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The Rise of the Medical Scribe: Industry Implications for the Advancement of Electronic Health Records

December 19, 2014 Comments off

The Rise of the Medical Scribe: Industry Implications for the Advancement of Electronic Health Records
Source: Journal of the American Medical Association

With federal meaningful-use incentives driving adoption of electronic health records (EHRs), physicians are increasingly concerned about the time spent documenting patient information and managing orders via computerized patient order entry (CPOE). Many perceive that the inefficiencies of EHRs are adversely affecting the quality of care, and because physicians see fewer patients per day, income may decline. Although physicians approve of EHRs in concept and appreciate their future promise, the current state of EHR technology has increased physician dissatisfaction. Poor EHR usability, time-consuming data entry, reduced patient care time, inability to exchange health information, and templated notes are central concerns. Physicians emphasize that EHR technology—especially user interfaces—must improve,1 and a new industry has emerged nationally to provide physicians with medical scribes.

Use of medical scribes—unlicensed individuals hired to enter information into the EHR under clinician supervision—has increased substantially. Scribes reportedly enable physicians to see more patients; generate more revenue; and improve productivity, efficiency, accuracy of clinical documentation and billing, and patient satisfaction.

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New From the GAO

December 19, 2014 Comments off

New GAO Reports
Source: Government Accountability Office

1. Fair Labor Standards Act: Extending Protections to Home Care Workers. GAO-15-12, December 17.
http://www.gao.gov/products/GAO-15-12
Highlights – http://www.gao.gov/assets/670/667603.pdf

2. Federal Emergency Management Agency: Opportunities Exist to Strengthen Oversight of Administrative Costs for Major Disasters. GAO-15-65, December 17.
http://www.gao.gov/products/GAO-15-65
Highlights – http://www.gao.gov/assets/670/667607.pdf

3. Department of Homeland Security: Continued Action Needed to Strengthen Management of Administratively Uncontrollable Overtime. GAO-15-95, December 17.
http://www.gao.gov/products/GAO-15-95
Highlights – http://www.gao.gov/assets/670/667618.pdf

4. Tax-Exempt Organizations: Better Compliance Indicators and Data, and More Collaboration with State Regulators Would Strengthen Oversight of Charitable Organizations. GAO-15-164, December 17.
http://www.gao.gov/products/GAO-15-164
Highlights – http://www.gao.gov/assets/670/667596.pdf

5.   State and Local Governments’ Fiscal Outlook: 2014 Update. GAO-15-224SP, December 17.
http://www.gao.gov/products/GAO-15-224SP
Podcast: http://www.gao.gov/multimedia/podcasts/667597

6.   Dodd-Frank Regulations: Regulators’ Analytical and Coordination Efforts. GAO-15-81, December 18.
http://www.gao.gov/products/GAO-15-81
Highlights – http://www.gao.gov/assets/670/667634.pdf

7.   Electronic Submissions in Federal Procurement: Implementation by the Army Corps of Engineers and Department of the Interior’s Bureau of Reclamation. GAO-15-253R, December 18.
http://www.gao.gov/products/GAO-15-253R

8.   Federal Food Safety Oversight: Additional Actions Needed to Improve Planning and Collaboration. GAO-15-180, December 18.
http://www.gao.gov/products/GAO-15-180
Highlights –  http://www.gao.gov/assets/670/667657.pdf

Misplaced Priorities: How the Social Security Administration Sacrificed Quality for Quality in the Disability Determination Process

December 18, 2014 Comments off

Misplaced Priorities: How the Social Security Administration Sacrificed Quality for Quality in the Disability Determination Process
Source: U.S. House of Representatives, Committee on Oversight and Government Reform

Key Findings:

  • All of the 48 ALJ focused reviews conducted by SSA and reviewed by Committee staff showed numerous deficiencies in ALJ decision-making and several disturbing patterns. ALJs conducted few or inadequate hearings, misused vocational experts, failed to properly assess work ability and relied too heavily on medical briefs prepared by claimants’ paid representatives. (p. 13)
  • SSA continues to allow ALJs to decide cases even when they demonstrate gross incompetence or negligence in handling their responsibilities. In several cases, SSA did not inform the ALJ about the negative focused review for over eight months after the review was completed. (p. 28)
  • SSA was singularly focused on churning out a large volume of dispositions, which led to inappropriate benefit awards. In 2007, the agency directed ALJs to decide 500 to 700 decisions each year, without conducting any study to determine how long it takes ALJs to evaluate cases and issue informed decisions.
  • SSA encouraged ALJs to take shortcuts in deciding cases to increase the amount of decisions issued each year. The agency promoted on-the-record decisions, which do not require a hearing, and bench decisions, which do not require a written opinion, to increase the number of decisions issued.

