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Racial Disparities In Health Care: Justin Dimick And Coauthors’ June Health Affairs Study


June 4th, 2013

Racial disparities in health and healthcare are a persistent and troubling problem for the U.S. Despite substantial policy efforts to the contrary, racial and ethnic minorities, especially African-Americans, often receive a lower quality of care and have worse outcomes. The key questions, of course, are why do these disparities exist, and what might we do about them?

Over the past decade, two primary theories have emerged to explain disparities and propose solutions to address them. The first focuses on issues around cultural competence, and suggests that many of the gaps in care are due to poor communication between providers and patients. Given the long history of discrimination against black Americans, the cultural competency theory argues that low trust on the part of patients, combined with the ineffective communication and lack of cultural sensitivity, leads to black patients receiving worse care with resultant poor outcomes. Ultimately, the cultural competency theory begs an approach to health disparities that requires more effective training of providers that care for minority patients.

The second theory of racial disparities in care suggests that the site of care really matters — that disparities are driven by the fact that black patients are more likely to receive care at poor quality hospitals. There is ample evidence for this theory as well – our prior work showed that care for black patients is highly concentrated among a small number of hospitals and these places generally provide a lower quality of care for all their patients. This theory calls for a somewhat different set of solutions: focusing on helping the subset of “minority-serving” providers to improve.

The Dimick Study

Of course, there need not be any contradiction between these two theories and one may suspect that both are likely at play. It is in this context that we have a terrific new study by Justin Dimick and colleagues from the University of Michigan, in the newly released June issue of Health Affairs, that helps us better understand why black patients generally have higher mortality after major surgeries than their white counterparts, and how we might try to reduce this gap.

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Trust But Verify: Why CMS Got It Right On EHR Oversight


November 30th, 2012

Yesterday’s New York Times headline read that “Medicare Is Faulted on Shift to Electronic Records.” The story describes an Office of Inspector General (OIG) report, released November 29, 2012, that faults the Centers for Medicare and Medicaid Services (CMS) for not providing adequate oversight of the Meaningful Use incentive program. Going after “waste, fraud, and abuse” always makes good headlines, but in this case, the story is not so simple.

For those not intimately familiar with the CMS policy, in 2009, Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act. The program, administered through CMS and state Medicaid programs, created financial incentives for doctors (and other eligible professionals) and hospitals to adopt and “meaningfully use” a certified electronic health record (EHR). To receive financial incentives, which began to be paid in May 2011, doctors and hospitals “attest” that they have met the meaningful use requirements, providing an affirmation for which they are held legally accountable.

The process works as follows: health care providers visit a CMS website, register, and enter data demonstrating that their EHRs are “certified” and that they met each of the individual requirements for meaningful use. Then they attest that that all the data they entered is true. For example, a physician might have to report, to meet just one of the 20 meaningful use measures, how many prescriptions she wrote over the past 90 days, and how many she wrote electronically. My conversations with colleagues suggest that it can take a lot of time for providers to gather all the data they need to “attest” to meeting Meaningful Use. Then, CMS runs logic checks to ensure that the numbers entered make sense and, if there are no errors, they cut the provider a check. Through September, 2012, CMS paid out about $4 billion in incentives to 82,000 professionals and more than 1,400 hospitals.

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The Stage 2 Meaningful Use Of EHRs Final Rules: Still No Surprises But Important Steps Forward


August 24th, 2012

Six months to the day after the Centers for Medicare and Medicaid Services (CMS) released the “preliminary rules” for Meaningful Use, the final rules are in.  For clinicians and policymakers who want to see Electronic Health Records (EHRs) play a key role in driving improvements in the healthcare system, there’s a lot to like here. […]

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The Stage 2 Meaningful Use Of EHRs Proposed Rules: No Surprises


February 24th, 2012

Editor’s note: For more on the Stage 2 proposed rules defining meaningful use of electronic health records, see Larry Wolf’s Health Affairs Blog post. Late in the day on February 23, 2012, the Centers for Medicare and Medicaid Services (CMS) released the preliminary rules for Stage 2 Meaningful Use.  For those not deep in the […]

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Hospital Costs And Quality: Ashish Jha’s View


June 11th, 2009

Editor’s Note: Health Affairs has recently published two studies looking at the association between hospital costs and quality. The first, by Ashish Jha and coauthors, appeared in our May-June issue, and the second by Laura Yasaitis, Amitabh Chandra, and coauthors, was published online. Variations in spending and intensity of care, and the effects of these […]

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