to agree on the strategic and operational plans for creating health-information exchange in each state, he said.

Health IT officials at the federal level will work closely with the states on their plans for exchanging health data. But the states are in the best position to identify and credential physicians and hospitals that should be receiving and sending private and secure health information transmissions, Dr. Blumenthal said.

The states are at different points in their implementation timeline based on their past work on health information exchange, Dr. Blumenthal added. But he said he expects that many states will have the technology and governance structures in place by 2013 to allow physicians and hospitals to meet the requirements established under the federal incentive program for EHR implementation.

Created under the Recovery Act, that program calls for physicians and hospitals to demonstrate the ability to exchange information by 2011; more robust exchange requirements start in 2013.

The federal government has awarded $162 million in grants to states to aid in the secure exchange of health information across different proprietary systems.

The grants will go to 16 states and qualified state-designated entities. The money was set aside under the American Recovery and Reinvestment Act of 2009. This final round of grants follows the release of $385 million to 40 states and qualified state-designed entities in February.

“What these awards will do is strengthen our health care system and speed our economic recovery,” Kathleen Sebelius, Health and Human Services Secretary, said during a press briefing to announce the grants. “They help to unleash the power of health information technology to cut costs, eliminate paperwork, and best of all help doctors deliver higher-quality, coordinated care.”

Despite the benefits of adopting electronic health records (EHRs), only about 20% of physicians and 10% of hospitals have implemented even a basic EHR system, Ms. Sebelius said. The goal in awarding these grants is that the states will be able to develop policies and frameworks based on nationally approved technical standards, which will allow physicians and hospitals to securely share information regardless of what type of EHR system they have.

States will need to begin by bringing all the parties to the table—from physicians and hospitals to health insurers and lawyers, said Dr. David Blumenthal, the national coordinator for health information technology. These groups will need to agree on the strategic and operational plans for creating health-information exchange in each state, he said.

Health IT officials at the federal level will work closely with the states on their plans for exchanging health data. But the states are in the best position to identify and credential physicians and hospitals that should be receiving and sending private and secure health information transmissions, Dr. Blumenthal said.

The states are at different points in their implementation timeline based on their past work on health information exchange, Dr. Blumenthal added. But he said he expects that many states will have the technology and governance structures in place by 2013 to allow physicians and hospitals to meet the requirements established under the federal incentive program for EHR implementation.

Created under the Recovery Act, that program calls for physicians and hospitals to demonstrate the ability to exchange information by 2011; more robust exchange requirements start in 2013.

The federal government has awarded $162 million in grants to states to aid in the secure exchange of health information across different proprietary systems.

The grants will go to 16 states and qualified state-designated entities. The money was set aside under the American Recovery and Reinvestment Act of 2009. This final round of grants follows the release of $385 million to 40 states and qualified state-designed entities in February.

“What these awards will do is strengthen our health care system and speed our economic recovery,” Kathleen Sebelius, Health and Human Services Secretary, said during a press briefing to announce the grants. “They help to unleash the power of health information technology to cut costs, eliminate paperwork, and best of all help doctors deliver higher-quality, coordinated care.”

Despite the benefits of adopting electronic health records (EHRs), only about 20% of physicians and 10% of hospitals have implemented even a basic EHR system, Ms. Sebelius said. The goal in awarding these grants is that the states will be able to develop policies and frameworks based on nationally approved technical standards, which will allow physicians and hospitals to securely share information regardless of what type of EHR system they have.

States will need to begin by bringing all the parties to the table—from physicians and hospitals to health insurers and lawyers, said Dr. David Blumenthal, the national coordinator for health information technology. These groups will need to agree on the strategic and operational plans for creating health-information exchange in each state, he said.

Health IT officials at the federal level will work closely with the states on their plans for exchanging health data. But the states are in the best position to identify and credential physicians and hospitals that should be receiving and sending private and secure health information transmissions, Dr. Blumenthal said.

The states are at different points in their implementation timeline based on their past work on health information exchange, Dr. Blumenthal added. But he said he expects that many states will have the technology and governance structures in place by 2013 to allow physicians and hospitals to meet the requirements established under the federal incentive program for EHR implementation.

Created under the Recovery Act, that program calls for physicians and hospitals to demonstrate the ability to exchange information by 2011; more robust exchange requirements start in 2013.

LAS VEGAS — There's a growing interest among physicians in Medicare's Physician Quality Reporting Initiative, launched in 2007, but it isn't because of the 2% bonus payments available this year.

More likely it's the possibility that the Physician Quality Reporting Initiative (PQRI) could be the basis for pay-for-performance programs down the road, Dr. Michael A. Granovsky said at a meeting on reimbursement sponsored by the American College of Emergency Physicians.

And, in the near term, the Centers for Medicare and Medicaid Services, which administers the program, could begin publishing whether doctors have successfully participated in PQRI.

“I think PQRI is here to stay,” said Dr. Granovsky, president of Medical Reimbursement Systems, based in Woburn, Mass. “I think this is the first leverage that CMS is developing to track quality and apply it on the reimbursement side. And I think they want a bigger and bigger stick over time.”

Under the PQRI program in 2010, physicians are eligible to receive up to a 2% bonus payment based on all of their Medicare Part B charges if they report successfully 80% of the time on at least three individual quality measures in 2010. They also can report on measures groups.

This year, the program includes 179 measures and 13 measures groups. In 2008, the average individual physician who successfully reported quality data received about $1,000, Dr. Granovsky said. Payments are expected to be somewhat higher this year, because the bonus was increased from 1.5% to 2%.

Over the last several years, CMS officials have laid out their vision for value-based purchasing, emphasizing their desire to pay physicians and hospitals for quality of care, rather than simply for volume of services, and to avoid unnecessary costs. PQRI is widely seen as the first step in that transition, Dr. Granovsky said.

Although the pending federal health care reform effort would include more moves in that direction, the CMS already has the tools it needs through prior legislation to make significant progress in that direction, Dr. Granovsky said. “Medicare already has the regulatory muscle to put this in place,” he said.

Medical groups that choose to participate in PQRI must commit to it, Dr. Granovsky added, because it requires a great deal of data collection and reporting. Groups also should collaborate closely with their billing company.

A regular internal auditing process will also help medical groups ensure that they are getting the most out of their reporting efforts, Dr. Granovsky said.

One of the criticisms of the PQRI program is that it takes about 18 months to get feedback reports from the CMS, making it nearly impossible to detect problems in a timely manner. However, a monthly internal audit will help alert groups if they have a data file transfer problem that could prevent their PQRI claims from being processed, he said.

LAS VEGAS — There's a growing interest among physicians in Medicare's Physician Quality Reporting Initiative, launched in 2007, but it isn't because of the 2% bonus payments available this year.

More likely it's the possibility that the Physician Quality Reporting Initiative (PQRI) could be the basis for pay-for-performance programs down the road, Dr. Michael A. Granovsky said at a meeting on reimbursement sponsored by the American College of Emergency Physicians.

And, in the near term, the Centers for Medicare and Medicaid Services, which administers the program, could begin publishing whether doctors have successfully participated in PQRI.

“I think PQRI is here to stay,” said Dr. Granovsky, president of Medical Reimbursement Systems, based in Woburn, Mass. “I think this is the first leverage that CMS is developing to track quality and apply it on the reimbursement side. And I think they want a bigger and bigger stick over time.”

