Everyone knew Obama was a Clinton Wall Street global corporate neo-liberal the first few months of his Administration as he appointed Clinton staff and Wall Street players throughout his Cabinet and agencies. We shouted FOUL and Obama said OH, SHUT UP! That is a global corporate pol that does not see the American people as citizens but works for global corporate tribunals.
I spoke of Obama's appointment of Burwell as Health and Human Services---Burwell is Bill Gates' new health corporation executive. He appointed to the Food and Drug Administration an executive for Monsanto and now he appointed an executive with this university as corporation research structure. These appointments are happening at the same time on state and local levels and this is the face of this global health care system preparing for Trans Pacific Trade Pact and its installation.
Below you see a clip of a good article that tracks the increased danger in public health efficacy as public health became more and more commercialized. It states at the end that medical research in the US now simply releases the PHARMA and/or medical device and watches the negative effects on the general population. US medical research corporations like Johns Hopkins have been doing this overseas for decades and now they are bringing it home hyping the patented product-mill in Baltimore. Now, Affordable Care Act seeks to take most Americans to preventative health care only recognizing the profiteering of the past decades---what they are not telling the American people is common, effective medical treatment will be going the same way. ACA does not have a goal of cutting health expenses by controlling profiteering---it will shorten people's lives with the inability of people to access ordinary care.
If you can imagine the health industry being allowed to act as Wall Street financial industry earning profit anyway it can-----you see the American people becoming third world human capital to be used any way to earn profit. How do you sell more of a Johns Hopkins' patented drug or molecular medical procedure? You build it into the medical protocol the insurance branch of its health system writes.
Death by Medicine
By Gary Null, Ph.D., PhD; Carolyn Dean MD, ND; Martin Feldman, MD; Debora Rasio, MD; and Dorothy Smith, PhD
'Medical Ethics and Conflict of Interest in Scientific Medicine Jonathan Quick, director of essential drugs and medicines policy for the World Health Organization (WHO), wrote in a recent WHO bulletin: "If clinical trials become a commercial venture in which self-interest overrules public interest and desire overrules science, then the social contract which allows research on human subjects in return for medical advances is broken."(19)
As former editor of the New England Journal of Medicine , Dr. Marcia Angell struggled to bring greater attention to the problem of commercializing scientific research. In her outgoing editorial entitled “ Is Academic Medicine for Sale?” Angell said that growing conflicts of interest are tainting science and called for stronger restrictions on pharmaceutical stock ownership and other financial incentives for researchers:(20) “When the boundaries between industry and academic medicine become as blurred as they are now, the business goals of industry influence the mission of medical schools in multiple ways.” She did not discount the benefits of research but said a Faustian bargain now existed between medical schools and the pharmaceutical industry'.
____________________________________________
It is very hard to find criticism of Affordable Care Act that isn't just Republicans pretending that the ACA is not a Republican policy ----this does a good job at looking where ACA will take us. The important thing now is making our state health systems public----Expanded and Improved Medicare for All to keep this vital Federal program intact as Clinton neo-liberals and Republicans work to kill it.
This is a clip of a very long article----take time to look at it. Maryland pols are all neo-cons and neo-liberals and this is why Maryland has one of the most profit-driven and excluding state health systems in the nation.
US Politics and Society
The neoliberal restructuring of healthcare in the US
By Sean PettyIssue #94: Features
There are a number of forces driving increases in healthcare costs. Increased profit extraction by the pharmaceutical, medical supply, and insurance industry that now totals over $100 billion annually, the 31 percent in administrative costs that insurance companies expend in order to extract their profits, severe and widespread price gouging by major medical centers, and the fact that United States has the highest inequality in the industrialized world and therefore a high prevalence of chronic and poorly treated diseases, are among the top contenders.15 The architects of the ACA chose not to directly confront these realities. Instead, according to Obama administration officials, the argument is that rising costs are due to people getting too much healthcare because their doctors and hospitals are ordering too many tests and procedures because they have a financial incentive to do so. “The sources of inefficiency in the US healthcare system include payment systems that reward medical inputs rather than outcomes,” says WhiteHouse.gov.16 This premise is false and is ideologically loaded. As Charles Idelson points out, this analysis:
stems from some highly-publicized abuses of a few practitioners who prescribe diagnostic procedures or medical treatment to profit from reimbursements. But it also coincides with the portrait of patients as a whole class of ‘takers’ who somehow enjoy spending hours waiting in doctors’ offices or undergoing colonoscopies, a theory that has race, gender, and class overtones, blaming minorities, women, and the poor for demanding “too much” care.17
__________________________________________
University of Maryland College Park executives testified in the Maryland Assembly that this corporate research structure in our public university has never been more profitable. What they are saying is that the administrative employees that are now corporate executives and not academic employees are getting rich! I wrote about the wage inequity at the top being created by appointees of the governor----Erhlich and O'Malley the most recent in this race to global corporate health structures. Larry Hogan, the current elected neo-conservative has kept most of O'Malley's appointments because neo-cons and neo-liberals have the same goals.
Everywhere you read you see the words -----HOSPITALS HAVE NEVER BEEN MORE PROFITABLE! CONSOLIDATION AND HEALTH TOURISM BRINGING HIGHER PRICES AND GETTING RID OF THE MARYLAND CITIZENS PAYING THE TAXES TO SUPPORT THESE HOSPITALS. Yet, all of these health systems are still NON-PROFITS---PAYING NO TAXES AS CORPORATE SUBSIDY SOARS.
This is the source of Baltimore's poverty----decades of allowing Johns Hopkins to suck billions from all revenue coming to Baltimore to advance this global corporate empire with the help of Baltimore City Hall, Maryland Assembly,and Congressional pols all running as Democrats and serving a very neo-conservative, repressive and regressive Johns Hopkins. More health deregulation and corporatization policy was presented by Baltimore pols these several years than you can shake a stick all the while the city was known to have a large population of citizens abused and neglected by health care just as in overseas developing nations.
Keep in mind as the article above states----the data coming from these corporate health systems are no longer accurate----they are skewed to hide errors, problems, and negative results that will cut into corporate profit.
BALTIMORE POLITICIANS -----RUNNING AS DEMOCRATS AND SERVING AS THE WORST OF NEO-CONSERVATIVES!!!!!
MARYLAND SPECIALIZES IN HAVING THE MOST PROFITABLE NON-PROFITS!
Maryland's most profitable hospitals
Sep 24, 2013, 1:31pm EDTRobert Loughrey
The University of Maryland Medical Center was the most profitable hospitals in the state during fiscal 2013.
Reporter- Baltimore Business Journa
Hospitals in Maryland are pretty worried about their financial condition — and with good reason.
Last week I reported that hospital operating profits dropped 71 percent in fiscal 2013 to about $100 million. Operating profits at Baltimore-area hospitals varied significantly, as you can see here. The data come from the state Health Services Cost Review Commission’s unaudited fiscal 2013 profits report. Unaudited means the numbers could change slightly, as the commission works through it all.
Profits are certainly down, but it’s not all bad.
Here are the most profitable hospitals in Maryland:
By total profits
One of the mantras of Affordable Care Act was ----the patients need to see all of the data on health systems to know which is better than the other. One thing that is evident with Clinton neo-liberalism and Bush neo-conservatism is NO TRANSPARENCY FOR THE PUBLIC---ALL CORPORATE WHEELING AND DEALING IS CONFIDENTIAL. So, did people really think this health reform was about creating a competitive market place when the goal was consolidation into global health corporations that operate any way they want? Of course not-----Clinton Wall Street global corporate neo-liberals just say anything they want to make policy sound progressive.
Below you see all of the elements that make a strong public health system and yet, all of the health policy these several years have been the opposite. We now have hospitals partnered with health insurance corporations and pharmacies all of which used to keep competition and prices down. We also have a dismantling of Federal public health Medicare which was always the method to keep prices down until Clinton deregulation and dismantling of oversight and accountability created massive Medicare and Medicaid frauds of hundreds of billions of dollars a year.
