New child HCAHPS for Medicaid would be poor measurement tool, and other letters

Regarding the article “CMS may use new child HCAHPS to adjust Medicaid hospital pay”, utilizing a child HCAHPS for Medicaid is just another way to reduce payment for care in an already underfunded service.

I am a strong advocate for providing quality care but am disappointed when my organization does follow-up on current Medicare HCAHPS. Often responses are given by people not involved in the patient's care (the patient or their spokesperson). Also, we find the patient's and family's responses are driven more by what they have heard or seen on the news, from TV shows and misunderstood Web searches. Chronic conditions are chronic conditions and are not cured by a single injection or short hospital stay.

Needless to say, I don't believe the current HCAHPS system renders a reasonable assessment of care provided. Therefore, I have to question its implementation as a modifier to reduce payments with a segment of the population that is often less informed and many times has unrealistic expectations before medical care is ever provided.

H. Dean Turner

In response to the recent Q&A with Dr. Darrell Kirch, CEO of the Association of American Medical Colleges, physician access, physician shortages and, not to be overlooked, physician reimbursement continue to be the pivots upon which our healthcare system turns. As patients jockey and position themselves with either no insurance or high-deductible health plans, and hospitals navigate the ever-changing landscape, it remains necessary to focus on physician issues for many of the solutions.

John G. Holstein

Regarding the recent article “Proposed regulation of lab tests draws mixed reviews at workshop”, it doesn't much matter which agency regulates laboratory-developed tests. The question is whether the agency evaluates long-term health outcomes. And that raises the question of whether/how well we are able to evaluate such outcomes, given the fact that they accrue (or perhaps the better word is diffuse) across the healthcare system. I suggest registries that gather data over the long term and that are then mined for deeper understanding. This is what industry and the regulators should be working toward.

Ron Geigle

Regarding the recent commentary “What's in your wallet? 'Big data' wants to tell doctors and health plans”, personal information-sharing programs such as the one noted in the Carolinas HealthCare example make sense, but should probably be conducted on an opt-in basis in return for reduced premiums. Working with partners such as Apple could also be effective. The program could be positioned as a health Sherpa that would nudge participants to rethink their lifestyles.

Using enrollment carrots such as this would minimize if not eliminate any privacy concerns and enable all stakeholders to benefit. Any underwriting concerns can be legislated and regulated away if they are not already obviated by the Patient Protection and Affordable Care Act.

Terry Nugent