Increasing Medicare’s Eligibility Age Could Aim Gov’t Savings, But Tally Higher Total Health Spending

Healthcare spending for few services dropped by almost a third when persons turned 65 and switched from private insurance to Medicare, in accordance to a recent study. The decline was driven by lower costs paid by the Medicare program to doctors and other contributors rather than a drop-off in the volume of services seniors receive.

The study offers a preview of the potential effect of raising the Medicare eligibility age to 67 from the present 65, said Jacob Wallace, a doctoral candidate in health policy at Harvard University who coauthored the study, which was published in the month of May issue of Health Affairs.

“What this study indicates, pretty clearly, is that while the government might save money by increasing Medicare eligibility to 67, overall national health care spending will go up,” Wallace stated.

Tool Makes Nursing Home Inspection Reports Easy to Search

August 15, 2012 — A new interactive tool makes it possible to search the results of government inspections in 14,565 nursing homes nationwide. The tool allows users to determine, for example, whether a given nursing home has a pattern of elopement among residents.

The tool, called Nursing Home Inspect, draws on government reports that were posted online in July 2012 by the US Centers for Medicare and Medicaid Services. Users can search reports by keywords such as "elopement," which refers to patients leaving the property undetected, and results can be sorted by severity of violation. Although up to 31% of nursing home residents with dementia wander at least once, a pattern of elopement at a home can be a sign of inadequate supervision.

Nursing Home Inspect is an application created by Propublica, an independent, nonprofit newsroom whose mission is "to expose abuses of power and betrayals of the public trust by government, business, and other institutions, using the moral force of investigative journalism to spur reform through the sustained spotlighting of wrongdoing." The Nursing Home Inspect effort was led by Charles Ornstein and Lena Groeger.

Ornstein and Groeger used the Nursing Home Inspect Tool to search nursing home inspection reports and described the results online in an article titled, "What We Found Using Nursing Home Inspect."

According to the 2010 Census, approximately 1.5 million people live in nursing homes. Nursing homes are inspected regularly, and additional inspections occur when there is a complaint. The Government Accountability Office has found that 19% of the complaints investigated nationally in 2009 were substantiated and resulted in at least one citation. The proportion of citations varies greatly from state to state.

Over the decades, federal auditors have flagged numerous dangerous and neglectful conditions. Auditors have found, however, that inspectors tend to be lenient, citing too few problems and ranking them as less severe than they actually are.

Among advocates, there has been a longstanding call those who for nursing home residents to make federal nursing home inspection reports available to the public.

Nursing Home Inspect now makes the recently released reports searchable online. When the word "elope" is typed into the interactive tool, the application returns 949 inspection reports. Other terms also return hundreds or thousands of results. For example, "injuries" returns 7912 results, "MRSA" returns 514 results, and "ignore" returns 275 results.

The search tool also allows users to compare the severity of the deficiency (ranked A through L) among institutions.

Advocates for residents hope that the reports and the application will be used as a tool for fixing the specific problems of each nursing home.

The reports do leave out valuable information; most notably, the things that the facilities are doing well. In addition, associated plans for correction are not included online, although they should be available at individual nursing homes. The reports also may be biased, in that inspectors for different regions have a tendency to issue citations for different things. Elopement, for example, may be defined differently, depending on the state.

Sara Singer, MBA, PhD, is an assistant professor of healthcare management and policy at Harvard University, Cambridge, Massachusetts. She is not affiliated with the creators of the tool, but discussed its implications withMedscape Medical News via email: "[Physicians] need to use this tool with care; eg, by searching for multiple keywords if they're interested in a particular topic. Moreover, it's important to consider what the nursing home is doing to address citations (ie, by reviewing the Plan for Correction and by talking to people at the home), and for nursing homes where their patients reside, they should consider ways they can be part of the solution to any problems identified. Physicians have an important role to play in leading and inspiring improvement in nursing homes."

