Sunday, August 3, 2008

Hearings Discuss Healthcare

Medical homes can deliver better healthcare according to Yul Ejnes, MD., Chairman, Medical Services Committee, American College of Physicians (ACP), and on the medical faculty at Brown University. Appearing before the House Committee on Ways and Means on July 28, 2008, he said “using HIT alone will not enable the healthcare system to deliver improved quality in a way that maintains or lowers costs to its full potential. The ACP believes that the Patient Centered Medical Home (PCMH) is the way to go to facilitate HIT.”

Dr. Ejnes explained that the PCMH is a delivery model that involves a patient relationship with a personal physician who works with a practice team to provide first contact and whole person continuous care. The PCMH model is based on the premise that the best quality of care is provided not in episodic, illness-oriented care, but through patient centered care that emphasizes prevention and care coordination. In addition, the PCMH practice must be able to demonstrate that it has the infrastructure and capability to provide care consistent with the patient’s needs and preferences.

He continued to say that the process by which an independent third party determines whether a physician practice is a PCMH is one reason why the model has gained considerable traction over the past few years. ACP understands that CMS intends to use a recognition process to identify the medical home practices that participate in the Medicare medical home demonstration project authorized by Congress and included in the Medicare legislation that just became law. Dr. Ejnes however pointed out that additional funding will be needed for CMS to expand the Medicare Medical Home Demonstration to more practices and states.

The House Committee on Small Business heard from the small physician community on July 31, 2008 on the challenges of using EHRs in small specialty practices. Edward Gotlieb, MD, FAAP, a practicing pediatrician and representing the American Academy of Pediatrics, told the Committee that if incentives for health IT adoption are structured to only flow through the Medicare program, more than 60,000 practicing pediatricians will be excluded from the opportunity to qualify for those incentives.

Also, providers often find that clinical information systems have diminished usefulness in pediatrics because EHRs are frequently designed for adult care. So it is important for the pediatric health record to have a number of special functions that can be incorporated into the EHR.

In a hearing held by the Senate’s Special Committee on Aging to specifically discuss “Aging in Rural America: Preserving Seniors Access to Health Care”, Tom Morris Acting Administrator, HRSA, Office of Rural Health, explained how HRSA’s Telehealth Network Grant Program (TNGP) is effectively reaching rural communities.

He told the Committee how TNGP provided nearly 140,000 telehealth visits in 46 specialty services from March 2007 through February 2008, to patients in rural communities. The TNGP program is actively involved in examining the impact of remote disease management services on patient outcomes. From September 2006 through February 2008, 33% of diabetic patients enrolled in telehealth diabetes case management programs achieved control over their disease as measured by their hemoglobin A1C levels