Under the PQRI program in 2010, physicians are eligible to receive up to a 2% bonus payment based on all of their Medicare Part B charges if they report successfully 80% of the time on at least three individual quality measures in 2010. They also can report on measures groups.

This year, the program includes 179 measures and 13 measures groups. In 2008, the average individual physician who successfully reported quality data received about $1,000, Dr. Granovsky said. Payments are expected to be somewhat higher this year, because the bonus was increased from 1.5% to 2%.

Over the last several years, CMS officials have laid out their vision for value-based purchasing, emphasizing their desire to pay physicians and hospitals for quality of care, rather than simply for volume of services, and to avoid unnecessary costs. PQRI is widely seen as the first step in that transition, Dr. Granovsky said.

Although the pending federal health care reform effort would include more moves in that direction, the CMS already has the tools it needs through prior legislation to make significant progress in that direction, Dr. Granovsky said. “Medicare already has the regulatory muscle to put this in place,” he said.

Medical groups that choose to participate in PQRI must commit to it, Dr. Granovsky added, because it requires a great deal of data collection and reporting. Groups also should collaborate closely with their billing company.

A regular internal auditing process will also help medical groups ensure that they are getting the most out of their reporting efforts, Dr. Granovsky said.

One of the criticisms of the PQRI program is that it takes about 18 months to get feedback reports from the CMS, making it nearly impossible to detect problems in a timely manner. However, a monthly internal audit will help alert groups if they have a data file transfer problem that could prevent their PQRI claims from being processed, he said.

LAS VEGAS — There's a growing interest among physicians in Medicare's Physician Quality Reporting Initiative, launched in 2007, but it isn't because of the 2% bonus payments available this year.

More likely it's the possibility that the Physician Quality Reporting Initiative (PQRI) could be the basis for pay-for-performance programs down the road, Dr. Michael A. Granovsky said at a meeting on reimbursement sponsored by the American College of Emergency Physicians.

And, in the near term, the Centers for Medicare and Medicaid Services, which administers the program, could begin publishing whether doctors have successfully participated in PQRI.

“I think PQRI is here to stay,” said Dr. Granovsky, president of Medical Reimbursement Systems, based in Woburn, Mass. “I think this is the first leverage that CMS is developing to track quality and apply it on the reimbursement side. And I think they want a bigger and bigger stick over time.”

Under the PQRI program in 2010, physicians are eligible to receive up to a 2% bonus payment based on all of their Medicare Part B charges if they report successfully 80% of the time on at least three individual quality measures in 2010. They also can report on measures groups.

This year, the program includes 179 measures and 13 measures groups. In 2008, the average individual physician who successfully reported quality data received about $1,000, Dr. Granovsky said. Payments are expected to be somewhat higher this year, because the bonus was increased from 1.5% to 2%.

Over the last several years, CMS officials have laid out their vision for value-based purchasing, emphasizing their desire to pay physicians and hospitals for quality of care, rather than simply for volume of services, and to avoid unnecessary costs. PQRI is widely seen as the first step in that transition, Dr. Granovsky said.

Although the pending federal health care reform effort would include more moves in that direction, the CMS already has the tools it needs through prior legislation to make significant progress in that direction, Dr. Granovsky said. “Medicare already has the regulatory muscle to put this in place,” he said.

Medical groups that choose to participate in PQRI must commit to it, Dr. Granovsky added, because it requires a great deal of data collection and reporting. Groups also should collaborate closely with their billing company.

A regular internal auditing process will also help medical groups ensure that they are getting the most out of their reporting efforts, Dr. Granovsky said.

One of the criticisms of the PQRI program is that it takes about 18 months to get feedback reports from the CMS, making it nearly impossible to detect problems in a timely manner. However, a monthly internal audit will help alert groups if they have a data file transfer problem that could prevent their PQRI claims from being processed, he said.

State-based high-risk health insurance pools are among the first programs to be implemented under health reform, Health and Human Services department officials announced in early April.

These state-based pools, designed to provide coverage to uninsured adults with preexisting conditions, are scheduled to be operational within 90 days and will operate until Jan. 1, 2014. At that time, the new state-based health insurance exchanges will open and coverage will be available to all individuals regardless of preexisting conditions.

“When it's up and running, the new high-risk pool program provides immediate relief to potentially millions of Americans with preexisting conditions like diabetes or high blood pressure who have been shut out of the insurance system,” HHS Secretary Kathleen Sebelius said during a press briefing.

The same day, Ms. Sebelius sent a letter to governors and state insurance commissioners asking how they plan to participate in the temporary high-risk pool program. Under the law, HHS has $5 billion in federal funds to set up pools on its own or in collaboration with states. HHS is asking states to respond with their plans by the end of April.

States will have a number of options for participation. For example, states that don't currently operate a high-risk insurance pool could establish one with federal help. Those that do have a pool in place could set up a companion high-risk pool that meets the new federal standards. States also could contract with an insurer to provide subsidized coverage for eligible residents. In states that choose to do nothing, HHS will operate the program on their behalf.

More than 30 states currently have high-risk insurance pools, according to HHS, with premiums 25%-100% higher than standard rates. Under the health reform law, the federal government would require new high-risk pools to set premiums at a standard rate, which would vary by state. The standard rate should be equivalent to what a typical person shopping on the individual market would be offered, according to HHS.

To be eligible for the new high-risk pools, individuals must be U.S. citizens or lawfully present here, have been uninsured for the previous 6 months, and have a preexisting condition.

Document

70396_fx1.sml

Source Elsevier Global Medical News

State-based high-risk health insurance pools are among the first programs to be implemented under health reform, Health and Human Services department officials announced in early April.

These state-based pools, designed to provide coverage to uninsured adults with preexisting conditions, are scheduled to be operational within 90 days and will operate until Jan. 1, 2014. At that time, the new state-based health insurance exchanges will open and coverage will be available to all individuals regardless of preexisting conditions.

“When it's up and running, the new high-risk pool program provides immediate relief to potentially millions of Americans with preexisting conditions like diabetes or high blood pressure who have been shut out of the insurance system,” HHS Secretary Kathleen Sebelius said during a press briefing.

The same day, Ms. Sebelius sent a letter to governors and state insurance commissioners asking how they plan to participate in the temporary high-risk pool program. Under the law, HHS has $5 billion in federal funds to set up pools on its own or in collaboration with states. HHS is asking states to respond with their plans by the end of April.

States will have a number of options for participation. For example, states that don't currently operate a high-risk insurance pool could establish one with federal help. Those that do have a pool in place could set up a companion high-risk pool that meets the new federal standards. States also could contract with an insurer to provide subsidized coverage for eligible residents. In states that choose to do nothing, HHS will operate the program on their behalf.

More than 30 states currently have high-risk insurance pools, according to HHS, with premiums 25%-100% higher than standard rates. Under the health reform law, the federal government would require new high-risk pools to set premiums at a standard rate, which would vary by state. The standard rate should be equivalent to what a typical person shopping on the individual market would be offered, according to HHS.

To be eligible for the new high-risk pools, individuals must be U.S. citizens or lawfully present here, have been uninsured for the previous 6 months, and have a preexisting condition.

Document

70396_fx1.sml

Source Elsevier Global Medical News

State-based high-risk health insurance pools are among the first programs to be implemented under health reform, Health and Human Services department officials announced in early April.

These state-based pools, designed to provide coverage to uninsured adults with preexisting conditions, are scheduled to be operational within 90 days and will operate until Jan. 1, 2014. At that time, the new state-based health insurance exchanges will open and coverage will be available to all individuals regardless of preexisting conditions.