ALL OF THIS CAN BE REVERSED IF DEMOCRATIC VOTERS WOULD STOP ALLOWING CLINTON NEO-LIBERALS---AND IN BALTIMORE'S CASE---NEO-CONSERVATIVES----CHOOSE YOUR CANDIDATES. ENGAGE IN POLITICS AND BE THE REAL LABOR AND JUSTICE CANDIDATE IN ALL PRIMARIES.
In Maryland the public cannot even access public policy being written and has no regulatory oversight and health institutions have been allowed to create their own data with no public health department verifying these data so do we think they really intend to give consumers information? Of course not---Maryland's health structure is rapidly consolidating into a few health systems that will be the only choices for Maryland citizens.
If you watched Maryland Health and Mental Hygiene develop these health system policies you know there was no transparency. I attended one public meeting where the public was shown a few topics with several others that were marked----TO BE DEVELOPED LATER---and then the panel went behind closed doors to discuss this policy. If you look at comparisons between electronics products---like a cell phone---you see all of the comparisons are the same.....you get no real information.
Health plan transparency.
The ACA requires that health plans provide consumers with a Summary of Benefits and Coverage (SBC). Health plans also must provide
a uniform glossary of terms commonly used in health insurance coverage, such as “deductible” and “co-payment,” written in plain language.
In addition, the new health insurance marketplaces in each state will provide information to the enrollee about out-of-pocket costs based on the essential
health benefits that health insurers are required to include in their plan offerings.
But plans can still substitute benefits as long as they are in the same category of benefits and are actuarially equivalent, generally meaning that a benefit can be substituted for another benefit as long as they have the same monetary value. So while these ACA consumer protections will provide basic information about what the health plan covers, they will not provide consumers with detailed information about what choices the health plan has made in substituting benefits
while still meeting the “actuarial equivalent” standard. The resulting differences in what plans cover may continue to make plan comparisons difficult. In addition,
the ACA consumer protections do little to standardize the information health plans provide consumers after care is given. The health plan explanation of benefits, or EOB, is largely left to the design of the health plan.
Transparency and Public Reporting Are Essential for a Safe Health Care System
Publication Date:
March 17, 2010 Citation:
L. L. Leape, Transparency and Public Reporting Are Essential for a Safe Health Care System, The Commonwealth Fund, March 2010.
What will it take to motivate hospitals to do what we know works to make health care safer? Of the three major approaches to improving patient safety—regulation/accreditation, financial incentives, and public reporting—the most promising is public reporting of performance information and feedback to providers. Transparency is an idea whose time has come and both hospitals and the public will be better off because of it.
Data from a large number of hospitals, gathered by several sources, show wide variations in the incidence of one of the most lethal hospital-acquired complications, central line–associated bloodstream infections (CLABSIs). Compared with the evidence on how to prevent other types of infections—and most other kinds of adverse events—the evidence on how to prevent CLABSIs is quite strong. Peter Pronovost demonstrated the potential for complete elimination of central line infections in his intensive care unit at Johns Hopkins Hospital seven years ago. In 2005, in a stunning display of generalizability, Pronovost and his team taught staff in over 100 Michigan hospitals to implement his protocol for central line insertion, and 68 hospitals completely eliminated CLABSIs for six months or more.
Yet, we still have significant rates of CLABSI in most hospitals, and some are very high. What is going on? What is going on is that the vast majority of hospitals have not implemented the Pronovost protocol because they have not made a meaningful commitment to reducing preventable injuries, much less eliminating them. Despite an avalanche of data, exhortation from all kinds of experts, and impressive results by some, most hospitals have in place programs to implement only a few of the known safe practices, and none has a strategic plan to implement all of the 34 evidence-based safe practices endorsed by the National Quality Forum. The "chasm" between what we know and what we actually do to prevent complications of our treatment matches that described for all of quality by the Institute of Medicine in its 2001 report, Crossing the Quality Chasm.3
What will it take to motivate hospitals to do what we know works to make health care safer? Evidence is available on the effectiveness of three major approaches: regulation/accreditation, financial incentives, and public reporting of performance and feedback to providers.
Regulation and Accreditation
Because regulation is a state function, and there is tremendous variation in state approaches to quality and safety, its use has been spotty. Information from reporting systems, for example, is seldom used by regulators to improve safety. Although licensing functions are usually supported with public funds, state departments of public health seldom have the resources to monitor hospital practices. Given cost constraints and inertia, this situation seems unlikely to change in the near future. The leading accreditor, the Joint Commission, has been the most effective force for change by requiring hospitals to implement its Patient Safety Goals. However, monitoring safe practices is only a small part of the Joint Commission's activities. It seems unlikely that either it or the states will be able to exert enough pressure to get health care systems to make the quantum changes necessary in hundreds of processes to make health care safe.
Financial Incentives
Using the reimbursement system to improve quality of care has been in vogue for a decade or more. Incentives are usually positive: payment of a bonus as a percentage of reimbursement—2 percent in the Centers for Medicare and Medicaid Services (CMS)/Premier Hospital Quality Incentive Demonstration—although rewards are sometimes packaged with penalties for underperformers. Rewards tend to be for process improvement, not outcomes. There is some evidence that financial incentives improve compliance with quality indicators (such as use of certain medications following acute myocardial infarction), but little or no evidence of improved outcomes. Programs tend to reward mostly providers who are already leaders in quality. As with standards to improve public education, many fear that providers will perform to the test rather than proactively seek to improve quality, but this is a concern with all measurement.
Financial incentives for improving safety, on the other hand, are relatively new. In contrast to those for improving quality, which are positive and process-oriented, incentives for safety have been negative and outcome-oriented: instead of receiving a bonus for adhering to a safe practice, providers are penalized for the consequences of not doing so. The focus has been on selected "never events," taken from the list of serious reportable events developed by the National Quality Forum.These are significant patient harms that hospitals know how to prevent—or should know. Such financial disincentives began in Minnesota but have been given national reach with CMS' recent decision not to reimburse hospitals for the additional costs attributable to eight serious reportable events.
Although the stakes for any hospital are small (these are, or should be, rare events), the pushback has been considerable. Hospitals claim, with some justification, that not all of these events are preventable. This concern seems particularly apt for at least two of the "no-pay" events on the CMS list: falls and urinary catheter–associated infections. Reliable and valid practices for preventing these adverse events have yet to be developed.
Evidence that not paying for serious reportable events improves safety is also lacking. The experience in Minnesota is not encouraging. For example, the number of wrong-site surgeries and retention of foreign bodies in Minnesota hospitals actually increased substantially from 2006 to 2009. Some of this increase is undoubtedly related to improved compliance with the reporting requirement, but nonetheless it does not indicate that the penalty is having a positive effect.
Reporting and Feedback
So far, the most powerful method for reducing preventable injuries has been to require physicians to provide data on their own performance and then provide them with comparisons of their risk-adjusted complication rates with those of their peers. The Veterans Administration (VA) pioneered this approach in the 1990s with its National Surgical Quality Improvement Program, which has since been adopted and promoted by the American College of Surgeons. Under this program, each hospital's surgical specialty department receives feedback on its risk-adjusted complication and mortality rates, together with a comparison with all of the other (unidentified) surgical departments in the VA system. In response to these reports, below-average units made substantial improvements, leading over several years to system-wide declines in both complication rates and mortality that significantly exceeded the secular trend.
It is reasonable to assume, though as yet unproved, that public reporting of similar types of data would spur hospitals to make greater efforts to reduce adverse events. Hospitals—or the public—can choose the benchmark level they prefer: above average, top decile, or others. But it seems evident that performance reporting works best when all providers participate—as in the VA experience. Thus, reporting has to be mandatory. As Wachter emphasizes, it is essential that the events to be reported are a) clinically significant, b) easily measured, and c) largely if not completely preventable. Risk adjustment is essential for fair comparisons.
