Fewer lab tests sought by docs with HIE access, -and- Medicaid payments for 'unnecessary' ER visits safe for now

Fri Apr 6 17:45:48 PDT 2012

Description: Description: Description: Description: Description: CAL/AAEM:
California Chapter of the American Academy of Emergency Medicine

April 2, 2012

Fewer lab tests sought by docs with HIE access

FierceHealthIT
<http://www.fiercehealthit.com/?utm_medium=nl&utm_source=internal> 

Physicians who had access to a health information exchange (HIE) ordered
fewer lab tests for patients with prior test results after the HIE was
formed than they did previously, according to a new study published in the
Archives of Internal Medicine.

This finding appears to contradict the results of a controversial paper
recently published in Health Affairs in early March. In that study,
researchers determined that physicians with access to the results of a
patient's previous imaging and blood tests in an electronic health record
(EHR) ordered more tests than those who did not have an EHR.

The Health Affairs paper set off a fierce debate over the value of EHRs.
Farzad Mostashari, the national coordinator of health IT, publicly
criticized the study, prompting a retort from its authors on the Health
Affairs blog.

The new Archives study is based on the medical records of more than 117,000
patients treated in the outpatient departments of Boston-based Brigham &
Women's and Massachusetts General Hospitals between 1999 and 2004. In 2000,
the two hospitals--both part of Partners Healthcare--created a health
information exchange (HIE).

The researchers found that 346 of the patients treated at one of the
hospitals had recently received tests at the other hospitals, according to
Reuters. Forty-four of those patients were tested prior to the HIE's
establishment. Nearly 22,000 patients who had not recently received tests
were treated at one of the hospitals before the HIE existed.

Overall, the number of tests ordered for each patient in the study fell from
an average of seven before the HIE's advent to four afterward. While the
number of tests ordered for people who had not undergone previous tests rose
slightly, the number ordered for those with prior tests fell by 49 percent,
indicating that physicians reduced the amount of redundant test ordering.

The contrast between results of the Archives study and the paper in Health
Affairs may be related to the different settings in which they were
conducted, Danny McCormick, a coauthor of the study, told Reuters. "We
studied a different population," he noted.

Whereas the patients in the Archives study were treated in hospital
outpatient departments in Boston, the other study was based on a national
cohort of office visits. In addition, noted Alexander Turchin, one of the
Archives paper's co-authors, physicians may be more likely to order
redundant imaging tests than redundant lab tests.

April 3, 2012

Medicaid payments for 'unnecessary' ER visits safe for now 

FierceHealthcare
<http://www.fiercehealthcare.com/story/medicaid-payments-unnecessary-er-visi
ts-safe-now/2012-04-03?utm_medium=nl&utm_source=internal> 

Washington state has pushed the pause button on the restrictive Medicaid
emergency room policy that would have stopped payment to hospitals for
roughly 500 "nonemergent" conditions on April 1.

Acknowledging increasing support for a more moderate approach to reducing ER
visits, Gov. Chris Gregoire (D) on Friday suspended the policy until state
budget negotiations conclude, reported The Seattle Times.

Meanwhile, emergency room physicians and hospitals proposed an alternative
policy, which focuses on case management of frequent ER users, limits on
narcotic prescribing, real-time tracking of ER visits and appropriate
primary care follow-up.

The House budget plan now includes this alternative approach to controlling
costly emergency care, according to a statement yesterday from the
Washington State Medical Association (WSMA), which praised the governor's
move.

Voicing its support for a less-severe Medicaid policy, the American College
of Emergency Physicians last month spoke out against basing Medicaid denials
on final diagnosis. Instead, the society is pushing for a national "prudent
layperson standard" that would require health plans to cover ED visits based
on an average person's belief that he or she may have a medical emergency,
FierceHealthcare previously reported.

Bryan Sloane
Deputy Editor, CAL/AAEM News Service

Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

Contact us at: calaaem.news.service1 at gmail.com

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