“When it's up and running, the new high-risk pool program provides immediate relief to potentially millions of Americans with preexisting conditions like diabetes or high blood pressure who have been shut out of the insurance system,” HHS Secretary Kathleen Sebelius said during a press briefing.

The same day, Ms. Sebelius sent a letter to governors and state insurance commissioners asking how they plan to participate in the temporary high-risk pool program. Under the law, HHS has $5 billion in federal funds to set up pools on its own or in collaboration with states. HHS is asking states to respond with their plans by the end of April.

States will have a number of options for participation. For example, states that don't currently operate a high-risk insurance pool could establish one with federal help. Those that do have a pool in place could set up a companion high-risk pool that meets the new federal standards. States also could contract with an insurer to provide subsidized coverage for eligible residents. In states that choose to do nothing, HHS will operate the program on their behalf.

More than 30 states currently have high-risk insurance pools, according to HHS, with premiums 25%-100% higher than standard rates. Under the health reform law, the federal government would require new high-risk pools to set premiums at a standard rate, which would vary by state. The standard rate should be equivalent to what a typical person shopping on the individual market would be offered, according to HHS.

To be eligible for the new high-risk pools, individuals must be U.S. citizens or lawfully present here, have been uninsured for the previous 6 months, and have a preexisting condition.

Document

70396_fx1.sml

Source Elsevier Global Medical News

Policymakers at the state and federal level should remove regulatory barriers that make it difficult for nurse practitioners and physician assistants to serve as primary care providers and lead primary care teams, according to a report that recommends changes to primary care in the United States.

The report from the Josiah Macy Jr. Foundation, based in New York City, also calls for more interprofessional education so physicians, nurses, and physician assistants can learn what it's like to work in a team environment during training. The recommendations represent the consensus reached by experts who convened in Durham, N.C., to discuss primary care areas in need of reform, from medical education to the physician payment system.

“Everyone agreed that there is great urgency to act now,” Dr. George E. Thibault, president of the Josiah Macy Jr. Foundation, said at a press briefing held to release the report. “Whether or not certain aspects of health care reform are enacted, everyone agreed that we will need well-trained providers from multiple professions to meet the public's need. This must be a team effort.”

Although most of the advice in the report was praised, some physician organizations expressed concern about the idea of expanding the role of nurse practitioners and physician assistants. The American Medical Association, for example, said it was concerned about extending patient care responsibilities to medical professionals who are “not adequately educated and trained to perform them.”

“Primary care benefits from a team approach to care delivery, with every member of physician-led teams playing the roles they are educated and trained to play,” Dr. Rebecca J. Patchin, chair of the AMA's board of trustees, said in a statement. “Every patient should have access to a personal physician, and the AMA is committed to increasing the physician workforce by advocating for increasing medical school class sizes and adding additional residency slots.”

Dr. Michael S. Barr, vice president of practice advocacy and improvement at the American College of Physicians, said the ACP supports team-based care and training with other health professionals, but the expanded role for nurse practitioners and physician assistants goes a bit too far. A 2009 ACP policy paper on the role of nurse practitioners in primary care stated that a patient-centered medical home should have a multidisciplinary clinical team that is led by a physician. But the paper also stated that demonstration projects on the medical home could test the effectiveness of clinical teams led by nurse practitioners, provided they are in line with state practice laws.

“We're all in alignment in terms of training together the way we should practice. We're all supportive of primary care–oriented programs in all of our respective health professional training venues,” Dr. Barr, who participated in the consensus conference, said in an interview. “It's just that we still feel like the team is best led by a physician.”

The Macy Foundation report made several other recommendations:

▸ Create stronger relationships between academic health centers and primary care sites within their communities.

▸ Invest in health information technology for primary care that supports data sharing, quality improvement, clinical care, and patient engagement.

▸ Reform primary care payments by creating global payments linked to patient complexity, care coordination, chronic disease management, and 24/7 access.

▸ Expand scholarship and loan repayment programs for students pursuing careers in primary care.

▸ Promote early exposure to primary care practice for all medical, nursing, and other health professional students.

Policymakers at the state and federal level should remove regulatory barriers that make it difficult for nurse practitioners and physician assistants to serve as primary care providers and lead primary care teams, according to a report that recommends changes to primary care in the United States.

The report from the Josiah Macy Jr. Foundation, based in New York City, also calls for more interprofessional education so physicians, nurses, and physician assistants can learn what it's like to work in a team environment during training. The recommendations represent the consensus reached by experts who convened in Durham, N.C., to discuss primary care areas in need of reform, from medical education to the physician payment system.

“Everyone agreed that there is great urgency to act now,” Dr. George E. Thibault, president of the Josiah Macy Jr. Foundation, said at a press briefing held to release the report. “Whether or not certain aspects of health care reform are enacted, everyone agreed that we will need well-trained providers from multiple professions to meet the public's need. This must be a team effort.”

Although most of the advice in the report was praised, some physician organizations expressed concern about the idea of expanding the role of nurse practitioners and physician assistants. The American Medical Association, for example, said it was concerned about extending patient care responsibilities to medical professionals who are “not adequately educated and trained to perform them.”

“Primary care benefits from a team approach to care delivery, with every member of physician-led teams playing the roles they are educated and trained to play,” Dr. Rebecca J. Patchin, chair of the AMA's board of trustees, said in a statement. “Every patient should have access to a personal physician, and the AMA is committed to increasing the physician workforce by advocating for increasing medical school class sizes and adding additional residency slots.”

Dr. Michael S. Barr, vice president of practice advocacy and improvement at the American College of Physicians, said the ACP supports team-based care and training with other health professionals, but the expanded role for nurse practitioners and physician assistants goes a bit too far. A 2009 ACP policy paper on the role of nurse practitioners in primary care stated that a patient-centered medical home should have a multidisciplinary clinical team that is led by a physician. But the paper also stated that demonstration projects on the medical home could test the effectiveness of clinical teams led by nurse practitioners, provided they are in line with state practice laws.

“We're all in alignment in terms of training together the way we should practice. We're all supportive of primary care–oriented programs in all of our respective health professional training venues,” Dr. Barr, who participated in the consensus conference, said in an interview. “It's just that we still feel like the team is best led by a physician.”

The Macy Foundation report made several other recommendations:

▸ Create stronger relationships between academic health centers and primary care sites within their communities.

▸ Invest in health information technology for primary care that supports data sharing, quality improvement, clinical care, and patient engagement.

▸ Reform primary care payments by creating global payments linked to patient complexity, care coordination, chronic disease management, and 24/7 access.

▸ Expand scholarship and loan repayment programs for students pursuing careers in primary care.

▸ Promote early exposure to primary care practice for all medical, nursing, and other health professional students.

Policymakers at the state and federal level should remove regulatory barriers that make it difficult for nurse practitioners and physician assistants to serve as primary care providers and lead primary care teams, according to a report that recommends changes to primary care in the United States.

The report from the Josiah Macy Jr. Foundation, based in New York City, also calls for more interprofessional education so physicians, nurses, and physician assistants can learn what it's like to work in a team environment during training. The recommendations represent the consensus reached by experts who convened in Durham, N.C., to discuss primary care areas in need of reform, from medical education to the physician payment system.

“Everyone agreed that there is great urgency to act now,” Dr. George E. Thibault, president of the Josiah Macy Jr. Foundation, said at a press briefing held to release the report. “Whether or not certain aspects of health care reform are enacted, everyone agreed that we will need well-trained providers from multiple professions to meet the public's need. This must be a team effort.”