The "benchmark" in safety, of course, should be zero. If it is, then risk adjustment is irrelevant. The hope is that, as it becomes public knowledge that some hospitals are able to eliminate certain types of adverse events, others will be motivated to follow. While a major thrust of the patient safety movement has been to eliminate blaming and shaming of individuals when they make mistakes, for organizations public reporting may be an appropriate use of shaming.
The larger issue here is transparency. From an ethical standpoint, the argument in favor of transparency is straightforward: the public has a vital stake in the outcomes of health care, and therefore it has a right to know how we are doing. (The contrary argument that hospitals and doctors have a right to keep their results secret in order to protect those with bad results is patently untenable.)
From an economic standpoint, Porter and others regard consumer access to full information as a critical element of value-driven purchasing of health care They contend that consumers can make meaningful choices only if they have complete information. While this formulation is attractive to some economists and policymakers, repeated studies over more than 20 years—going back to the Pennsylvania cardiac surgical scorecards of the 1980s—show that few patients and even fewer doctors pay much attention to this type of information in deciding with whom and where they will receive their medical care.
From the standpoint of improving patient safety, however, transparency is crucial. It is the cornerstone of the cultural transformation that our health care organizations need to undergo to become safe. Transparency is essential within an institution if caregivers are to feel safe in reporting and talking about their mistakes. The free flow of information is essential for identifying and correcting the underlying systems failures. Transparency is also the key to successful—and ethical—responses to patients when things go wrong. It is the cover-ups that lead to lawsuits. And transparency is essential for accountability, to show the public that the hospital or system responds ethically to its failures. Internal transparency begets external transparency—and vice-versa.
Although most hospitals are still skeptical about being transparent, evidence from a few organizations that have gone public with their bad news shows that it is a win-win. First, transparency motivates caregivers to improve care. Lives are saved. In addition, openness shows that the hospital feels accountable and has nothing to hide, which increases public confidence. Transparency is an idea whose time has come and both hospitals and the public will be better off because of it.
_____________________________________________
Raise your hand if you hang onto corporate call centers for hours waiting for any kind of basic help in resolving every problem you have with a product! EVERYONE----WE HAVE BEEN MOVED FROM TALKING WITH A PERSON IN A STORE TO CALLING A GLOBAL CALL CENTER WITH EMPLOYEES TRAINED TO GET RID OF YOU. FEWER AND FEWER WORKERS ARE EVEN STAFFING THESE CALL CENTERS.
Raise your hand if you already watch the amount of minutes you take while talking on a cell phones because your plans are moving rates higher and higher......some people are already reduced to texting. So, do you really think all of this mobile phone health care will really work? OF COURSE NOT---
IT IS MOVING LARGE SECTORS OF AMERICANS OUT OF THE HEALTH SYSTEM ALTOGETHER. REMEMBER, PREVENTATIVE CARE ONLY MEANS VERY LITTLE ACCESS TO CARE THAT REQUIRES COMMUNICATIONS WITH DOCTORS THAT ARE NOT PRIMARY CARE DOCTORS.
I spoke of how Baltimore was already starting to close brick and mortar social services buildings and pushing low-income citizens to call centers where they increasingly cannot reach a staff person. Well, we do not need to be rocket scientists to see that is where this policy goes. Think about who the low-income affording only Medicaid or Bronze level health plans will be----as all union health plans are imploded in this coming bond market crash-----as Medicare is dismantled with fraud and privatization----as Trans Pacific Trade Pact seeks to move 90% of Americans to third world poverty-----YOU CAN BE SURE THAT YOU, YOUR CHILDREN, OR GRANDCHILDREN WILL BE THE ONES PUSHED TO THIS LEVEL OF HEALTH ACCESS.
All because you allow Maryland election primaries to be rigged for Clinton neo-liberals and allow Bush neo-conservatives in Baltimore run as Democrats----GET RID OF THESE CORPORATE POLS TO RETURN TO STRONG PUBLIC HEALTH CARE.
Mobile Health and Patient Engagement in the Safety Net: A Survey of Community Health Centers and Clinics
Publication Date:
May 13, 2015 Authors:
Andrew Broderick, Farshid Haque Contact:
Andrew Broderick, Codirector, Center for Innovation and Technology in Public Health
Patient-centered technologies have emerged as a way to actively engage patients in care. The reach and potential of cell phones to engage diverse patient populations is great. Evidence of their effectiveness in improving health-related outcomes is limited. Researchers conducted an online survey of community health centers and clinics to assess if and how health care providers in the safety net use cell phones to support patient engagement. The findings indicate that the use of cell phones in patient care is at an early stage of deployment across the safety net. Organizations identify chronic disease management as an area where cell phones offer considerable potential to effectively engage patients. To promote widespread adoption and use, technical assistance to support the implementation and management of interventions, evidence-based or best practice models that highlight successful implementation strategies in care delivery, and the introduction of new payment or reimbursement policies will be essential.
OVERVIEW
Cell phones and other consumer digital technologies have emerged as potentially powerful tools to engage patients in health care. They can strengthen the efficacy of safetynet health systems by improving providers’ capacity to reach vulnerable populations and actively engage them in their care. In the United States, minority and low-income people have a high level of cell phone adoption,1,2 and often use features such as text messaging3,4 and mobile Internet.5,6,7 Mobile health interventions frequently involve the use of text messaging to provide concise, timely, and customized care-related information in the form of reminders and motivational and educational messages. These notifications can promote self-management practices for chronic conditions, educate consumers about preventive care and personal wellness, and improve patients’ adherence with recommended treatment.
Providers have the opportunity to enhance care delivery and strengthen patient engagement using these new forms of interactive health services that facilitate greater connectedness between patients and their care team.8 Safety-net communities, in particular, are at greater risk for chronic, preventable diseases. Perhaps more important, text messaging represents a desirable, low-cost means to amplify and reinforce patient-empowerment strategies among the populations they serve given the high penetration of cell phones, high literacy with text messaging, and low costs of implementation. Recent research with low-income patients in California found that continuity and connectedness are key predictors of patient empowerment and efficacy.9 Although few patients can currently communicate with their providers by text or e-mail, a majority of those who currently can find it useful, while many of those who can’t are interested in doing so.10
RECENT FINDINGS More Effectively Engaging Patients in Care Activities or Practices
Most respondents (86%, or 155 of 181 respondents) report that patient engagement has been challenging, particularly in areas related to the adoption of healthy behaviors and compliance with standard care recommendation and treatment protocols. When asked in which areas organizations would like to more effectively engage patients, the greatest number of respondents (89%, or 160 of 180 respondents) said chronic disease management (Exhibit 1).
Using Cell Phones in Patient Care
Using cell phones as a tool for patient engagement remains at an early stage of deployment across the safety net, with just more than one-quarter (27%, or 48 of 180) of respondents reporting they use cell phones in care delivery. Of the centers or clinics that do use cell phones in care, the most common application is to provide patients with appointment reminders (66%, or 31 of 47 respondents) (Exhibit 2). Interventions to support chronic disease management, medication adherence, and smoking cessation remain at low levels, but organizations indicate they are planning to significantly increase their use within the next year.
Benefits of Engaging Patients in Care
Forty-two organizations (of 48) ranked the top three benefits of patients’ use of cell phones. The ability to improve overall compliance with standard care practices (19 respondents), facilitate improved case management and targeted outreach (17 respondents), promote sustained patient engagement in behavior change (16 respondents), and improve compliance and prevent exacerbations of chronic conditions (15 respondents) ranked highest (Exhibit 3).
Developing and Adopting Cell Phone Interventions
We asked organizations about their strategies for developing mobile health interventions. Most have relied on their electronic health record (EHR) platforms and the ability of those platforms to support text-messaging applications (62% of 42 respondents). A smaller number of organizations have collaborated with other health service organizations to co-develop interventions (10 respondents), contracted with mobile health solution providers (9 respondents), or developed proprietary technical or content elements (9 respondents) (Exhibit 4).
