The Commonwealth Fund has published a brief suggesting components of a framework to track health care delivery system reform.  Citing the national health care reform law's emphasis on delivery system reform, the authors note that a tool is needed to track community-level progress.  The brief offers the rationale for implementing such a system and outlines a potential framework for its operation.

From the report:

Delivery System Reform Tracking: A Framework for Understanding Change

The primary goal of a delivery system tracking tool is to understand whether progress is being made in a given community. It is necessary, therefore, to have some notion of what progress would look like. In other words, what is a reformed delivery system, and how will we know it when we see it? As stated by the Institute of Medicine, we believe that the United States needs a health care system that is safer, more effec­tive, more patient-centered, timelier, more efficient, and more equitable than the traditional non-system that dominates American health care today.2 In short, a reformed system is one in which the various ele­ments—primary care physicians, specialists, hospitals, ambulatory surgery centers, etc.—can manage health and economic outcomes by measuring, planning, and executing changes to improve performance and are held accountable for delivering high-quality, affordable care and a positive patient experience.

Full report: Delivery System Reform Tracking: A Framework for Understanding Change (PDF | 943.51 KB)

Commonwealth Fund.  (2011).  Delivery system reform tracking: a framework for understanding change.  Tollen, R., Enthover, A., Crosson, F., Audet, A., Schoen, C. and Ross, M.

The Robert Wood Johnson Foundation has released a report examining the impact of electronic health records (EHRs) on health care quality.  The brief notes that doctors and hospitals serving Medicare patients must implement EHRs by 2015 or face a financial penalty.  Examining the care received by patients with diabetes at Better Health Greater Cleveland, the authors found those in practices employing EHRs provided all needed care to patients with diabetes at a statistically significantly higher rate that practices with paper records.

From the report:

Long Term Care and Dual Eligibles: Overview and Managed Care Opportunities

Health care is one of the last U.S. industries to universally incorporate technological advancements. While most sectors—from banking to hospitality—have made investments in information technology to improve efficiency and consumer relationships, America’s health care system is still largely paper-driven. Partly as a result, the U.S. health care system is plagued by inefficiency and poor quality. Delivery is slower, more error-prone and harder to measure and coordinate than it should be. One study found that 80 percent of medical errors began with miscommunication, incorrect or missing information about patients or lack of access to patient records.

Full report: Does Use of EHRs Help Improve Quality?  (PDF | 309.19 KB)

Robert Wood Johnson Founation.  (2011).  Does use of EHRs help improve quality?.  

From the report:  

The Congressional Budget Office (CBO) projects that, under current law, payment rates for physician services will be reduced by 29.4 percent in 2012. That large reduction called for under current law follows several years of legislative action to either maintain or increase physician payment rates under the Medicare program when those rates were otherwise scheduled to decrease under the provisions of law known as Medicare’s Sustainable Growth Rate (SGR) mechanism. Such legislative actions have overridden the SGR.

Full Report: Medicare’s Payments to Physicians: The Budgetary Impact of Alternative Policies (PDF | 127 KB)

Congressional Budget Office. (2011). Medicare's payments to physicians: the budgetary impact of alternative policies.

A study published in the Archives of Internal Medicine found that 88 percent of physicians accepted new privately insured patients in 2008, down from 93 percent in 2005.  The authors cited low reimbursement rates and significant administrative burdens as possible reasons for the decline.  The study also notes that rate of acceptance declined less for Medicare beneficiaries, dropping from 96 to 93 percent between 2005 and 2008.

Bishop, T. F., Federman, A. D., and Keyhani, S. (2011). Declines in physician acceptance of Medicare and private coverage. Archives of Internal Medicine, 171(12):1117-1119. doi:10.1001/archinternmed.2011.251. http://archinte.ama-assn.org/cgi/content/short/171/12/1117

Authors: Tara F. Bishop, Alex D. Federman, and Salomeh Keyhani

The American Hospital Association (AHA) has released a study estimating that start-up and first year costs of an accountable care organization (ACO) could be up to 14 times those projected by U.S. Department of Health and Human Services (HHS) officials.   Outlined in the national health care reform law to coordinate patient care, ACOs are networks of physicians and hospitals.  In its proposed rules governing ACOs, the Centers for Medicare & Medicaid Services (CMS) estimated start-up and first year costs for an ACO at $1.8 million; however, AHA’s report projects that those costs will be between $11.6 million and $26.1 million.  The authors recommend that CMS restructure its ACO shared savings payments to reflect these higher costs.

From the study:

Full Report: Activities and Costs to Develop an Accountable Care Organization (PDF 1.05 MB)

American Hospital Association. (2011). Activities and costs to develop an accountable care organization.

On May 17, the Urban Institute released a brief comparing ten surveys that are used to determine the extent to which a health practice is a patient-centered medical home.  The authors compare the merits of the various survey tools and outline their implications for payers.  The brief provides issues for payers to consider when determining whether to select an existing measurement tool or craft their own and explains the importance of various survey tool components.

From the report:

This report compares ten provider survey tools designed to measure the extent to which a practice is a “patient-centered medical home” (PCMH). These tools are primarily used for recognition purposes (i.e., to qualify for entry into a payment pilot or demonstration), as opposed to for practice self-improvement, research/evaluation, or quality measurement. Our analysis compares these ten tools’ operational details (e.g., price, whether a site visit is required) and their content emphases (i.e., the different practice capabilities that the tools emphasize).

Full report: Patient-Centered Medical Home Recognition Tools: A Comparison of Ten Surveys' Content and Operational Details (PDF | 577 KB)

Urban Institute.  (2011).  Patient-centered medical home recognition tools: a comparison of ten surveys' content and operational details.  Burton, R., Devers, K. and Berenson, R.