Although most of the advice in the report was praised, some physician organizations expressed concern about the idea of expanding the role of nurse practitioners and physician assistants. The American Medical Association, for example, said it was concerned about extending patient care responsibilities to medical professionals who are “not adequately educated and trained to perform them.”

“Primary care benefits from a team approach to care delivery, with every member of physician-led teams playing the roles they are educated and trained to play,” Dr. Rebecca J. Patchin, chair of the AMA's board of trustees, said in a statement. “Every patient should have access to a personal physician, and the AMA is committed to increasing the physician workforce by advocating for increasing medical school class sizes and adding additional residency slots.”

Dr. Michael S. Barr, vice president of practice advocacy and improvement at the American College of Physicians, said the ACP supports team-based care and training with other health professionals, but the expanded role for nurse practitioners and physician assistants goes a bit too far. A 2009 ACP policy paper on the role of nurse practitioners in primary care stated that a patient-centered medical home should have a multidisciplinary clinical team that is led by a physician. But the paper also stated that demonstration projects on the medical home could test the effectiveness of clinical teams led by nurse practitioners, provided they are in line with state practice laws.

“We're all in alignment in terms of training together the way we should practice. We're all supportive of primary care–oriented programs in all of our respective health professional training venues,” Dr. Barr, who participated in the consensus conference, said in an interview. “It's just that we still feel like the team is best led by a physician.”

The Macy Foundation report made several other recommendations:

▸ Create stronger relationships between academic health centers and primary care sites within their communities.

▸ Invest in health information technology for primary care that supports data sharing, quality improvement, clinical care, and patient engagement.

▸ Reform primary care payments by creating global payments linked to patient complexity, care coordination, chronic disease management, and 24/7 access.

▸ Expand scholarship and loan repayment programs for students pursuing careers in primary care.

▸ Promote early exposure to primary care practice for all medical, nursing, and other health professional students.

The federal government will begin its incentive program for the use of electronic health record information systems in less than a year, but many physician organizations say the timeline is just too aggressive and runs the risk of turning some physicians away from the technology.

Starting next year, physicians who demonstrate “meaningful use” of certified electronic health record (EHR) technology will be eligible to receive bonus payments of up to $18,000 from the Medicare program. Those bonuses continue for 5 years, with physicians eligible to earn up to a total of $44,000.

Physicians can still receive bonuses if they begin their meaningful use of the technology later, but they must start before 2013 to get all the available incentives. A similar program is in place under the Medicaid program, with physicians eligible to receive nearly $64,000 over 6 years for the adoption and use of certified EHR technology.

Last December, officials at the Centers for Medicare and Medicaid Services released a proposal outlining the requirements to achieve meaningful use of EHRs. The requirements are phased in, with minimum standards taking effect in 2011 and 2012 and stricter criteria phasing in over time.

Under Stage 1, physicians must meet 25 objectives including the use of computerized provider order entry, electronic prescribing, reporting on quality measures, and checking insurance eligibility electronically, among others.

In a letter to CMS officials, sent last month, a coalition of more than 95 national and state physician organizations, including the American College of Physicians, the American Academy of Family Physicians, and the Society of Hospital Medicine, voiced concerns about the Stage 1 requirements. Though the coalition supports the phased-in approach to meaningful use, it said there is too much being asked of physicians in the first stage of the program.

The problem is the “all or nothing” approach outlined in the proposal, said Dr. Steven Waldren, director of the Center for Health Information Technology at the AAFP. While officials at the AAFP agree with the goals outlined in the rule, they don't want to see physicians lose out on the EHR incentives because they fulfilled 99% of the requirements. The AAFP is suggesting that the CMS consider awarding a partial incentive payment based on the level of meaningful use achieved.

For physicians weighing whether to purchase EHR technology, Dr. Waldren advised making the choice based on practice needs, not just the financial incentives. Physicians who rush out and buy technology just to take advantage of the incentives without making the commitment to reengineer their practice could end up spending a lot more than $44,000.

For those who do want to implement a system, Dr. Waldren does not advise waiting. On average, physicians will need about 18 months to evaluate their practice and the available products, contract with a vendor, and get to meaningful use, he said.

Dr. Waldren added that under the Medicare incentives, physicians don't have to be ready to go on Jan. 1, 2011. If they choose to start in 2011, they only need to have 90 days of meaningful use in that calendar year. Those physicians starting in 2012 can begin meaningful use in the last 3 months of that year.

Other specialties, such as neurology, have their own challenges. “The biggest hurdle is that the majority of neurologists don't even use an electronic health record,” said Dr. Gregory Esper, director of general neurology at Emory University in Atlanta and a member of the American Academy of Neurology's Medical Economics and Management Committee. To implement an EHR under the meaningful use definition would be a huge change in the operational workflow of most neurology offices. Even offices that have an EHR likely do not use the system in the way envisioned under meaningful use, he said.

Since the timeline is aggressive, it could actually deter people from wanting to invest in the EHR technology, he said. “You're trying to take people from zero to 60 in 2 seconds and it's just not going to happen.”

Physicians should keep in mind that the landscape is changing and the federal government isn't the only player driving the move toward EHR adoption. Patients are increasingly looking for medical practices to be able to securely exchange electronic data and practices that remain paper-based could become less competitive in the long run, he said.

“Business as usual is frankly over,” Dr. Esper said.

The Medical Group Management Association, which also signed the letter to the CMS, said it has survey data suggesting that requiring practices to meet all 25 meaningful use objectives would actually lead to decreased productivity. Nearly 68% of respondents to a recent survey predicted that physician productivity would drop if all of the meaningful use objectives were implemented. That drop would be separate from the temporary decline expected with implementation of a new EHR, the MGMA said.

 

Survey respondents said they would have a particularly hard time meeting the requirement that at least 80% of all patient requests for an electronic copy of their health information be fulfilled within 48 hours and the requirement that at least 10% of all patients be given timely electronic access to their health information. The survey, which was conducted in February, included responses from 445 providers in medical group practices.

The federal government will begin its incentive program for the use of electronic health record information systems in less than a year, but many physician organizations say the timeline is just too aggressive and runs the risk of turning some physicians away from the technology.

Starting next year, physicians who demonstrate “meaningful use” of certified electronic health record (EHR) technology will be eligible to receive bonus payments of up to $18,000 from the Medicare program. Those bonuses continue for 5 years, with physicians eligible to earn up to a total of $44,000.

Physicians can still receive bonuses if they begin their meaningful use of the technology later, but they must start before 2013 to get all the available incentives. A similar program is in place under the Medicaid program, with physicians eligible to receive nearly $64,000 over 6 years for the adoption and use of certified EHR technology.

Last December, officials at the Centers for Medicare and Medicaid Services released a proposal outlining the requirements to achieve meaningful use of EHRs. The requirements are phased in, with minimum standards taking effect in 2011 and 2012 and stricter criteria phasing in over time.

Under Stage 1, physicians must meet 25 objectives including the use of computerized provider order entry, electronic prescribing, reporting on quality measures, and checking insurance eligibility electronically, among others.

In a letter to CMS officials, sent last month, a coalition of more than 95 national and state physician organizations, including the American College of Physicians, the American Academy of Family Physicians, and the Society of Hospital Medicine, voiced concerns about the Stage 1 requirements. Though the coalition supports the phased-in approach to meaningful use, it said there is too much being asked of physicians in the first stage of the program.