The survey asked center and clinic leaders about the criteria used to assess and justify the adoption of a cell phone intervention. More than half of respondents (22 of 40) indicated the appropriateness of an intervention for use across diverse patient populations as the leading criterion. Evidence of improvement in care quality (18 of 40) as well as cost-effectiveness (16 of 40) were also ranked as leading criteria. Only five respondents listed user participation in design and development (Exhibit 5).
Barriers to Implementation and Actions to Encourage Adoption
Of the 173 organizations that identified three leading barriers to implementing cell phone interventions, 94 cited a lack of external funding sources and 91 said limited human and technical resources. The next-most significant barrier (65 respondents) was the integration of mobile health solutions with electronic health records and other health information technology infrastructure (Exhibit 6).
The survey asked the organizations which criteria they view as essential to promote or justify adoption of a cell phone intervention. Of the 163 organizations that responded, most said technical assistance to support the implementation and management of interventions (106 respondents), evidence-based or best practice models of cell phone use in care delivery models (95 respondents), and the introduction of new payment or reimbursement policies for cell phone use in patient care (90 respondents) were most important (Exhibit 7).
DISCUSSION Digital technologies like cellular phones can increase the interactivity of health services and improve the capacity of public health organizations to care for underserved populations. In addition to improving patient engagement, mobile health solutions can support critical components of health reform, like patient-centered medical homes and accountable care organizations. There is limited evidence, however, of effectiveness in improving health-related outcomes with underserved populations and insufficient case studies that illustrate best practices or effective strategies for the deployment of interventions. Moreover, there are few financial and technical resources that can support implementation. Such limitations constrain organizations’ abilities to realize the potential of digital health solutions.
On a larger scale, using technology to promote patient-centered, coordinated care can help make significant advances in improving population health and reducing inefficiencies in care delivery. But, as the findings from this survey reveal, providers have not been able to effectively leverage technology tools toward these goals. To fully unlock the potential of technology to improve health care will require an improved understanding of the use of mobile health in patient care, as well as policies that provide funding, technical assistance, and reimbursement and address the issues of informed consent, privacy and security.
METHODOLOGY
This brief presents findings from an online survey of a national sample of urban and rural community health centers and clinics on their current use of and experiences with the implementation of mobile health solutions. The survey instrument was designed with input from key informant interviews, and questions were designed with a multiple-choice format and programmed with skip logic. Our sample frame of safety-net providers comprises urban and rural community health centers and clinics that offer health care services to low-income people, including those without insurance, and represents a subset of the larger health care safety-net provider system and the even-larger health care system beyond the safety net. National outreach to the senior leadership of 959 organizations nationwide took place between June and October 2013 and resulted in 230 organizations participating in the survey, of which 181 were completed and included in our final analysis (18.9% response). Exhibit M1 shows the response rates for organizations by state and in relation to the number of Health Resources and Services Administration’s Bureau of Primary Care grantees by state.
I spoke of Obama's appointment of Burwell as Health and Human Services---Burwell is Bill Gates' new health corporation executive. He appointed to the Food and Drug Administration an executive for Monsanto and now he appointed an executive with this university as corporation research structure. These appointments are happening at the same time on state and local levels and this is the face of this global health care system preparing for Trans Pacific Trade Pact and its installation.
Below you see a clip of a good article that tracks the increased danger in public health efficacy as public health became more and more commercialized. It states at the end that medical research in the US now simply releases the PHARMA and/or medical device and watches the negative effects on the general population. US medical research corporations like Johns Hopkins have been doing this overseas for decades and now they are bringing it home hyping the patented product-mill in Baltimore. Now, Affordable Care Act seeks to take most Americans to preventative health care only recognizing the profiteering of the past decades---what they are not telling the American people is common, effective medical treatment will be going the same way. ACA does not have a goal of cutting health expenses by controlling profiteering---it will shorten people's lives with the inability of people to access ordinary care.
If you can imagine the health industry being allowed to act as Wall Street financial industry earning profit anyway it can-----you see the American people becoming third world human capital to be used any way to earn profit. How do you sell more of a Johns Hopkins' patented drug or molecular medical procedure? You build it into the medical protocol the insurance branch of its health system writes.
Death by Medicine
By Gary Null, Ph.D., PhD; Carolyn Dean MD, ND; Martin Feldman, MD; Debora Rasio, MD; and Dorothy Smith, PhD
'Medical Ethics and Conflict of Interest in Scientific Medicine Jonathan Quick, director of essential drugs and medicines policy for the World Health Organization (WHO), wrote in a recent WHO bulletin: "If clinical trials become a commercial venture in which self-interest overrules public interest and desire overrules science, then the social contract which allows research on human subjects in return for medical advances is broken."(19)
As former editor of the New England Journal of Medicine , Dr. Marcia Angell struggled to bring greater attention to the problem of commercializing scientific research. In her outgoing editorial entitled “ Is Academic Medicine for Sale?” Angell said that growing conflicts of interest are tainting science and called for stronger restrictions on pharmaceutical stock ownership and other financial incentives for researchers:(20) “When the boundaries between industry and academic medicine become as blurred as they are now, the business goals of industry influence the mission of medical schools in multiple ways.” She did not discount the benefits of research but said a Faustian bargain now existed between medical schools and the pharmaceutical industry'.
____________________________________________
It is very hard to find criticism of Affordable Care Act that isn't just Republicans pretending that the ACA is not a Republican policy ----this does a good job at looking where ACA will take us. The important thing now is making our state health systems public----Expanded and Improved Medicare for All to keep this vital Federal program intact as Clinton neo-liberals and Republicans work to kill it.
This is a clip of a very long article----take time to look at it. Maryland pols are all neo-cons and neo-liberals and this is why Maryland has one of the most profit-driven and excluding state health systems in the nation.
US Politics and Society
The neoliberal restructuring of healthcare in the US
By Sean PettyIssue #94: Features
There are a number of forces driving increases in healthcare costs. Increased profit extraction by the pharmaceutical, medical supply, and insurance industry that now totals over $100 billion annually, the 31 percent in administrative costs that insurance companies expend in order to extract their profits, severe and widespread price gouging by major medical centers, and the fact that United States has the highest inequality in the industrialized world and therefore a high prevalence of chronic and poorly treated diseases, are among the top contenders.15 The architects of the ACA chose not to directly confront these realities. Instead, according to Obama administration officials, the argument is that rising costs are due to people getting too much healthcare because their doctors and hospitals are ordering too many tests and procedures because they have a financial incentive to do so. “The sources of inefficiency in the US healthcare system include payment systems that reward medical inputs rather than outcomes,” says WhiteHouse.gov.16 This premise is false and is ideologically loaded. As Charles Idelson points out, this analysis:
stems from some highly-publicized abuses of a few practitioners who prescribe diagnostic procedures or medical treatment to profit from reimbursements. But it also coincides with the portrait of patients as a whole class of ‘takers’ who somehow enjoy spending hours waiting in doctors’ offices or undergoing colonoscopies, a theory that has race, gender, and class overtones, blaming minorities, women, and the poor for demanding “too much” care.17
__________________________________________
University of Maryland College Park executives testified in the Maryland Assembly that this corporate research structure in our public university has never been more profitable. What they are saying is that the administrative employees that are now corporate executives and not academic employees are getting rich! I wrote about the wage inequity at the top being created by appointees of the governor----Erhlich and O'Malley the most recent in this race to global corporate health structures. Larry Hogan, the current elected neo-conservative has kept most of O'Malley's appointments because neo-cons and neo-liberals have the same goals.
Everywhere you read you see the words -----HOSPITALS HAVE NEVER BEEN MORE PROFITABLE! CONSOLIDATION AND HEALTH TOURISM BRINGING HIGHER PRICES AND GETTING RID OF THE MARYLAND CITIZENS PAYING THE TAXES TO SUPPORT THESE HOSPITALS. Yet, all of these health systems are still NON-PROFITS---PAYING NO TAXES AS CORPORATE SUBSIDY SOARS.