Dr. Singer has disclosed no relevant financial relationships.

Policy analysts see big ACO challenges

Hospitals and doctors may underestimate the complexity, cost and time required to establish successful accountable care organizations, a scenario that would set providers up to fail, two health policy experts argue in the Journal of the American Medical Association.

Stephen Shortell, dean of the University of California at Berkeley School of Public Health, and Sara Singer, a Harvard University assistant professor of health policy and management, said a “constellation of potential shortcomings” could leave newly formed accountable care organizations unable to improve health care quality.

Hospitals and doctors have limited experience managing care and costs for all the care patients' receive, regardless of the setting, the authors said. Healthcare information technology can vary from one provider to another and providers need time to adapt to newly adopted IT systems, the article continued.

Shortell and Singer said providers risk overestimating their ability to handle such substantial challenges, as well as others, such as performance reporting and reducing variation in medical care. That would compromise timely access to information. It could also undermine efforts to engage patients; develop needed contracts with specialists; avoid legal pitfalls; and change healthcare delivery to improve quality, the authors wrote.

To avoid such potential problems will require leadership across the public and private sector and well-developed performance measurement, the article said.

Fellow doctors laud Blumenthal

After Dr. David Blumenthal's announcement that he will step down this spring as national coordinator for health information technology to return to Harvard University, several of Blumenthal's fellow physicians in the medical-informatics community praised him for his accomplishments and expressed optimism that his legacy will continue.

Over the past two years, Dr. Paul Tang worked with Blumenthal as closely as anyone not on the ONC's staff. Tang served as vice chairman of the Health IT Policy Committee under Blumenthal's chairmanship. The advisory panel was established under the American Recovery and Reinvestment Act of 2009 to guide the ONC on health IT policy matters. When not serving as a federal adviser, Tang works as vice president and chief medical information officer at the Palo Alto (Calif.) Medical Foundation.In an e-mail late Thursday, Tang described Blumenthal as "a superb national coordinator who accomplished an enormous amount in his two-year tenure." Blumenthal's "wise, even-handed guidance," he added, was essential in promoting a healthcare IT transformation for the country.

Dr. Peter Basch, medical director for electronic health records and health IT policy at MedStar Health, Columbia, Md., and a member of three Health IT Policy Committee work groups, said Blumenthal's prior use of electronic health-record systems in his medical practice served him well in his ONC job.

"Really, from the beginning—he was chosen as a non-IT person leading the IT strategy—I felt comfortable," Basch said. "Someone who has practiced medicine using IT was the right person. David has focused on making it real and meaningful and was not distracted by what I'd call the flashing lights."

Dr. William Bria III, chief medical information officer at the Shriners Hospitals for Children, Tampa, and president of the Association of Medical Directors of Information Systems, noted the challenges Blumenthal and the ONC have faced in just the last two months.

A handful of developments in the federal health IT world—a report from the President's Council of Advisors on Science and Technology that was somewhat critical of the ONC's sense of direction with the federal IT program, the introduction in the U.S. House of federal legislation that could strip unexpended funds from the electronic health-record system incentive program and some general grumblings about meaningful-use requirements—represent a "nibbling at the edges" of the government's health IT initiative, Bria said. And in light of those, Bria said he would have preferred "a completely stable platform of individuals and leadership at least going into the rest of this year."

Still, he said: "Do I think the things are so fragile that his leaving will have a major impact? I don't think so. He's built enough of a team and enough of a legacy, there has been enough support, including from our organization, to get this done. I remain very happy and hopeful. I think America is on a threshold of a major transformation of improving its healthcare environment."

The U.S. is "heading in the right path" in health IT in no small part thanks to Blumenthal's leadership, he said. "Certainly, whoever is following David will have large shoes to fill, but will find it easier to keep on the right path," Basch said. "There is a tremendous team now in place at ONC. Granted, there is a lot going on, but there are a lot of people with the same mission to keep that going."