The problem is the “all or nothing” approach outlined in the proposal, said Dr. Steven Waldren, director of the Center for Health Information Technology at the AAFP. While officials at the AAFP agree with the goals outlined in the rule, they don't want to see physicians lose out on the EHR incentives because they fulfilled 99% of the requirements. The AAFP is suggesting that the CMS consider awarding a partial incentive payment based on the level of meaningful use achieved.

For physicians weighing whether to purchase EHR technology, Dr. Waldren advised making the choice based on practice needs, not just the financial incentives. Physicians who rush out and buy technology just to take advantage of the incentives without making the commitment to reengineer their practice could end up spending a lot more than $44,000.

For those who do want to implement a system, Dr. Waldren does not advise waiting. On average, physicians will need about 18 months to evaluate their practice and the available products, contract with a vendor, and get to meaningful use, he said.

Dr. Waldren added that under the Medicare incentives, physicians don't have to be ready to go on Jan. 1, 2011. If they choose to start in 2011, they only need to have 90 days of meaningful use in that calendar year. Those physicians starting in 2012 can begin meaningful use in the last 3 months of that year.

Other specialties, such as neurology, have their own challenges. “The biggest hurdle is that the majority of neurologists don't even use an electronic health record,” said Dr. Gregory Esper, director of general neurology at Emory University in Atlanta and a member of the American Academy of Neurology's Medical Economics and Management Committee. To implement an EHR under the meaningful use definition would be a huge change in the operational workflow of most neurology offices. Even offices that have an EHR likely do not use the system in the way envisioned under meaningful use, he said.

Since the timeline is aggressive, it could actually deter people from wanting to invest in the EHR technology, he said. “You're trying to take people from zero to 60 in 2 seconds and it's just not going to happen.”

Physicians should keep in mind that the landscape is changing and the federal government isn't the only player driving the move toward EHR adoption. Patients are increasingly looking for medical practices to be able to securely exchange electronic data and practices that remain paper-based could become less competitive in the long run, he said.

“Business as usual is frankly over,” Dr. Esper said.

The Medical Group Management Association, which also signed the letter to the CMS, said it has survey data suggesting that requiring practices to meet all 25 meaningful use objectives would actually lead to decreased productivity. Nearly 68% of respondents to a recent survey predicted that physician productivity would drop if all of the meaningful use objectives were implemented. That drop would be separate from the temporary decline expected with implementation of a new EHR, the MGMA said.

 

Survey respondents said they would have a particularly hard time meeting the requirement that at least 80% of all patient requests for an electronic copy of their health information be fulfilled within 48 hours and the requirement that at least 10% of all patients be given timely electronic access to their health information. The survey, which was conducted in February, included responses from 445 providers in medical group practices.

The federal government will begin its incentive program for the use of electronic health record information systems in less than a year, but many physician organizations say the timeline is just too aggressive and runs the risk of turning some physicians away from the technology.

Starting next year, physicians who demonstrate “meaningful use” of certified electronic health record (EHR) technology will be eligible to receive bonus payments of up to $18,000 from the Medicare program. Those bonuses continue for 5 years, with physicians eligible to earn up to a total of $44,000.

Physicians can still receive bonuses if they begin their meaningful use of the technology later, but they must start before 2013 to get all the available incentives. A similar program is in place under the Medicaid program, with physicians eligible to receive nearly $64,000 over 6 years for the adoption and use of certified EHR technology.

Last December, officials at the Centers for Medicare and Medicaid Services released a proposal outlining the requirements to achieve meaningful use of EHRs. The requirements are phased in, with minimum standards taking effect in 2011 and 2012 and stricter criteria phasing in over time.

Under Stage 1, physicians must meet 25 objectives including the use of computerized provider order entry, electronic prescribing, reporting on quality measures, and checking insurance eligibility electronically, among others.

In a letter to CMS officials, sent last month, a coalition of more than 95 national and state physician organizations, including the American College of Physicians, the American Academy of Family Physicians, and the Society of Hospital Medicine, voiced concerns about the Stage 1 requirements. Though the coalition supports the phased-in approach to meaningful use, it said there is too much being asked of physicians in the first stage of the program.

The problem is the “all or nothing” approach outlined in the proposal, said Dr. Steven Waldren, director of the Center for Health Information Technology at the AAFP. While officials at the AAFP agree with the goals outlined in the rule, they don't want to see physicians lose out on the EHR incentives because they fulfilled 99% of the requirements. The AAFP is suggesting that the CMS consider awarding a partial incentive payment based on the level of meaningful use achieved.

For physicians weighing whether to purchase EHR technology, Dr. Waldren advised making the choice based on practice needs, not just the financial incentives. Physicians who rush out and buy technology just to take advantage of the incentives without making the commitment to reengineer their practice could end up spending a lot more than $44,000.

For those who do want to implement a system, Dr. Waldren does not advise waiting. On average, physicians will need about 18 months to evaluate their practice and the available products, contract with a vendor, and get to meaningful use, he said.

Dr. Waldren added that under the Medicare incentives, physicians don't have to be ready to go on Jan. 1, 2011. If they choose to start in 2011, they only need to have 90 days of meaningful use in that calendar year. Those physicians starting in 2012 can begin meaningful use in the last 3 months of that year.

Other specialties, such as neurology, have their own challenges. “The biggest hurdle is that the majority of neurologists don't even use an electronic health record,” said Dr. Gregory Esper, director of general neurology at Emory University in Atlanta and a member of the American Academy of Neurology's Medical Economics and Management Committee. To implement an EHR under the meaningful use definition would be a huge change in the operational workflow of most neurology offices. Even offices that have an EHR likely do not use the system in the way envisioned under meaningful use, he said.

Since the timeline is aggressive, it could actually deter people from wanting to invest in the EHR technology, he said. “You're trying to take people from zero to 60 in 2 seconds and it's just not going to happen.”

Physicians should keep in mind that the landscape is changing and the federal government isn't the only player driving the move toward EHR adoption. Patients are increasingly looking for medical practices to be able to securely exchange electronic data and practices that remain paper-based could become less competitive in the long run, he said.

“Business as usual is frankly over,” Dr. Esper said.

The Medical Group Management Association, which also signed the letter to the CMS, said it has survey data suggesting that requiring practices to meet all 25 meaningful use objectives would actually lead to decreased productivity. Nearly 68% of respondents to a recent survey predicted that physician productivity would drop if all of the meaningful use objectives were implemented. That drop would be separate from the temporary decline expected with implementation of a new EHR, the MGMA said.

 

Survey respondents said they would have a particularly hard time meeting the requirement that at least 80% of all patient requests for an electronic copy of their health information be fulfilled within 48 hours and the requirement that at least 10% of all patients be given timely electronic access to their health information. The survey, which was conducted in February, included responses from 445 providers in medical group practices.

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers around the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology. At press time, several centers were preparing to enroll physicians.

The staff at these regional extension centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference on April 6 to announce the final round of regional extension center grants.

That day, HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 regional extension centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers to become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over 5 years for the meaningful use of a certified health information system. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

To help physicians become meaningful users, the regional extension centers will provide a broad range of services, Dr. Blumenthal said, from helping physicians select the most appropriate equipment for their practice through the implementation of the products. The centers also will help practices purchase technology in groups at reduced prices, he said.

“We hope that these regional extension centers will help providers improve their workflow using electronic health records, improve the quality and efficiency of the care they can provide using electronic health records, and of course thereby increase the efficiency and quality of care available to the American people,” Dr. Blumenthal said.