This is the source of Baltimore's poverty----decades of allowing Johns Hopkins to suck billions from all revenue coming to Baltimore to advance this global corporate empire with the help of Baltimore City Hall, Maryland Assembly,and Congressional pols all running as Democrats and serving a very neo-conservative, repressive and regressive Johns Hopkins. More health deregulation and corporatization policy was presented by Baltimore pols these several years than you can shake a stick all the while the city was known to have a large population of citizens abused and neglected by health care just as in overseas developing nations.
Keep in mind as the article above states----the data coming from these corporate health systems are no longer accurate----they are skewed to hide errors, problems, and negative results that will cut into corporate profit.
BALTIMORE POLITICIANS -----RUNNING AS DEMOCRATS AND SERVING AS THE WORST OF NEO-CONSERVATIVES!!!!!
MARYLAND SPECIALIZES IN HAVING THE MOST PROFITABLE NON-PROFITS!
Maryland's most profitable hospitals
Sep 24, 2013, 1:31pm EDTRobert Loughrey
The University of Maryland Medical Center was the most profitable hospitals in the state during fiscal 2013.
Reporter- Baltimore Business Journa
Hospitals in Maryland are pretty worried about their financial condition — and with good reason.
Last week I reported that hospital operating profits dropped 71 percent in fiscal 2013 to about $100 million. Operating profits at Baltimore-area hospitals varied significantly, as you can see here. The data come from the state Health Services Cost Review Commission’s unaudited fiscal 2013 profits report. Unaudited means the numbers could change slightly, as the commission works through it all.
Profits are certainly down, but it’s not all bad.
Here are the most profitable hospitals in Maryland:
By total profits
- University of Maryland Medical Center $89.1 million
- Johns Hopkins Hospital $51 million
- Anne Arundel Medical Center $42 million
- Saint Agnes Hospital $41.8 million
- Holy Cross Hospital $37.4 million
- Suburban Hospital $34.6 million
- Sinai Hospital $34.5 million
- Carroll Hospital Center $30.5 million
- Greater Baltimore Medical Center $28.2 million
- Mercy Medical Center $25.7 million
- Suburban Hospital 13.25%
- Carroll Hospital Center 11.63%
- University of Maryland Shock Trauma 11.61%
- Dorchester General Hospital 10.84%
- Harford Memorial Hospital 10.69%
- Northwest Hospital 10.25%
- Saint Agnes Hospital 10.25%
- MedStar St. Mary’s Hospital 9.77%
- Holy Cross Hospital 8.97%
- Howard County General Hospital 8.22%
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If you look at every job creation policy you see Maryland pushing non-profits in health care and education-----JOBS JOBS JOBS TAKING ALL OF PUBLIC SECTOR EMPLOYMENT TO NON-PROFIT SO THEY CAN THEN MAKE THEM CORPORATIONS THAT PAY NO TAXES.
Republicans like to pretend this is socialism----but it is corporate state. The government becomes a corporation that works to advance global corporate profit in a state. This is a very Republican policy so this is why Republicans must pretend it is all socialism.
This status of corporations as non-profits started under Clinton as he privatized Federal agencies and moved to privatize state and local agencies. It takes an appointed head of the IRS and US Treasury to ignore the hundreds of billions of dollars in corporate tax revenue lost because of this illegal designation and it is why national debt and the excuse for 'austerity' to end all of our War on Poverty and New Deal programs exists. Republican voters don't mind ending these programs but they shout when all that revenue must be replaced by ever higher Federal, state, and local taxes by both Bush neo-cons and Clinton neo-liberals. It isn't O'Malley that is all about taxes----it was Erhlich and you will see after Hogan makes a few gestures---he will need to create revenue lost from corporate fraud and subsidy.
Statewide, it is the State Treasurer Kopp and Comptroller Franchot----and Maryland Secretary of State that all know these non=profits are corporations that should be paying taxes. Maryland citizens elect these captured pols in these vital positions every election cycle.
MARYLAND HAS SOME OF THE WORST HEALTH OUTCOMES AND ACCESS TO HEALTH AND THIS IS WHY----NO TAX REVENUE COMING IN TO SUPPORT PUBLIC HEALTH.
Trans Pacific Trade Pact seeks to allow corporations to ignore any policy that takes away from global corporate profit ----what takes away from profit like taxation. Small businesses as non-profits that are then taken by global corporations---that is called STARTUPS.
Why Nonprofits are the Most Profitable Hospitals in the US
Posted by Laura Sesana on April 8, 2014- WASHINGTON, April 8, 2014--Almost two thirds of hospitals in the U.S. are nonprofit institutions. Given the significant tax breaks that come with nonprofit status, in the healthcare context, nonprofit translates to massive profits. Critics argue that coupled with the low level of charity some nonprofits provide, in most cases tax breaks are unjustifiable and unsustainable.
Of the country’s thousands of hospitals, 23 percent are owned by governments (state and local), 18 percent are for-profit and the rest are nonprofit, according to the American Hospital Association (AHA).
Most people understand nonprofit hospitals as charity organizations that provide free or discounted services for those who cannot afford to pay, and as such, perform a necessary and valuable community service. However, in reality U.S. nonprofit hospitals are extremely lucrative. At the same time, many fail to provide the valuable services for which they get preferential tax treatment.
The profitable nonprofit
In the U.S. healthcare industry, being nonprofit is more lucrative than being for-profit.
“The 2,900 nonprofit hospitals across the country, which are exempt from income taxes, actually end up averaging higher operating profit margins than the 1,000 for-profit hospitals after the for-profit’s income-tax obligations are deducted,” writes Steven Brill in his pioneering health exposé in Time Magazine. “In health care, being nonprofit produces more profit.”
To qualify as a nonprofit, hospitals must follow a number of rules including having a written policy delineating how patients “in need of financial assistance” will be treated, as well as a written policy explaining how charges to patients are calculated. Under the Affordable Care Act (ACA), hospitals will have to conduct a community needs assessment every three years and develop strategies for meeting identified needs.
Nonprofit does not mean that the facility does not make any profits; instead, it means that profits are reinvested in the hospital in the form of new facilities and equipment, massive salaries and bonuses for nonmedical administrators, expanding staff, offering more services and buying out competing hostpitals and health systems.
***Unable to find profit info for Florida Hospital Orlando
There are currently no regulatory limits on hospital profits, including nonprofits.
Considering nonprofit hospitals are exempt from local and state property taxes as well as income and sales taxes, profits can be considerable. Add to that the fact that nonprofits may also issue tax-exempt bonds, and nonprofit hospitals are huge moneymakers.
The requirement that nonprofits reinvest in facilities and expand services gives rise to huge hospital systems that virtually dominate host cities and become the area’s largest employer, with some hospitals bringing in more revenue than what the host city collects in taxes and fees.
Another way for nonprofits to spend their profits is compensation, with top administrator salaries in the millions of dollars. For example, in 2010 the combined compensation of the top executives at the 25 most profitable non-profit hospitals in the country totaled $59 million, according to Becker’s Hospital Review. The reported 2011 compensation for Jeffrey Romoff, head of University of Pittsburgh Medical Center Presbyterian (the highest-grossing nonprofit in the country) was $5.97 million.
The high wages do not stop at top-level administrators. A study by the Bureau of Labor Statistics found that, on average, hourly workers get higher wages in nonprofit hospitals than in for-profit ones.
“Payment of excessive compensation to executives, managers, and administrators undermines the purposes of nonprofit corporations because it results in fewer funds being available for their charitable purposes,” concluded a 2013 study by the office of the attorney general in Sacramento, California. “It is often the case that the hospitals, hospital groups, and affiliated medical entities that pay the most excessive compensation also provide less charitable care than comparable institutions that pay reasonable compensation to their executives, managers, and administrators.”
Can tax breaks to nonprofits be justified?
Tax breaks to nonprofit hospitals amount to billions–$13 billion, according to a recent study published in the New England Journal of Medicine. However, critics question whether the community service they provide is commensurate with the economic benefit nonprofits receive.
Many argue that they are not.
