[email protected] IMPLICATIONS FOR COST, QUALITY, AND ACCESS TO HEALTHCARE SHANNON C. SCOTT,...
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[email protected] IMPLICATIONS FOR COST, QUALITY, AND ACCESS TO HEALTHCARE SHANNON C. SCOTT, DO HEALTH POLICY FELLOWSHIP 2012-2013 OSTEOPATHIC FAMILY PHYSICIAN
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Transcript of [email protected] IMPLICATIONS FOR COST, QUALITY, AND ACCESS TO HEALTHCARE SHANNON C. SCOTT,...
[email protected] IMPLICATIONS FOR COST, QUALITY, AND
ACCESS TO HEALTHCARE
SHANNON C. SCOTT, DOHEALTH POLICY FELLOWSHIP 2012-2013
OSTEOPATHIC FAMILY PHYSICIAN
Patient Access
The public wants access to e-health technology and the ability to communicate with their physicians via email.
2012 Harris Interactive Poll (n= 2,311)
E-Health Challenges
• Cost of health information technology (HIT)• Work load changes• Reimbursement• State licensing requirements• Quality of care issues• Safety and security of transmitted
information
What is E-Health?
• Over 50 different definitions– Creates health policy confusion
• Umbrella Term– Telemedicine– Telehealth– E-mail
• Synchronous (real-time) video, audio• Asynchronous (delayed-time) e-mail, text msg
Electronic Health Records By 2012, 72% of physicians have an EHR• 7% use email to communicate with
patients
EHR Costs:• Implementation and maintenance• Meaningful Use incentive programs
assist but do not reimburse. • As high as $80,000 over four years per
provider
Meaningful Use Stage 2 - Jan 2014• Requires “providers to use secure
e-mail with patients” to qualify for incentive payments
Reimbursement of E-health
• Limited in both private and federal programs
• In some states Medicaid pays for Telemedicine
• Private payer CPT 99444 exists– Many limitations to use of code
• Cost of health IT ≠ reimbursement
State Medical Licensing Issues
• Policies differ among states regarding e-health• Full license required to practice electronically– Limited to the state where the patient lives
• Unintended consequences– Expensive and time consuming to obtain multiple
state licenses– Decreased access to care– Proposal of national medical license
Security
• Increased physician and patient risk when using e-health on unencrypted sites.
• Un-secure Messages – Manipulated– Forwarded– Read by unintended recipients– Contain protected health information (PHI)
Three Pilot Projects
Group Health Cooperative
• 2003• “Shared Health Record”• Online medical records• Secure email messaging• 235,000 (54%) of eligible
adults accessed services• 1,055 physicians
engaged• 23% of their encounters
now occur via secure messaging
• Replaced 27% of office visits and 66% of telephone calls
Kaiser Permanente Experience
• 2004-2010• “Suite” online services• 2.3 million (64%)
members enrolled by 2010
• 7,000 physicians had received over 5.8 million secure messages
• 35,423 patients who used secure messaging had a reduction in office visits and an increase in health quality outcomes
Virtuwell/ HealthPartners Minnesota and Wisconsin
• 2010• Online health care
service• Medicare coverage• Accessed by 40,000
patients• Visits screened by nurse
practitioners via protocol
• $88 savings per visit• In-person office visits
were displaced by 90%• 94% patients satisfied
Pilot Project Feedback
• Critical to the success of each program included attention to provider work flow, reimbursement, and organization of the information transmitted electronically.
Access
Quality
Cost
Recommendations: Payment Reform• Traditional fee-for-service will not
support e-health. • Develop e-health business models for
private insurers.• Overhaul federal e-health incentive
programs.– The MU program designed to run
through 2016 should be lengthened instead of assessing penalties.
Recommendations: State Medical Licensing
• Develop uniform licensure rules among all states. • State medical licensing boards retain control of all
licensing fees and disciplinary regulation.• Integrate all medical licensure into a national database.
• Establish clear definitions among electronic health subsystems for policy making groups.