Farzad Mostashari, a senior advisor in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

Physicians can expect to get a lot of assistance from the regional extension center staff, he said. For example, the practice staff and the regional extension staff may have weekly contacts as the practice works to establish a work plan for implementation, as well as during the implementation period. Following implementation, the regional extension center staff may check in with the practice on a monthly basis to see how they are progressing with quality improvement and workflow design.

Initially, the regional extension centers will focus on aiding primary care providers in small practices. HHS estimates that the 60 regional extension centers will provide services to at least 100,000 primary care providers and hospitals within 2 years. Small primary care practices are being targeted because this group reaches a large number of patients, Dr. Blumenthal said, but they are also the least likely to be able to afford to purchase health information technology support services in the private market.

Although the stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers, all physicians are encouraged to participate in the outreach and educational opportunities of these centers, according to HHS. The agency defines primary care as family medicine, internal medicine, pediatrics, or obstetrics and gynecology.

In addition to small practices, HHS is also reaching out to small hospitals. HHS plans to award another $25 million to regional extension centers that work with critical access and rural hospitals with 50 beds or less. Small hospitals have an especially difficult time finding the resources and expertise to successfully adopt health information technology, Dr. Blumenthal said.

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers around the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology. At press time, several centers were preparing to enroll physicians.

The staff at these regional extension centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference on April 6 to announce the final round of regional extension center grants.

That day, HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 regional extension centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers to become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over 5 years for the meaningful use of a certified health information system. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

To help physicians become meaningful users, the regional extension centers will provide a broad range of services, Dr. Blumenthal said, from helping physicians select the most appropriate equipment for their practice through the implementation of the products. The centers also will help practices purchase technology in groups at reduced prices, he said.

“We hope that these regional extension centers will help providers improve their workflow using electronic health records, improve the quality and efficiency of the care they can provide using electronic health records, and of course thereby increase the efficiency and quality of care available to the American people,” Dr. Blumenthal said.

Farzad Mostashari, a senior advisor in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

Physicians can expect to get a lot of assistance from the regional extension center staff, he said. For example, the practice staff and the regional extension staff may have weekly contacts as the practice works to establish a work plan for implementation, as well as during the implementation period. Following implementation, the regional extension center staff may check in with the practice on a monthly basis to see how they are progressing with quality improvement and workflow design.

Initially, the regional extension centers will focus on aiding primary care providers in small practices. HHS estimates that the 60 regional extension centers will provide services to at least 100,000 primary care providers and hospitals within 2 years. Small primary care practices are being targeted because this group reaches a large number of patients, Dr. Blumenthal said, but they are also the least likely to be able to afford to purchase health information technology support services in the private market.

Although the stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers, all physicians are encouraged to participate in the outreach and educational opportunities of these centers, according to HHS. The agency defines primary care as family medicine, internal medicine, pediatrics, or obstetrics and gynecology.

In addition to small practices, HHS is also reaching out to small hospitals. HHS plans to award another $25 million to regional extension centers that work with critical access and rural hospitals with 50 beds or less. Small hospitals have an especially difficult time finding the resources and expertise to successfully adopt health information technology, Dr. Blumenthal said.

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers around the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology. At press time, several centers were preparing to enroll physicians.

The staff at these regional extension centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference on April 6 to announce the final round of regional extension center grants.

That day, HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 regional extension centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers to become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over 5 years for the meaningful use of a certified health information system. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

To help physicians become meaningful users, the regional extension centers will provide a broad range of services, Dr. Blumenthal said, from helping physicians select the most appropriate equipment for their practice through the implementation of the products. The centers also will help practices purchase technology in groups at reduced prices, he said.

“We hope that these regional extension centers will help providers improve their workflow using electronic health records, improve the quality and efficiency of the care they can provide using electronic health records, and of course thereby increase the efficiency and quality of care available to the American people,” Dr. Blumenthal said.

Farzad Mostashari, a senior advisor in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

Physicians can expect to get a lot of assistance from the regional extension center staff, he said. For example, the practice staff and the regional extension staff may have weekly contacts as the practice works to establish a work plan for implementation, as well as during the implementation period. Following implementation, the regional extension center staff may check in with the practice on a monthly basis to see how they are progressing with quality improvement and workflow design.

Initially, the regional extension centers will focus on aiding primary care providers in small practices. HHS estimates that the 60 regional extension centers will provide services to at least 100,000 primary care providers and hospitals within 2 years. Small primary care practices are being targeted because this group reaches a large number of patients, Dr. Blumenthal said, but they are also the least likely to be able to afford to purchase health information technology support services in the private market.

Although the stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers, all physicians are encouraged to participate in the outreach and educational opportunities of these centers, according to HHS. The agency defines primary care as family medicine, internal medicine, pediatrics, or obstetrics and gynecology.

In addition to small practices, HHS is also reaching out to small hospitals. HHS plans to award another $25 million to regional extension centers that work with critical access and rural hospitals with 50 beds or less. Small hospitals have an especially difficult time finding the resources and expertise to successfully adopt health information technology, Dr. Blumenthal said.

The quality of health care in the United States is improving slowly, with the slowest progress occurring in prevention and chronic disease management, according to the latest government data.

The nation also continues to struggle with health care disparities. Despite efforts to improve access and quality of care for minorities, new national data show that, overall, minorities and low-income individuals receive the worst health care.

The findings were detailed in two reports released by the Health and Human Service department on April 13.

The 2009 National Healthcare Quality Report provides a snapshot of how the nation is performing on 169 quality measures; the National Healthcare Disparities Report provides a summary of health care quality and access among various racial and ethnic groups and across income groups.

Although the two reports show significant gaps in care, HHS Secretary Kathleen Sebelius said that she expects to see improvement with the implementation of the new health care reform laws (the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act).

“While the Affordable Care Act isn’t a cure, we think it’s one of the most effective treatments we’ve had for these problems in a long time,” Ms. Sebelius said during a news conference to release the reports.

Specifically, the health care reform laws will expand data collection and research efforts on health care disparities, increase the size and diversity of the health care workforce, and establish a new national institute on minority health and health disparities at the National Institutes of Health. But most importantly, the laws will expand coverage for millions of Americans who are currently uninsured, Ms. Sebelius said.

“In almost every case, populations who are currently underserved get relief [under the new laws], whether it’s minority Americans, women, early retirees, rural Americans, or Americans with disabilities,” she said.

The 2009 quality report showed that overall quality is improving at a rate of about 2.3% annually. However, the speed of improvement varied across settings of care: Hospitals are improving more rapidly, at a median rate of change of about 5.8%, whereas outpatient settings improved at a median rate of change about 1.4%, according to the report.

As a result, improvements in prevention and chronic disease management are lagging behind improvements in acute care. For example, of the nine process measures tracked in the report that worsened, eight related to either preventive services or chronic disease management, including mammography, Pap testing, and fecal occult blood testing.

“Although the trend is going in the right direction, which is good, the pace is unacceptably slow,” said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, which produced the reports.

On the disparities side, the report showed that many disparities have not decreased over time. For example, from 2000 to 2005, disparities in colorectal cancer screening have grown between American Indians and Alaska Natives vs. whites, increasing at a rate of 7.7% per year. Additionally, blacks and Hispanics had worsening disparities in colorectal cancer mortality from 2000 to 2006.

The quality of health care in the United States is improving slowly, with the slowest progress occurring in prevention and chronic disease management, according to the latest government data.

