Outpatient CPOE Difficult But Can Improve Productivity and Quality
October 24, 2010
Posted by chcablogadmin in : Quality, Technology
In June, we covered the groundbreaking study by researchers at Lucile Packard Children’s Hospital at Stanford that associated a decrease in mortality with CPOE. Now, we share Seattle Children’s Hospital’s efforts in implementing CPOE on an outpatient basis. Where is your organization on the CPOE continuum? Have you aligned your efforts in meaningful use with overall organizational goals around quality and clinical integration? – Don
By Mark A. Del Beccaro, M.D., Pediatrician-in-Chief, CMIO, Seattle Children’s Hospital
Dr. Del Beccaro
At the spring 2010 meeting of the Cerner Pediatric Leadership Council meeting, much of the talk centered around meaningful use and provider eligibility in the ambulatory setting. Many attending children’s hospitals have not yet ventured into this space. Seattle Children’s Hospital implemented CPOE in the outpatient services about six years ago. All orders, including orders between visits, are included in the system. This system has wide implications for the organization in terms of productivity and safety. Our experience brings to others the fact that if an organization has no experience with ambulatory order entry, just imagine it being twice as difficult as CPOE on the inpatient unit. The volume of patient encounters rotating in and out of your primary care and specialty clinics and the complexity of managing those patients (prescriptions, lab, radiology, etc.) in between visits contributes to this difficulty. On top of the volume issue, EMR vendors have not yet made it easy for providers to match an order to a specific encounter when orders are for procedures to occur several months into the future.
The upside of order entry in ambulatory is that now our organization has a mechanism for knowing what’s happening to the patient in real time. This is now transparent and hugely applicable for quality and safety reasons. We can track orders and perform the appropriate analysis. We’ve never had this in the past. This is the reason to get into CPOE in the outpatient setting. Organizations considering this simply for the reimbursement associated with meaningful use will find it far more costly and complex than could have been anticipated. Only alignment with organizational goals and strategy around clinical integration and quality will make order entry in the ambulatory setting a worthwhile endeavor in the end.
(Note: View a list of CHCA Owner Hospital Clinical Information Systems.)
add a commentReports on the GPO Industry Spur Discussion
October 10, 2010
Posted by chcablogadmin in : Group Purchasing
As you know, HIGPA and HGPII have been working closely with others in the GPO industry to provide transparency and information to those in Washington, D.C. Last week, the U.S. Government Accountability Office released its official report on GPOs titled “Group Purchasing Organizations: Services Provided to Customers and Initiatives Regarding Their Business Practices.”
The report detailed the comprehensive, industry-leading steps taken by GPOs to ensure transparency, fair contracting and discount product pricing for American hospitals. HIGPA applauded the report and President Curtis Rooney stated in HIPGA’s response, “The GAO… confirmed what the 8th Circuit Court of Appeals, U.S. Department of Justice, Government Accountability Office, the Federal Trade Commission, and virtually all of the 5,000+ American hospitals have already found – GPOs reduce costs for hospitals.” The report contained no surprises and HIGPA immediately provided an overview and talking points as well as speaking to National Journal and Modern Healthcare to correct some misinterpretations.
Ranking member of the Senate Finance Committee Sen. Chuck Grassley (R-Iowa) released his own minority staff report, “Empirical Data Lacking to Support Claims of Savings with Group Purchasing Organizations,” based on the GAO’s findings. Grassley’s report contains expected talking points: that it is difficult to determine the amount of savings brought about by GPOs, and that administrative fees far exceed operating costs and are used for more than negotiation of contracts. The report may serve as a basis for Grassley to attack Safe Harbor at some point in the future. Many expect he will push for more hearings.
