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VHIG Digest: Volume 2, No. 3

Posted by on Tuesday, February 22, 2011 in Digest, Our Blog and Digest, Volume 2.

By Janice Babbs, OGSM II

In the News

1. HealthGrades Releases List of Top 50 Cities for Hospital Care

HealthGrades, a leading independent healthcare ratings organization, released the first-ever list of America’s Top 50 Cities for hospital care. The rankings are based on a comprehensive study of patient death and complication rates at the nation’s nearly 5,000 hospitals. HealthGradesidentified those hospitals performing in the top 5% nationwide across 26 different medical procedures and diagnoses, then ranked cities by highest percentage of these hospitals. The top cities were:

  • West Palm Beach, FL
  • Brownsville, TX
  • Dayton, OH
  • Minneapolis/St. Paul, MN
  • Tucson, AZ
  • Cincinnati, OH
  • Phoenix, AZ
  • Greenville, SC
  • Chattanooga, TN
  • Richmond, VA

Another key finding of the study was that if all hospitals performed at a top-rated level, 158,684 Medicare beneficiaries’ lives could have been saved and 3,511 Medicare in-hospital complications could have been potentially avoided across the study period.

2. Accountable Care Organizations, Explained

Accountable Care Organization (ACO) development is one of the provisions in the health care law. The Centers for Medicare & Medicaid Services is expected to release detailed rules on ACOs within a few weeks, according to NPR.

NPR states the facts that are known about ACO’s so far:

  • · An ACO is a network of doctors and hospitals that shares responsibility for providing care to patients. Under the new law, ACOs would agree to manage all of the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years.
  • · ACOs would make providers jointly accountable for the health of their patients, giving them strong incentives to cooperate and save money by avoiding unnecessary tests and procedures.
  • · ACOs wouldn’t do away with fee for service but would create savings incentives by offering bonuses when providers keep costs down and meet specific quality benchmarks, focusing on prevention and carefully managing patients with chronic diseases.  The law also gives regulators the ability to devise other payment methods, which would likely ask ACOs to bear more risk.
  • · ACOs differ from health maintenance organizations in that patients are not required to stay in a network.

Critics of ACOs worry that the mergers formed between providers and hospitals will drive up health care costs because they will have increased bargaining power with insurance companies.

3. Doctor Watson, I Presume? IBM Supercomputer Now Heads to Two Hospitals

Watson, IBM’s supercomputer who recently defeated two humans on the show Jeopardy!, will head to Columbia University Medical Center and the University of Maryland School of Medicine with the hope of aiding patient diagnosis. Though Watson is unlikely to be used on patients for at least two years, the supercomputer will be tested to see if it can help physicians better diagnose patients by sifting through large amounts of medical literature and by interpreting electronic health records. As seen on Jeopardy!, Watson has the power to focus more than 2,000 computer processors on one task. Watson uses millions of disconnected pieces of information stored in its database to connect patterns by linking words and phrases that often go together. Watson still needs to learn how to understand electronic health records and stockpile information from medical literature, but Columbia University and University of Maryland faculty are optimistic about the possibilities.

In the Literature

1. Pay For Performance Metrics Do Not Show Benefits to Patients

Pay-for-performance targets set for general practitioners in the United Kingdom are failing to improve the health of patients with high blood pressure, according to a study in the British Medical Journal. The UK pay for performance incentive (the Quality and Outcomes Framework), was implemented in April 2004 and included specific targets for general practitioners to show high quality care for patients with hypertension and other diseases. For the study, researchers examined medical records of patients with hypertension in the UK, comparing data from before and after the pay for performance incentive was introduced. Researchers found that pay for performance had no discernible effects on processes of care or on hypertension-related clinical outcomes, and conclude that the system may not be sufficient to improve quality of care and outcomes for hypertension and other common chronic conditions.

Soumerai, ST et al. Effect of Pay for Performance on the Management and Outcomes of Hypertension in the United Kingdom: Interrupted Time Series Study. British Medical Journal. 2011; 342:d108.

2. Clinical Practice Guidelines to Inform Evidence-Based Clinical Practice

Clinical Practice Guidelines (CPGs) combine evidence-based medicine with expert opinion to improve health care by identifying evidence that supports the best clinical care and making clear which practices appear to be ineffective. Practitioners are challenged by two extremes, however – the high volume of medical research currently published on some conditions and the lack of good evidence published on others. This article explains that the application of high-quality CPGs improves patient care, but all too often CPGs are not used to the greatest advantage because of inadequate dissemination and incorporation into practice.

Wolf JS Jr, et al. Clinical Guidelines to Inform Evidence-Based Clinical Practice. World Journal of Urology. 2011. [Epub ahead of print, Feb. 18]

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