The nation also continues to struggle with health care disparities. Despite efforts to improve access and quality of care for minorities, new national data show that, overall, minorities and low-income individuals receive the worst health care.

The findings were detailed in two reports released by the Health and Human Service department on April 13.

The 2009 National Healthcare Quality Report provides a snapshot of how the nation is performing on 169 quality measures; the National Healthcare Disparities Report provides a summary of health care quality and access among various racial and ethnic groups and across income groups.

Although the two reports show significant gaps in care, HHS Secretary Kathleen Sebelius said that she expects to see improvement with the implementation of the new health care reform laws (the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act).

“While the Affordable Care Act isn’t a cure, we think it’s one of the most effective treatments we’ve had for these problems in a long time,” Ms. Sebelius said during a news conference to release the reports.

Specifically, the health care reform laws will expand data collection and research efforts on health care disparities, increase the size and diversity of the health care workforce, and establish a new national institute on minority health and health disparities at the National Institutes of Health. But most importantly, the laws will expand coverage for millions of Americans who are currently uninsured, Ms. Sebelius said.

“In almost every case, populations who are currently underserved get relief [under the new laws], whether it’s minority Americans, women, early retirees, rural Americans, or Americans with disabilities,” she said.

The 2009 quality report showed that overall quality is improving at a rate of about 2.3% annually. However, the speed of improvement varied across settings of care: Hospitals are improving more rapidly, at a median rate of change of about 5.8%, whereas outpatient settings improved at a median rate of change about 1.4%, according to the report.

As a result, improvements in prevention and chronic disease management are lagging behind improvements in acute care. For example, of the nine process measures tracked in the report that worsened, eight related to either preventive services or chronic disease management, including mammography, Pap testing, and fecal occult blood testing.

“Although the trend is going in the right direction, which is good, the pace is unacceptably slow,” said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, which produced the reports.

On the disparities side, the report showed that many disparities have not decreased over time. For example, from 2000 to 2005, disparities in colorectal cancer screening have grown between American Indians and Alaska Natives vs. whites, increasing at a rate of 7.7% per year. Additionally, blacks and Hispanics had worsening disparities in colorectal cancer mortality from 2000 to 2006.

The quality of health care in the United States is improving slowly, with the slowest progress occurring in prevention and chronic disease management, according to the latest government data.

The nation also continues to struggle with health care disparities. Despite efforts to improve access and quality of care for minorities, new national data show that, overall, minorities and low-income individuals receive the worst health care.

The findings were detailed in two reports released by the Health and Human Service department on April 13.

The 2009 National Healthcare Quality Report provides a snapshot of how the nation is performing on 169 quality measures; the National Healthcare Disparities Report provides a summary of health care quality and access among various racial and ethnic groups and across income groups.

Although the two reports show significant gaps in care, HHS Secretary Kathleen Sebelius said that she expects to see improvement with the implementation of the new health care reform laws (the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act).

“While the Affordable Care Act isn’t a cure, we think it’s one of the most effective treatments we’ve had for these problems in a long time,” Ms. Sebelius said during a news conference to release the reports.

Specifically, the health care reform laws will expand data collection and research efforts on health care disparities, increase the size and diversity of the health care workforce, and establish a new national institute on minority health and health disparities at the National Institutes of Health. But most importantly, the laws will expand coverage for millions of Americans who are currently uninsured, Ms. Sebelius said.

“In almost every case, populations who are currently underserved get relief [under the new laws], whether it’s minority Americans, women, early retirees, rural Americans, or Americans with disabilities,” she said.

The 2009 quality report showed that overall quality is improving at a rate of about 2.3% annually. However, the speed of improvement varied across settings of care: Hospitals are improving more rapidly, at a median rate of change of about 5.8%, whereas outpatient settings improved at a median rate of change about 1.4%, according to the report.

As a result, improvements in prevention and chronic disease management are lagging behind improvements in acute care. For example, of the nine process measures tracked in the report that worsened, eight related to either preventive services or chronic disease management, including mammography, Pap testing, and fecal occult blood testing.

“Although the trend is going in the right direction, which is good, the pace is unacceptably slow,” said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, which produced the reports.

On the disparities side, the report showed that many disparities have not decreased over time. For example, from 2000 to 2005, disparities in colorectal cancer screening have grown between American Indians and Alaska Natives vs. whites, increasing at a rate of 7.7% per year. Additionally, blacks and Hispanics had worsening disparities in colorectal cancer mortality from 2000 to 2006.

The Health and Human Services department has taken the first steps toward greater oversight of the health insurance industry called for by the new health reform laws.

On April 12, HHS officials issued requests for public comment on how to calculate medical-loss ratios for health plans as well as factors to consider in determining whether a plan’s premium rate increase is “unreasonable.” The comments will be used to help HHS officials develop regulations over the next several months.

Under the Patient Protection and Affordable Care Act, signed into law on March 23, health plans must submit annual reports to HHS on their medical-loss ratios, the percentage of premiums spent on medical care and quality improvement versus the percentage spent on administrative overhead. Beginning on Jan. 1, 2011, if the medical-loss ratio does not meet minimum federal standards, the health plans will have to provide customers with a rebate. For plans in the large group market, the amount of premium revenue spent on clinical services must be at least 85%. For those in the small group and individual markets, the threshold is at least 80%.

HHS is also asking the National Association of Insurance Commissioners to establish uniform definitions and standard methodologies to determine how to define clinical services and quality improvement as part of the medical-loss ratio. The health reform law had called on the organization to develop these definitions by the end of this year, but HHS has asked them to do it by June 1 so that the agency can publish regulations as soon as possible.

The health reform law also includes new oversight of insurance company rate increases. It requires HHS, in partnership with states, to establish a process for the annual review of “unreasonable” increases in premiums for health insurance coverage. As part of this process, insurers have to publicly post and submit to HHS and their state the rationale for any premium increase considered “unreasonable” before the increases goes into effect.

“This increased accountability aims to use transparency and competition to prevent rampant premium escalations,” Jeanne Lambrew, Ph.D., director of the HHS Office of Health Reform, said during a press conference on April 12.

HHS is seeking comment from states and health plans on a number of issues including what types of methods states use to determine whether to approve a rate increase as well as whether special consideration should be given for certain types of plans such as HMOs or high-deductible plans.

The Health and Human Services department has taken the first steps toward greater oversight of the health insurance industry called for by the new health reform laws.

On April 12, HHS officials issued requests for public comment on how to calculate medical-loss ratios for health plans as well as factors to consider in determining whether a plan’s premium rate increase is “unreasonable.” The comments will be used to help HHS officials develop regulations over the next several months.

Under the Patient Protection and Affordable Care Act, signed into law on March 23, health plans must submit annual reports to HHS on their medical-loss ratios, the percentage of premiums spent on medical care and quality improvement versus the percentage spent on administrative overhead. Beginning on Jan. 1, 2011, if the medical-loss ratio does not meet minimum federal standards, the health plans will have to provide customers with a rebate. For plans in the large group market, the amount of premium revenue spent on clinical services must be at least 85%. For those in the small group and individual markets, the threshold is at least 80%.

HHS is also asking the National Association of Insurance Commissioners to establish uniform definitions and standard methodologies to determine how to define clinical services and quality improvement as part of the medical-loss ratio. The health reform law had called on the organization to develop these definitions by the end of this year, but HHS has asked them to do it by June 1 so that the agency can publish regulations as soon as possible.