“You should get close to the value of tax exemption in community benefit,” said Paula Song, professor of health services organization at Ohio State University, to The New York Times. “I think you’ll find most hospitals aren’t providing that.”
The issue is further complicated because the level of charity services provided varies widely between nonprofits.
“A lot of hospitals are doing a good job of building their communities by providing health services, but other facilities aren’t doing a good job and we need a level of transparency to differentiate between the two,” said Holly Lang, hospital accountability project director for Georgia Watch, a consumer advocacy group, to the Atlanta Journal-Constitution. “The public has a stake in this because we’re forgoing needed tax revenue and we need to know what we’re getting,” she said.
As the largest landowners in many cities and communities, tax breaks to nonprofits represent a significant loss in revenue for the host community, as well as higher taxes for its residents.
Nonprofit supporters argue that in exchange for tax breaks these institutions provide and estimated $39.3 billion in care for those who cannot pay. That figure is hotly contested.
Steven Brill argues that the figure is calculated based on inflated prices listed on hospital chargematers, not what it actually costs hospitals to provide these services. A hospital chargemaster is a hospital’s official price list for every supply, procedure and drug it provides patients. Medicare and Insurance companies pay prices significantly lower than the ones on the chargemaster, as prices listed on these documents are known to be highly inflated.
“Judging from the difference I saw in the bills examined between a typical chargemaster price and what Medicare says the item cost, this would mean that this $39.3 billion in charity care cost the hospitals less than $3 billion to provide,” writes Brill. “That’s less than half of 1% of U.S. hospitals’ annual revenue and includes bad debt that the hospital did not give away willingly in any event.”
Moreover, nonprofits do not necessarily provide more charity care than for-profit hospitals. A Government Accountability Office (GAO) report concluded that while government hospitals devoted a substantially larger share of their operating expenses to charity care, the difference between nonprofit and for-profit hospitals was small.
“Further […], the burden of uncompensated care costs was not evenly distributed among hospitals but instead was concentrated in a small number of hospitals,” states the GAO report. “This meant that a small number of nonprofit hospitals accounted for substantially more of the uncompensated care burden than did others receiving the same tax preference.”
Additionally, while some nonprofits may be providing adequate charity services, many nonprofit hospitals are located in communities that are less likely to have a large percentage of people requiring charity services.
“On average, nonprofit hospitals were found to operate in areas with higher average incomes, lower poverty rates, and lower rates of un-insurance than for-profit hospitals,” states a report by the Congressional Budget Office (CBO).
The definition of charity
The legal definition of charity for purposes of tax breaks is partly to blame for why hospitals are allowed to profit at the expense of community taxpayers while providing little community service in return.
“For decades, being a hospital seemed sufficient justification for nonprofit status, but as medical services took on aspects of big business — aggressive bill collection tactics and six-figure pay for executives — the distinction between not-for-profit hospitals and their for-profit competitors blurred,” writes M.B. Pell in the Atlanta-Journal-Constitutional.
While the federal government, through the IRS, sets several requirements for nonprofit hospitals to qualify for federal tax breaks, a large number of states do not have specific requirements to qualify for state tax breaks.
On a federal level, until 1969 IRS required hospitals to provide charity care (providing services free of charge or at a discount to low-income patients who cannot pay) to qualify for tax-exempt, nonprofit status.
Currently, however, the IRS allows a far broader definition of charity care. Things like running a research lab, hosting health fairs, making environmental improvements, developing community leadership programs and having administrators serve on community boards are all defined as “charity care” and therefore allow the hospital to qualify for nonprofit status (while providing less actual free healthcare).
“Regardless of their merits, these programs do not replace uncompensated care,” said Mark Rukavina, executive director of the Access Project, a Boston-based patient advocacy organization, to the Atlanta Journal-Constitution.
The debate regarding nonprofit hospitals and tax breaks will continue as long as there IRS and local governments fail to set clear guidelines for the receipt of tax breaks based on nonprofit status.
A step in the right direction was a 2009 rule change by IRS that now requires hospitals to itemize what kind of charity care they provide. This will go a long way in helping the public and lawmakers understand whether nonprofits are “worth” the tax breaks. However, much more needs to be done in terms of transparency in the healthcare industry.
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One of the mantras of Affordable Care Act was ----the patients need to see all of the data on health systems to know which is better than the other. One thing that is evident with Clinton neo-liberalism and Bush neo-conservatism is NO TRANSPARENCY FOR THE PUBLIC---ALL CORPORATE WHEELING AND DEALING IS CONFIDENTIAL. So, did people really think this health reform was about creating a competitive market place when the goal was consolidation into global health corporations that operate any way they want? Of course not-----Clinton Wall Street global corporate neo-liberals just say anything they want to make policy sound progressive.
Below you see all of the elements that make a strong public health system and yet, all of the health policy these several years have been the opposite. We now have hospitals partnered with health insurance corporations and pharmacies all of which used to keep competition and prices down. We also have a dismantling of Federal public health Medicare which was always the method to keep prices down until Clinton deregulation and dismantling of oversight and accountability created massive Medicare and Medicaid frauds of hundreds of billions of dollars a year.
ALL OF THIS CAN BE REVERSED IF DEMOCRATIC VOTERS WOULD STOP ALLOWING CLINTON NEO-LIBERALS---AND IN BALTIMORE'S CASE---NEO-CONSERVATIVES----CHOOSE YOUR CANDIDATES. ENGAGE IN POLITICS AND BE THE REAL LABOR AND JUSTICE CANDIDATE IN ALL PRIMARIES.
In Maryland the public cannot even access public policy being written and has no regulatory oversight and health institutions have been allowed to create their own data with no public health department verifying these data so do we think they really intend to give consumers information? Of course not---Maryland's health structure is rapidly consolidating into a few health systems that will be the only choices for Maryland citizens.
If you watched Maryland Health and Mental Hygiene develop these health system policies you know there was no transparency. I attended one public meeting where the public was shown a few topics with several others that were marked----TO BE DEVELOPED LATER---and then the panel went behind closed doors to discuss this policy. If you look at comparisons between electronics products---like a cell phone---you see all of the comparisons are the same.....you get no real information.
Health plan transparency.
The ACA requires that health plans provide consumers with a Summary of Benefits and Coverage (SBC). Health plans also must provide
a uniform glossary of terms commonly used in health insurance coverage, such as “deductible” and “co-payment,” written in plain language.
In addition, the new health insurance marketplaces in each state will provide information to the enrollee about out-of-pocket costs based on the essential
health benefits that health insurers are required to include in their plan offerings.
But plans can still substitute benefits as long as they are in the same category of benefits and are actuarially equivalent, generally meaning that a benefit can be substituted for another benefit as long as they have the same monetary value. So while these ACA consumer protections will provide basic information about what the health plan covers, they will not provide consumers with detailed information about what choices the health plan has made in substituting benefits
while still meeting the “actuarial equivalent” standard. The resulting differences in what plans cover may continue to make plan comparisons difficult. In addition,
the ACA consumer protections do little to standardize the information health plans provide consumers after care is given. The health plan explanation of benefits, or EOB, is largely left to the design of the health plan.
Transparency and Public Reporting Are Essential for a Safe Health Care System
Publication Date:
March 17, 2010 Citation:
L. L. Leape, Transparency and Public Reporting Are Essential for a Safe Health Care System, The Commonwealth Fund, March 2010.
What will it take to motivate hospitals to do what we know works to make health care safer? Of the three major approaches to improving patient safety—regulation/accreditation, financial incentives, and public reporting—the most promising is public reporting of performance information and feedback to providers. Transparency is an idea whose time has come and both hospitals and the public will be better off because of it.