• Prevent telemedicine or e-health from being singled out as a medical specialty or granted special license.
Recommendations: Security
• Secure confidential information through a patient portal. – Adhere to HIPPA and AMA medico-legal guidelines.
• National policy making groups collaborate regarding security.
• Educate physicians through CME on E-health best practices.– Recommend clear practice policies regarding:
• Message response times• The amount of information transmitted electronically• Types of conditions treated with e-health technology
Well-designed e-health systems have the potential to increase physician efficiency, patient engagement, and
health outcomes.
The full potential of e-health is yet to be understood; virtually every patient could be
touched by this innovation.
BibliographyHarris Interactive Poll. (2012). Patient Choice an Increasingly Important Factor in the Age of the "Healthcare Consumer". Accessed May 24, 2013, from Harris Interactive News Room: http://www.harrisinteractive.com/NewsRoom/HarrisPolls/tabid/447/mid/1508/articleId/1074/ctl/ReadCustom%20Default/Default.aspx
Dixon, R. Enhancing Primary Care Through Online Communication. Health Affairs, 2010; 29(7), 1364-1369.
American College of Physicians. (2008). Center for Practice Improvement and Innovation: Communicating with Patients Electronically (Via Telephone, Email, & Web Sites). Accessed May, 2013, from: http://www.acponline.org/running_practice/technology/comm_electronic.pdf
Schroeder, S., & Frist, W. Phasing Out Fee-for-Service Payment. New England Journal of Medicine, 2013; (368) 2029-2032.
Health Policy Institute of Ohio. (2013). Looking Ahead: Understanding Telehealth in Ohio. Accessed June 2013, from Health Policy Institute of Ohio: http://a5e8c023c8899218225edfa4b02e4d9734e01a28.gripelements.com/pdf/publications/hpio_telehealth_brief.pdf
Kittler, A., et. al. Primary care physician attitudes towards using a secure web-based portal designed to facilitate electronic communication with patients. Informatics in Primary Care, 2004; (12) 129-138.
Boukus, E., et al. Physicians Slow to E-mail Routinely with Patients. Health System Change, 2010. Accessed June 2013, from: http://www.hschange.com/CONTENT/1156/
American Medical Association. (2010). Report of the Council on Medical Service- Payment for Electronic Communication. Accessed June 2013, from American Medical Association: http://www.ama-assn.org/resources/doc/cms/a10-cms-rpt-1.pdf
American College of Physicians. (2008). Position Paper: E-Health and Its Impact on Medical Practice. Accessed May 24, 2013, from: http://www.acponline.org/acp_policy/policies/ehealth_impact_medical_practices_2008.pdf
Bibliography, cont.Federation of State Medical Boards. (2012). Telemedicine Overview Board-by-Board Approach. Accessed June 2013, from Federation of State Medical Boards: http://www.fsmb.org/pdf/grpol_telemedicine_licensure.pdf
Courneya, P., et al. HealthPartner's ONline Clinic For Simple Conditions Delivers Savings of $88 Per Episode and High Patient Approval. Health Affairs, 2013; 32(2), 385-392.
Rowthorn, V. White Paper: Legal Impediments to the Diffusion of Telemedicine. Journal of Health Care Law and Policy, 2011; Volume 14, pages 1-24.
Federation of State Medical Boards. (2011). Telemedicine Conference: Balancing Access, Safety and Quality in a New Era of Telemedicine. Washington DC: Federation of State Medical Boards. Accessed June, 2013 from: http://www.fsmb.org/pdf/pub-symposium-telemed.pdf
Zhou, Y., et al. Improved Quality At Kaiser Permanente Through E-Mail Between Physicians And Patients. Health Affairs, 2010; 29(7), 1370-1375
Baer, D. Patient-Physician E-Mail Communication: The Kaiser Permanente Experience. Journal of Oncology Practice, 2011; 7(4), 230-233.
LeRouge, C., et al. The Business of Telemedicine: Strategy Primer. Telemedicine and e-Health, 2010; 16(8), 898-909.