The health reform law also includes new oversight of insurance company rate increases. It requires HHS, in partnership with states, to establish a process for the annual review of “unreasonable” increases in premiums for health insurance coverage. As part of this process, insurers have to publicly post and submit to HHS and their state the rationale for any premium increase considered “unreasonable” before the increases goes into effect.

“This increased accountability aims to use transparency and competition to prevent rampant premium escalations,” Jeanne Lambrew, Ph.D., director of the HHS Office of Health Reform, said during a press conference on April 12.

HHS is seeking comment from states and health plans on a number of issues including what types of methods states use to determine whether to approve a rate increase as well as whether special consideration should be given for certain types of plans such as HMOs or high-deductible plans.

The Health and Human Services department has taken the first steps toward greater oversight of the health insurance industry called for by the new health reform laws.

On April 12, HHS officials issued requests for public comment on how to calculate medical-loss ratios for health plans as well as factors to consider in determining whether a plan’s premium rate increase is “unreasonable.” The comments will be used to help HHS officials develop regulations over the next several months.

Under the Patient Protection and Affordable Care Act, signed into law on March 23, health plans must submit annual reports to HHS on their medical-loss ratios, the percentage of premiums spent on medical care and quality improvement versus the percentage spent on administrative overhead. Beginning on Jan. 1, 2011, if the medical-loss ratio does not meet minimum federal standards, the health plans will have to provide customers with a rebate. For plans in the large group market, the amount of premium revenue spent on clinical services must be at least 85%. For those in the small group and individual markets, the threshold is at least 80%.

HHS is also asking the National Association of Insurance Commissioners to establish uniform definitions and standard methodologies to determine how to define clinical services and quality improvement as part of the medical-loss ratio. The health reform law had called on the organization to develop these definitions by the end of this year, but HHS has asked them to do it by June 1 so that the agency can publish regulations as soon as possible.

The health reform law also includes new oversight of insurance company rate increases. It requires HHS, in partnership with states, to establish a process for the annual review of “unreasonable” increases in premiums for health insurance coverage. As part of this process, insurers have to publicly post and submit to HHS and their state the rationale for any premium increase considered “unreasonable” before the increases goes into effect.

“This increased accountability aims to use transparency and competition to prevent rampant premium escalations,” Jeanne Lambrew, Ph.D., director of the HHS Office of Health Reform, said during a press conference on April 12.

HHS is seeking comment from states and health plans on a number of issues including what types of methods states use to determine whether to approve a rate increase as well as whether special consideration should be given for certain types of plans such as HMOs or high-deductible plans.

State-based high-risk health insurance pools are among the first programs to be implemented under health reform, Health and Human Service department officials announced today.

These state-based pools, designed to provide coverage to uninsured adults with preexisting conditions, are scheduled to be up and running within 90 days and will operate until Jan. 1, 2014. At that time, the new state-based health insurance exchanges would open and coverage would be available to all individuals regardless of preexisting conditions.

"When it's up and running, the new high-risk pool program provides immediate relief to potentially millions of Americans with preexisting conditions like diabetes or high blood pressure who have been shut out of the insurance system," HHS Secretary Kathleen Sebelius said during a news conference.

Also today, Ms. Sebelius sent a letter to governors and state insurance commissioners asking how they plan to participate in the temporary high-risk pool program. Under the law, HHS has $5 billion in federal funds to set up pools on its own or to collaborate with states. HHS is asking states to respond with their plans by the end of April.

States will have a number of options for participation. For example, states that don't currently operate a high-risk insurance pool could establish one with federal help. Those that do have a pool in place could set up a companion high-risk pool that meets the new federal standards. States also could contract with an insurer to provide subsidized coverage for eligible residents. In states that choose to do nothing, HHS will operate the program on their behalf.

More than 30 states currently have high-risk insurance pools, according to HHS, with premiums 25%-100% higher than standard rates. Under the health reform law, the federal government would require new high-risk pools to set premiums at a standard rate, which would vary by state. The standard rate should be equivalent to what a typical person shopping on the individual market would be offered, according to HHS.

To be eligible for the new high-risk pools, individuals must be citizens of the United States or lawfully present here, have been uninsured for the previous 6 months, and have a preexisting condition.

State-based high-risk health insurance pools are among the first programs to be implemented under health reform, Health and Human Service department officials announced today.

These state-based pools, designed to provide coverage to uninsured adults with preexisting conditions, are scheduled to be up and running within 90 days and will operate until Jan. 1, 2014. At that time, the new state-based health insurance exchanges would open and coverage would be available to all individuals regardless of preexisting conditions.

"When it's up and running, the new high-risk pool program provides immediate relief to potentially millions of Americans with preexisting conditions like diabetes or high blood pressure who have been shut out of the insurance system," HHS Secretary Kathleen Sebelius said during a news conference.

Also today, Ms. Sebelius sent a letter to governors and state insurance commissioners asking how they plan to participate in the temporary high-risk pool program. Under the law, HHS has $5 billion in federal funds to set up pools on its own or to collaborate with states. HHS is asking states to respond with their plans by the end of April.

States will have a number of options for participation. For example, states that don't currently operate a high-risk insurance pool could establish one with federal help. Those that do have a pool in place could set up a companion high-risk pool that meets the new federal standards. States also could contract with an insurer to provide subsidized coverage for eligible residents. In states that choose to do nothing, HHS will operate the program on their behalf.

More than 30 states currently have high-risk insurance pools, according to HHS, with premiums 25%-100% higher than standard rates. Under the health reform law, the federal government would require new high-risk pools to set premiums at a standard rate, which would vary by state. The standard rate should be equivalent to what a typical person shopping on the individual market would be offered, according to HHS.

To be eligible for the new high-risk pools, individuals must be citizens of the United States or lawfully present here, have been uninsured for the previous 6 months, and have a preexisting condition.

State-based high-risk health insurance pools are among the first programs to be implemented under health reform, Health and Human Service department officials announced today.

These state-based pools, designed to provide coverage to uninsured adults with preexisting conditions, are scheduled to be up and running within 90 days and will operate until Jan. 1, 2014. At that time, the new state-based health insurance exchanges would open and coverage would be available to all individuals regardless of preexisting conditions.

"When it's up and running, the new high-risk pool program provides immediate relief to potentially millions of Americans with preexisting conditions like diabetes or high blood pressure who have been shut out of the insurance system," HHS Secretary Kathleen Sebelius said during a news conference.

Also today, Ms. Sebelius sent a letter to governors and state insurance commissioners asking how they plan to participate in the temporary high-risk pool program. Under the law, HHS has $5 billion in federal funds to set up pools on its own or to collaborate with states. HHS is asking states to respond with their plans by the end of April.

States will have a number of options for participation. For example, states that don't currently operate a high-risk insurance pool could establish one with federal help. Those that do have a pool in place could set up a companion high-risk pool that meets the new federal standards. States also could contract with an insurer to provide subsidized coverage for eligible residents. In states that choose to do nothing, HHS will operate the program on their behalf.

More than 30 states currently have high-risk insurance pools, according to HHS, with premiums 25%-100% higher than standard rates. Under the health reform law, the federal government would require new high-risk pools to set premiums at a standard rate, which would vary by state. The standard rate should be equivalent to what a typical person shopping on the individual market would be offered, according to HHS.

To be eligible for the new high-risk pools, individuals must be citizens of the United States or lawfully present here, have been uninsured for the previous 6 months, and have a preexisting condition.