Data from a large number of hospitals, gathered by several sources, show wide variations in the incidence of one of the most lethal hospital-acquired complications, central line–associated bloodstream infections (CLABSIs). Compared with the evidence on how to prevent other types of infections—and most other kinds of adverse events—the evidence on how to prevent CLABSIs is quite strong. Peter Pronovost demonstrated the potential for complete elimination of central line infections in his intensive care unit at Johns Hopkins Hospital seven years ago. In 2005, in a stunning display of generalizability, Pronovost and his team taught staff in over 100 Michigan hospitals to implement his protocol for central line insertion, and 68 hospitals completely eliminated CLABSIs for six months or more.
Yet, we still have significant rates of CLABSI in most hospitals, and some are very high. What is going on? What is going on is that the vast majority of hospitals have not implemented the Pronovost protocol because they have not made a meaningful commitment to reducing preventable injuries, much less eliminating them. Despite an avalanche of data, exhortation from all kinds of experts, and impressive results by some, most hospitals have in place programs to implement only a few of the known safe practices, and none has a strategic plan to implement all of the 34 evidence-based safe practices endorsed by the National Quality Forum. The "chasm" between what we know and what we actually do to prevent complications of our treatment matches that described for all of quality by the Institute of Medicine in its 2001 report, Crossing the Quality Chasm.3
What will it take to motivate hospitals to do what we know works to make health care safer? Evidence is available on the effectiveness of three major approaches: regulation/accreditation, financial incentives, and public reporting of performance and feedback to providers.
Regulation and Accreditation
Because regulation is a state function, and there is tremendous variation in state approaches to quality and safety, its use has been spotty. Information from reporting systems, for example, is seldom used by regulators to improve safety. Although licensing functions are usually supported with public funds, state departments of public health seldom have the resources to monitor hospital practices. Given cost constraints and inertia, this situation seems unlikely to change in the near future. The leading accreditor, the Joint Commission, has been the most effective force for change by requiring hospitals to implement its Patient Safety Goals. However, monitoring safe practices is only a small part of the Joint Commission's activities. It seems unlikely that either it or the states will be able to exert enough pressure to get health care systems to make the quantum changes necessary in hundreds of processes to make health care safe.
Financial Incentives
Using the reimbursement system to improve quality of care has been in vogue for a decade or more. Incentives are usually positive: payment of a bonus as a percentage of reimbursement—2 percent in the Centers for Medicare and Medicaid Services (CMS)/Premier Hospital Quality Incentive Demonstration—although rewards are sometimes packaged with penalties for underperformers. Rewards tend to be for process improvement, not outcomes. There is some evidence that financial incentives improve compliance with quality indicators (such as use of certain medications following acute myocardial infarction), but little or no evidence of improved outcomes. Programs tend to reward mostly providers who are already leaders in quality. As with standards to improve public education, many fear that providers will perform to the test rather than proactively seek to improve quality, but this is a concern with all measurement.
Financial incentives for improving safety, on the other hand, are relatively new. In contrast to those for improving quality, which are positive and process-oriented, incentives for safety have been negative and outcome-oriented: instead of receiving a bonus for adhering to a safe practice, providers are penalized for the consequences of not doing so. The focus has been on selected "never events," taken from the list of serious reportable events developed by the National Quality Forum.These are significant patient harms that hospitals know how to prevent—or should know. Such financial disincentives began in Minnesota but have been given national reach with CMS' recent decision not to reimburse hospitals for the additional costs attributable to eight serious reportable events.
Although the stakes for any hospital are small (these are, or should be, rare events), the pushback has been considerable. Hospitals claim, with some justification, that not all of these events are preventable. This concern seems particularly apt for at least two of the "no-pay" events on the CMS list: falls and urinary catheter–associated infections. Reliable and valid practices for preventing these adverse events have yet to be developed.
Evidence that not paying for serious reportable events improves safety is also lacking. The experience in Minnesota is not encouraging. For example, the number of wrong-site surgeries and retention of foreign bodies in Minnesota hospitals actually increased substantially from 2006 to 2009. Some of this increase is undoubtedly related to improved compliance with the reporting requirement, but nonetheless it does not indicate that the penalty is having a positive effect.
Reporting and Feedback
So far, the most powerful method for reducing preventable injuries has been to require physicians to provide data on their own performance and then provide them with comparisons of their risk-adjusted complication rates with those of their peers. The Veterans Administration (VA) pioneered this approach in the 1990s with its National Surgical Quality Improvement Program, which has since been adopted and promoted by the American College of Surgeons. Under this program, each hospital's surgical specialty department receives feedback on its risk-adjusted complication and mortality rates, together with a comparison with all of the other (unidentified) surgical departments in the VA system. In response to these reports, below-average units made substantial improvements, leading over several years to system-wide declines in both complication rates and mortality that significantly exceeded the secular trend.
It is reasonable to assume, though as yet unproved, that public reporting of similar types of data would spur hospitals to make greater efforts to reduce adverse events. Hospitals—or the public—can choose the benchmark level they prefer: above average, top decile, or others. But it seems evident that performance reporting works best when all providers participate—as in the VA experience. Thus, reporting has to be mandatory. As Wachter emphasizes, it is essential that the events to be reported are a) clinically significant, b) easily measured, and c) largely if not completely preventable. Risk adjustment is essential for fair comparisons.
The "benchmark" in safety, of course, should be zero. If it is, then risk adjustment is irrelevant. The hope is that, as it becomes public knowledge that some hospitals are able to eliminate certain types of adverse events, others will be motivated to follow. While a major thrust of the patient safety movement has been to eliminate blaming and shaming of individuals when they make mistakes, for organizations public reporting may be an appropriate use of shaming.
The larger issue here is transparency. From an ethical standpoint, the argument in favor of transparency is straightforward: the public has a vital stake in the outcomes of health care, and therefore it has a right to know how we are doing. (The contrary argument that hospitals and doctors have a right to keep their results secret in order to protect those with bad results is patently untenable.)
From an economic standpoint, Porter and others regard consumer access to full information as a critical element of value-driven purchasing of health care They contend that consumers can make meaningful choices only if they have complete information. While this formulation is attractive to some economists and policymakers, repeated studies over more than 20 years—going back to the Pennsylvania cardiac surgical scorecards of the 1980s—show that few patients and even fewer doctors pay much attention to this type of information in deciding with whom and where they will receive their medical care.
From the standpoint of improving patient safety, however, transparency is crucial. It is the cornerstone of the cultural transformation that our health care organizations need to undergo to become safe. Transparency is essential within an institution if caregivers are to feel safe in reporting and talking about their mistakes. The free flow of information is essential for identifying and correcting the underlying systems failures. Transparency is also the key to successful—and ethical—responses to patients when things go wrong. It is the cover-ups that lead to lawsuits. And transparency is essential for accountability, to show the public that the hospital or system responds ethically to its failures. Internal transparency begets external transparency—and vice-versa.
Although most hospitals are still skeptical about being transparent, evidence from a few organizations that have gone public with their bad news shows that it is a win-win. First, transparency motivates caregivers to improve care. Lives are saved. In addition, openness shows that the hospital feels accountable and has nothing to hide, which increases public confidence. Transparency is an idea whose time has come and both hospitals and the public will be better off because of it.
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Raise your hand if you hang onto corporate call centers for hours waiting for any kind of basic help in resolving every problem you have with a product! EVERYONE----WE HAVE BEEN MOVED FROM TALKING WITH A PERSON IN A STORE TO CALLING A GLOBAL CALL CENTER WITH EMPLOYEES TRAINED TO GET RID OF YOU. FEWER AND FEWER WORKERS ARE EVEN STAFFING THESE CALL CENTERS.
Raise your hand if you already watch the amount of minutes you take while talking on a cell phones because your plans are moving rates higher and higher......some people are already reduced to texting. So, do you really think all of this mobile phone health care will really work? OF COURSE NOT---
IT IS MOVING LARGE SECTORS OF AMERICANS OUT OF THE HEALTH SYSTEM ALTOGETHER. REMEMBER, PREVENTATIVE CARE ONLY MEANS VERY LITTLE ACCESS TO CARE THAT REQUIRES COMMUNICATIONS WITH DOCTORS THAT ARE NOT PRIMARY CARE DOCTORS.