This week, Navigant Economics (a subsidiary of Navigant Consulting; see description below) released their own study entitled “Do Group Purchasing Organizations Achieve the Best Prices for Member Hospitals? An Empirical Analysis of Aftermarket Transactions.” This study, funded by the Medical Device Manufacturers Association (MDMA), examined a database of medical device transactions conducted between 2001 and 2010 in which hospitals sought to improve GPO prices through competitive bidding processes. Findings indicate that when the hospital purchasing process is exposed to greater competition, hospitals were able to achieve savings of up to 18 percent off the GPO price achieved on average for 2010. This study suggested the need to reform the way GPOs are compensated to help ensure they deliver value to the health care system. Premier responded to Navigant’s report by stating that the $200 billion medical device industry and its largest manufacturers are the only parties that stand to benefit from changing a working, competitive GPO market. They added “the relationship between GPOs and manufacturers should be adversarial in this context, and the attacks tell us that we are effective in driving manufacturer prices down and providing significant cost savings to hospitals, patients and payers alike.”
As a result of these published studies, health care and political blogs as well as national magazines including Modern Healthcare are engaged in dialogue about the benefits, concerns, reach and oversight of GPOs. On the Action for Better Healthcare blog, Kester Freeman, former CEO, Palmetto Health, discusses the GAO study and states “GPOs are a major asset to health care. They are helping lead the way with important aspects of health care reform. They improve the way care is delivered, setting standards in safety and quality. The work they do helps make non-profit hospitals and health care systems stronger. In the end this is a win for patients and the health care system in this country.”
HIGPA and HGPII will continue to proactively follow and respond to developments and I will keep you informed as well. As HIGPA Board Chairman Rand Ballard concluded, “As we move toward implementation of federal health care reform, the cost savings that GPOs provide to American hospitals are more critical than ever. HIGPA is committed to further increasing price transparency in the health care sector and to promoting access, competition and choice so hospitals are able to identify and purchase the best products at the highest value.”
__________________________________________________________________________________________
Navigant Economics, a subsidiary of Navigant Consulting, provides economic and financial analysis of legal and business issues to law firms, corporations and government agencies. Their clients are engaged in litigation, regulatory proceedings, policy debates and strategic planning.
Health Care in California: Implementing a Medical Foundation Model
October 10, 2010
Posted by chcablogadmin in : Manpower & Workforce
Is the proposal of the Hospital Association of Southern California to create a joint medical foundation for its members a sign of the growing alignment between doctors and hospitals? Will this trend be accelerated by health care reform? The new law encourages formation of health organizations that can coordinate overall patient care as a means of improving outcomes and efficiency. But critics of the mergers say integrated health systems may be able to drive up prices because of their leverage in negotiations with private insurers. Kim Cripe gives us an insider’s perspective on the medical foundation model. — Don
by Kimberly C. Cripe, President and CEO, Children’s Hospital of Orange County
Kim Cripe
Like many states across the country, California is suffering from a shortage of pediatric subspecialty physicians. Factors unique to the state include high cost of living, debt burden of new graduates and comparatively poor reimbursement rates. Faced with this physician shortage, Children’s Hospital of Orange County (CHOC) is pursuing the California medical foundation model to help fulfill subspecialty recruitment needs as well as to improve relationships and provide stability to existing medical staff.
The foundation model was developed in response to California’s corporate practice of medicine statute that prohibits hospitals from employing physicians. The foundation does not employ physicians; instead, it contracts with independent physicians or medical groups to provide professional services to foundation patients. This model is required to provide teaching and research services. Another potential benefit may be functioning on some level as a group purchasing organization. While the foundation model is specific to California law, similar models may be appropriate in other states where laws restrict the employment of physicians.
By implementing the foundation model at CHOC, we anticipate it will:
Create a more stable and reliable physician organization
As our nation’s health care delivery model continues to focus on providing coordinated care for patients and managing costs, we believe formal arrangements between physicians and hospitals, like the foundation, will enable all involved to work more collaboratively on systems and structures to reach this goal.
Attract physician recruits and allow for joint contracting
The critical goal is to develop strong physician relations and loyalties that will allow us to provide the best and most comprehensive care for our patients. By contracting for physician services through a foundation, we are able to ensure reasonable compensation and a stable working environment for our physician partners.
Integrate and improve quality of care
Ultimately, we believe the best care for our patients can be achieved when hospitals and physicians have an organizational structure that allows them to jointly focus on delivering the best care to our shared patient population.
We believe this is a very sound model for CHOC. I’m curious what your thoughts are. Have you seen similar models at play in your markets? I’d appreciate your comments.
1 comment so far | add a comment
