Issue for the frail homebound is validating quality measures, and other letters

We were pleased to see the article “Quality-of-care standards missing for homebound seniors”, on the continued evolution of quality-of-care measurement for house calls to the frail, elderly home-limited patients. Just to prevent confusion: The physicians, nurse practitioners and physicians who make house calls do engage in the same quality reporting all medical practices do, using the existing Physician Quality Reporting System measures.

The issue is that these measures have not been validated in this very sick population or in the home setting. We commend Drs. Bruce Leff and Christine Ritchie for their important work to define setting-specific measures and look forward to the completion of this important project.

Constance Row

Regarding the article “Where healthcare is on march to value-based care”, accountable care organizations for Medicare have struggled to achieve significant cost reductions, with more losers than winners, and even those that saved Medicare money probably cost more to administer than they saved. Moving this model to the private insurance market faces a huge obstacle in the high percentage of this population now in low actuarial-value plans with high deductibles and copayments. Those with significant chronic health conditions are often unable to afford to visit their doctors or fill their prescriptions, so providers will be hard-pressed to achieve quality metrics.

Moving the ACO model to the privately insured means holding doctors and hospitals accountable for outcomes they cannot control—a bad deal for all.

Dr. Stephen Kemble

Regarding the recent Best Practices feature “Dedicated panel sets executive pay”, we implemented a similar program almost seven years ago.

Our committee members include compensation and human resources consultants and recruiters. The committee meets at least three times a year and the chair reports directly to our board of directors. This approach provides board members with confidence that the compensation they are paying their key leaders is appropriate and aligns with our mission, vision and values. I strongly recommend others take a similar approach.

Tabatha Erck

Regarding the article “Looming nursing shortage fueled by fewer faculty, training sites”, if academia expects nurses to pursue further education for advanced degrees, there needs to be better tuition assistance and student loan forgiveness options. For example, the Nurse Corps student loan forgiveness awards are too narrowly defined and only a fraction of the nurses who apply receive any funds. Nurses who do receive funds are not allowed to change employment from nursing school/faculty to a critical-access facility or vice versa. This job role restriction appears to feed the nursing faculty shortages across the nation.

Faculty pay also needs to be addressed. The cost of a doctorate education is huge, but the academic pay is nominal at best. While many might feel a calling to teach, can they afford to do it?

Beth Scott, R.N., Ph.D.

Regarding coverage of the recent data breach at Anthem, “Hackers breach Anthem; 80 million exposed,” the Affordable Care Act and HHS' push to move every medical provider to an electronic health-record system—and the requirement that the systems must all talk to one another—are only going to make this issue exponentially worse.

Using firewalls and sophisticated anti-hacking software to prevent attacks is like building the Great Wall of China. It will be very expensive, yet very easy to breach by bribing a guard at the gate. A single employee with access and a USB drive or a smartphone with a camera can defeat any system so far devised.

Lawrence Jankowski