New From the GAO

December 17, 2014 Comments off

New GAO Reports
Source: Government Accountability Office

1. Hanford Cleanup: Condition of Tanks May Further Limit DOE’s Ability to Respond to Leaks and Intrusions. GAO-15-40, November 25.
http://www.gao.gov/products/GAO-15-40
Highlights – http://www.gao.gov/assets/670/667191.pdf

2. Nuclear Regulatory Commission: NRC Needs to Improve Its Cost Estimates by Incorporating More Best Practices. GAO-15-98, December 12.
http://www.gao.gov/products/GAO-15-98
Highlights – http://www.gao.gov/assets/670/667500.pdf

3. Defense Infrastructure: Risk Assessment Needed to Identify If Foreign Encroachment Threatens Test and Training Ranges. GAO-15-149, December 16.
http://www.gao.gov/products/GAO-15-149
Highlights – http://www.gao.gov/assets/670/667551.pdf

4. Higher Education: State Funding Trends and Policies on Affordability. GAO-15-151, December 16.
http://www.gao.gov/products/GAO-15-151
Highlights – http://www.gao.gov/assets/670/667558.pdf
Podcast – http://www.gao.gov/multimedia/podcasts/667387

5. Tax Filing Season: 2014 Performance Highlights the Need to Better Manage Taxpayer Service and Future Risks. GAO-15-163, December 16.
http://www.gao.gov/products/GAO-15-163
Highlights –  http://www.gao.gov/assets/670/667562.pdf

CRS — Federal Inspectors General: History, Characteristics, and Recent Congressional Actions (December 8, 2014)

December 17, 2014 Comments off

Federal Inspectors General: History, Characteristics, and Recent Congressional Actions (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

Federal inspectors general (IGs) are authorized to combat waste, fraud, and abuse within their affiliated federal entities. To execute their missions, offices of inspector general (OIGs) conduct and publish audits and investigations—among other duties. Two major enactments—the Inspector General Act of 1978 and its amendments of 1988 (codified at 5 U.S.C. Appendix)—established federal IGs as permanent, nonpartisan, and independent offices in more than 70 federal agencies.

OIGs serve to assist Congress in overseeing executive branch—and a few legislative branch— agencies. They provide recommendations and findings to their affiliated agency head and to Congress that may save the government millions of dollars per year. As a result, Congress may have an interest in ensuring that federal OIGs have the appropriate authorities and access to information they need to perform their investigations, audits, and evaluations. Concurrently, Congress has a responsibility to protect some records and information, such as national security information or information about an ongoing criminal investigation, from improper release. This report provides background on the statutory creation of federal OIGs and provides historical context for contemporary debates about the strengths and limitations of the offices.

CRS — Hospital-Based Emergency Departments: Background and Policy Considerations (December 8, 2014)

December 17, 2014 Comments off

Hospital-Based Emergency Departments: Background and Policy Considerations (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

Hospital-based Emergency Departments (EDs) are required to stabilize patients with emergent conditions regardless of the patients’ ability to pay as a requirement of the Emergency Medical Treatment and Active Labor Act (EMTALA). Given this requirement, EDs play an important part in the health care safety net by serving the uninsured, the underserved, and those enrolled in Medicaid. Open 24 hours a day, EDs provide emergency care, urgent care, primary care, and behavioral health care services in communities where these services are unavailable or unavailable after hours. EDs also play a key role during emergencies, such as natural disasters.

Some EDs are challenged to provide effective care. For example, EDs provide a disproportionate amount of health care to the U.S. population, in general, and to the safety net population, in particular. Specifically, while 4% of all U.S. physicians are ED physicians, they are the treating physicians in 28% of all acute care visits. Some EDs face financial challenges. ED services are costly both to payers, because services provided in an ED are more costly than those provided in community-based settings, and to hospitals, because operating an ED has high fixed costs and because if patients enter with an emergent condition, hospitals are required by EMTALA to stabilize the patient regardless of the patient’s ability to pay.

CRS — Overview of Federal Real Property Disposal Requirements and Procedures (December 10, 2014)

December 17, 2014 Comments off

Overview of Federal Real Property Disposal Requirements and Procedures (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

The federal government holds thousands of properties that agencies no longer need to accomplish their missions. When the government disposes of unneeded properties—through transfer, donation, or sale—it generates savings by eliminating maintenance costs. In addition, when state or local governments, nonprofits, or businesses acquire unneeded federal properties, they may be used to provide services to the public, such as temporary housing, or contribute to economic development.

The General Services Administration (GSA) plays a central role in disposing of unneeded property at most federal agencies. The Federal Real Property and Administrative Services Act of 1949 (Property Act) gives GSA the authority to dispose of real property at all federal agencies unless they have independent statutory authority to dispose of their own properties themselves. A number of agencies have independent disposal authority—ranging from limited to broad in scope—including two of the largest federal landholders, the U.S. Postal Service (USPS) and the Department of Defense.

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