I spoke of how Baltimore was already starting to close brick and mortar social services buildings and pushing low-income citizens to call centers where they increasingly cannot reach a staff person. Well, we do not need to be rocket scientists to see that is where this policy goes. Think about who the low-income affording only Medicaid or Bronze level health plans will be----as all union health plans are imploded in this coming bond market crash-----as Medicare is dismantled with fraud and privatization----as Trans Pacific Trade Pact seeks to move 90% of Americans to third world poverty-----YOU CAN BE SURE THAT YOU, YOUR CHILDREN, OR GRANDCHILDREN WILL BE THE ONES PUSHED TO THIS LEVEL OF HEALTH ACCESS.
All because you allow Maryland election primaries to be rigged for Clinton neo-liberals and allow Bush neo-conservatives in Baltimore run as Democrats----GET RID OF THESE CORPORATE POLS TO RETURN TO STRONG PUBLIC HEALTH CARE.
Mobile Health and Patient Engagement in the Safety Net: A Survey of Community Health Centers and Clinics
Publication Date:
May 13, 2015 Authors:
Andrew Broderick, Farshid Haque Contact:
Andrew Broderick, Codirector, Center for Innovation and Technology in Public Health
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Cell phones have emerged as potentially powerful tools to engage patients in the safety net -
A new survey finds only one-quarter of community centers are using cell phones in care delivery
Patient-centered technologies have emerged as a way to actively engage patients in care. The reach and potential of cell phones to engage diverse patient populations is great. Evidence of their effectiveness in improving health-related outcomes is limited. Researchers conducted an online survey of community health centers and clinics to assess if and how health care providers in the safety net use cell phones to support patient engagement. The findings indicate that the use of cell phones in patient care is at an early stage of deployment across the safety net. Organizations identify chronic disease management as an area where cell phones offer considerable potential to effectively engage patients. To promote widespread adoption and use, technical assistance to support the implementation and management of interventions, evidence-based or best practice models that highlight successful implementation strategies in care delivery, and the introduction of new payment or reimbursement policies will be essential.
OVERVIEW
Cell phones and other consumer digital technologies have emerged as potentially powerful tools to engage patients in health care. They can strengthen the efficacy of safetynet health systems by improving providers’ capacity to reach vulnerable populations and actively engage them in their care. In the United States, minority and low-income people have a high level of cell phone adoption,1,2 and often use features such as text messaging3,4 and mobile Internet.5,6,7 Mobile health interventions frequently involve the use of text messaging to provide concise, timely, and customized care-related information in the form of reminders and motivational and educational messages. These notifications can promote self-management practices for chronic conditions, educate consumers about preventive care and personal wellness, and improve patients’ adherence with recommended treatment.
Providers have the opportunity to enhance care delivery and strengthen patient engagement using these new forms of interactive health services that facilitate greater connectedness between patients and their care team.8 Safety-net communities, in particular, are at greater risk for chronic, preventable diseases. Perhaps more important, text messaging represents a desirable, low-cost means to amplify and reinforce patient-empowerment strategies among the populations they serve given the high penetration of cell phones, high literacy with text messaging, and low costs of implementation. Recent research with low-income patients in California found that continuity and connectedness are key predictors of patient empowerment and efficacy.9 Although few patients can currently communicate with their providers by text or e-mail, a majority of those who currently can find it useful, while many of those who can’t are interested in doing so.10
RECENT FINDINGS More Effectively Engaging Patients in Care Activities or Practices
Most respondents (86%, or 155 of 181 respondents) report that patient engagement has been challenging, particularly in areas related to the adoption of healthy behaviors and compliance with standard care recommendation and treatment protocols. When asked in which areas organizations would like to more effectively engage patients, the greatest number of respondents (89%, or 160 of 180 respondents) said chronic disease management (Exhibit 1).
Using Cell Phones in Patient Care
Using cell phones as a tool for patient engagement remains at an early stage of deployment across the safety net, with just more than one-quarter (27%, or 48 of 180) of respondents reporting they use cell phones in care delivery. Of the centers or clinics that do use cell phones in care, the most common application is to provide patients with appointment reminders (66%, or 31 of 47 respondents) (Exhibit 2). Interventions to support chronic disease management, medication adherence, and smoking cessation remain at low levels, but organizations indicate they are planning to significantly increase their use within the next year.
Benefits of Engaging Patients in Care
Forty-two organizations (of 48) ranked the top three benefits of patients’ use of cell phones. The ability to improve overall compliance with standard care practices (19 respondents), facilitate improved case management and targeted outreach (17 respondents), promote sustained patient engagement in behavior change (16 respondents), and improve compliance and prevent exacerbations of chronic conditions (15 respondents) ranked highest (Exhibit 3).
Developing and Adopting Cell Phone Interventions
We asked organizations about their strategies for developing mobile health interventions. Most have relied on their electronic health record (EHR) platforms and the ability of those platforms to support text-messaging applications (62% of 42 respondents). A smaller number of organizations have collaborated with other health service organizations to co-develop interventions (10 respondents), contracted with mobile health solution providers (9 respondents), or developed proprietary technical or content elements (9 respondents) (Exhibit 4).
The survey asked center and clinic leaders about the criteria used to assess and justify the adoption of a cell phone intervention. More than half of respondents (22 of 40) indicated the appropriateness of an intervention for use across diverse patient populations as the leading criterion. Evidence of improvement in care quality (18 of 40) as well as cost-effectiveness (16 of 40) were also ranked as leading criteria. Only five respondents listed user participation in design and development (Exhibit 5).
Barriers to Implementation and Actions to Encourage Adoption
Of the 173 organizations that identified three leading barriers to implementing cell phone interventions, 94 cited a lack of external funding sources and 91 said limited human and technical resources. The next-most significant barrier (65 respondents) was the integration of mobile health solutions with electronic health records and other health information technology infrastructure (Exhibit 6).
The survey asked the organizations which criteria they view as essential to promote or justify adoption of a cell phone intervention. Of the 163 organizations that responded, most said technical assistance to support the implementation and management of interventions (106 respondents), evidence-based or best practice models of cell phone use in care delivery models (95 respondents), and the introduction of new payment or reimbursement policies for cell phone use in patient care (90 respondents) were most important (Exhibit 7).
DISCUSSION Digital technologies like cellular phones can increase the interactivity of health services and improve the capacity of public health organizations to care for underserved populations. In addition to improving patient engagement, mobile health solutions can support critical components of health reform, like patient-centered medical homes and accountable care organizations. There is limited evidence, however, of effectiveness in improving health-related outcomes with underserved populations and insufficient case studies that illustrate best practices or effective strategies for the deployment of interventions. Moreover, there are few financial and technical resources that can support implementation. Such limitations constrain organizations’ abilities to realize the potential of digital health solutions.
On a larger scale, using technology to promote patient-centered, coordinated care can help make significant advances in improving population health and reducing inefficiencies in care delivery. But, as the findings from this survey reveal, providers have not been able to effectively leverage technology tools toward these goals. To fully unlock the potential of technology to improve health care will require an improved understanding of the use of mobile health in patient care, as well as policies that provide funding, technical assistance, and reimbursement and address the issues of informed consent, privacy and security.
METHODOLOGY
This brief presents findings from an online survey of a national sample of urban and rural community health centers and clinics on their current use of and experiences with the implementation of mobile health solutions. The survey instrument was designed with input from key informant interviews, and questions were designed with a multiple-choice format and programmed with skip logic. Our sample frame of safety-net providers comprises urban and rural community health centers and clinics that offer health care services to low-income people, including those without insurance, and represents a subset of the larger health care safety-net provider system and the even-larger health care system beyond the safety net. National outreach to the senior leadership of 959 organizations nationwide took place between June and October 2013 and resulted in 230 organizations participating in the survey, of which 181 were completed and included in our final analysis (18.9% response). Exhibit M1 shows the response rates for organizations by state and in relation to the number of Health Resources and Services Administration’s Bureau of Primary Care grantees by state.
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