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Health Affairs Examines Health IT, Payment and Practice Reforms


Several August articles examine how technology has altered the health care landscape


Bethesda, MD -- Health Affairs' August issue covers a range of topics, including changes in health care delivery and financing sparked by the rise in health information technology (HIT) adoption. In the United States, progress in health IT adoption has been fueled in large part by the nearly $30 billion in incentives authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. Founding editor John Iglehart observed that, "Strides forward have been steady, if uneven among different provider groups. Yet the end of the journey toward universal adoption of electronic health records is still years away."


Featured articles include:


Achieving Meaningful Use In HIT: Some Hospitals Falling Behind. With nearly $30 billion in incentives available to US hospitals, to what extent have hospitals adopted electronic health record (EHR) systems that meet Medicare's criteria for their "meaningful use"? Catherine M. DesRoches of Mathematica Policy Research Institute and coauthors analyzed Medicare data; they found a substantial increase in the percentage of hospitals receiving EHR incentive payments between 2011 (17.4 percent) and 2012 (36.8 percent). However, this increase was not uniform across all hospitals: critical access, smaller, and publicly owned or nonprofit hospitals appeared to be at particular risk for failing to meet Medicare's meaningful-use criteria. Because hospitals failing to meet the criteria will be subject to financial penalties beginning in 2015, the authors recommend providing additional information technology workforce support, targeted grant programs, and close monitoring of the EHR vendor market to ensure that all hospitals have access to the technology they need.


Hospital Electronic Health Information Exchange Shows Improvement. Some encouraging findings are reported in a study by Michael F. Furukawa and coauthors of the Office of the National Coordinator for Health Information Technology, Department of Health and Human Services. Using national surveys of hospitals from 2008 to 2012, the authors found that in 2012 nearly six in ten hospitals actively exchanged electronic health information with providers and hospitals outside their organization, an increase of 41 percent since 2008. They also determined that EHR adoption and health information organization participation were associated with significantly greater hospital exchange activity, but the majority of hospitals still do not exchange clinical care summaries and medication lists. To address these deficiencies, the authors point to existing initiatives, such as the State Health Information Exchange Cooperative Agreement Program, to assist hospitals and help prepare to meet stage 2 meaningful-use requirements.


For Small Physician Practices, Sharing Resources To Improve The Quality Of Care. Lawrence P. Casalino of Weill Cornell Medical College and coauthors conducted a national survey of 1,164 practices with nineteen or fewer physicians to provide the first information available on the extent to which independent practice associations (IPAs) and physician-hospital organizations (PHOs) make it possible for these smaller practices to share resources and improve care. According to the authors' data, medical practices belonging to these organizations used nearly three times as many care management processes (10.4 versus 3.8) as did nonparticipating practices in their treatment of patients with chronic conditions. The authors concluded that IPAs and PHOs may provide a way for small and medium-size practices to systematically improve care and participate in accountable care organizations.


In Orthopedic Surgery, Reference Pricing Can Lower Hospital Prices And Employer Costs. Some efforts designed to make consumers and hospitals more cost conscious have been successful. James C. Robinson and Timothy T. Brown of the University of California, Berkeley, evaluated the impact of "reference pricing" on knee and hip replacement surgery by members of the California Public Employees' Retirement System (CalPERS) from 2008 to 2012. Under this benefit design, the insurer sets limits on the amount to be paid for a procedure, with employees paying any remaining difference. The authors found that in the first-year results, surgical volumes for CalPERS members increased by 21.2 percent at low-price facilities and decreased by 34.3 percent at high-price hospitals. Hospitals reduced their prices by an average of 20 percent after implementation of the reference pricing initiative. Their analysis indicates that in 2011 reference pricing accounted for $2.8 million in savings for CalPERS and $0.3 million in lower cost sharing for CalPERS members.


Malpractice Liability Concern Linked To Some Increases In Diagnostic Tests. There is widespread agreement that physicians practicing defensive medicine drive up health care costs. Yet, the extent to which defensive medicine increases costs is unclear. To find some answers, Emily R. Carrier of the Center for Studying Health System Change and coauthors linked physicians' responses about their levels of malpractice liability concern as reported in the 2008 Health Tracking Physician Survey to Medicare A and B claims for the patients they treated between 2007 and 2009 for new complaints of chest pains, headaches, or lower back pains. They found that physicians who reported a high level of malpractice concern were most likely to engage in defensive practices when diagnosing patients visiting their offices because of these symptoms. However, the authors found no consistent relationship when state-level indicators of malpractice liability risk, such as caps on damages, replaced self-rated concern. Reducing such defensive medicine, they concluded, may require shifting the focus to physicians' perceptions of legal risk and the underlying factors driving those perceptions.


Also of interest in the August issue:


  • Low-Socioeconomic-Status Enrollees In High-Deductible Plans Reduced High-Severity Emergency Care; J. Frank Wharam of Harvard Medical School and the Harvard Pilgrim Health Care Institute and coauthors

  • An Improved Approach To Measuring Drug Innovation Finds Steady Rates Of First-In-Class Pharmaceuticals, 1987-2011; Michael Lanthier of the Food and Drug Administration and coauthors
About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically at The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a one-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the new iPad app.