IOM Names 15 “Vital Signs” for Tracking U.S. Progress on Health

In its report VITAL SIGNS: Core Metrics for Health and Health Care Progress, the Institute of Medicine (IOM) outlined 15 core measures for monitoring and assessing progress toward improved health and healthcare in the U.S. The new measures are intended to:

• Reduce measurement-taking burden on clinicians;
• Enhance transparency and comparability;
• Improve health outcomes.

According to the report, current health measures are numerous and overlapping. The Centers for Medicare and Medicaid Services lists nearly 1,700 measures, while the National Quality Forum counts 630. Yet most differ enough to prevent direct comparisons.

The 15 core measures are:

• Life expectancy
• Well-being
• Overweight and obesity
• Addictive behavior
• Unintended pregnancy
• Healthy communities
• Preventive services
• Access to care
• Patient safety
• Evidence-based care
• Care that matches patient goals
• Personal spending burden
• Population spending burden
• Individual engagement
• Community engagement

“If we want to know how effective and efficient our health expenditures are in order to improve health and lower costs, we need to measure the most crucial health outcomes to guide our choices and gauge impact,” said committee chair David Blumenthal, president of the Commonwealth Fund. “The proposed core set focuses on the most powerful measures that have the greatest potential to positively affect the health and well-being of Americans.”

The report recommends the secretary of the U.S. Department of Health and Human Services use the core measures to improve measure reporting in HHS programs and develop a strategy to facilitate their adoption by other federal and state agencies and national organizations.

See https://www.iom.edu/Reports/2015/Vital-Signs-Core-Metrics.aspx.

Pediatric Telemedicine Consults Yield Significant Savings

Telemedicine systems can be expensive, but UC Davis research showed they saved an average $4,662 per use. The study, published in the journal Medical Decision Making, looked into whether pediatric telemedicine consultations with rural emergency departments save money compared to telephone consults.

“Our previous work showed that telemedicine was good for kids, families and providers, but we didn’t really address the cost issue,” said James Marcin, UC Davis interim head of pediatric critical care medicine. “Now we know, not only does it improve quality, safety and satisfaction, but it also saves money.”

Public health researchers and health economists evaluated both the costs and potential savings of a telemedicine consult. The study found that costs, including hospital investment in equipment, software and IT support plus the amounts urban hospitals must pay on-call subspecialists, averaged $3,641 per consultation. It also found that, compared to telephone, telemedicine consults reduced the number of patients being transferred between hospitals by 31%. Transferring patients adds significant costs, especially if they are moved by air ambulance.

To reach its findings, the team reviewed the Pediatric Critical Care Telemedicine Program at UC Davis, tracking its interactions with eight rural emergency departments between 2003 and 2009. It collected detailed information on the costs of implementing and maintaining the telemedicine program and weighed those against the transfer logs at the eight hospitals, as well as the costs of ED visits. The team focused on five conditions that can be treated at rural hospitals with appropriate guidance: asthma, bronchiolitis, dehydration, fever and pneumonia.

For more information, see https://www.ucdmc.ucdavis.edu/publish/news/newsroom/10039.

Increased Hospice Use Drives Up Medicare Costs

Between the years 2004 and 2009, the use of hospice among nursing-home residents increased substantially. It wasn’t known whether that increase affected expenditures on end-of-life care.

To find out, Brown University researchers compared the records of nursing home residents who died in 2004 with the records of a similar group who died in 2009. Their findings, published in the May 7, 2015, New England Journal of Medicine, show that while more hospice care was associated with less aggressive care near death, it was also associated with increased Medicare expenditures.

Specifically, the researchers looked at:

• Changes in per-person Medicare expenditures in the last year of life;
• Intensive care unit use in the last 30 days of life;
• Feeding-tube use and hospital transfers within the last 90 days of life for patients with advanced dementia.

 Source: Gozalo P et al. Changes in Medicare Costs with the Growth of Hospice Care in Nursing Homes. New Engl J Med, 2015 May 7; 372:1823-1831. https://www.nejm.org/doi/full/10.1056/NEJMsa1408705.

HHS Awards $101 Million to Fund New Community Health Centers

In May, Health and Human Services Secretary Sylvia M. Burwell announced approximately $101 million in Affordable Care Act funding to 164 new health center sites in 33 states and two U.S. Territories. The new health centers are projected to increase access to healthcare services for nearly 650,000 patients.

The investment will add to the more than 550 new health center sites that have opened in the past four years as a result of the Affordable Care Act. Today, nearly 1,300 health centers operate more than 9,000 service delivery sites that provide care to nearly 22 million patients. That’s nearly 5 million more patients than at the beginning of 2009.

Since 2013, health centers have helped more than 9 million people sign up for health insurance.

“More people have insurance in the United States than ever before,” said Jim Macrae, acting administrator of the Health Resources and Services Administration. “Health centers provide an accessible and dependable source of culturally competent primary care for many of the newly insured.”

See https://www.hhs.gov/news/press/2015pres/05/20150505a.html.