How the Stimulus Package affects Gotham and its Patient Population
The American Recovery and Reinvestment Act (ARRA) popularly known as the Stimulus Package was signed into law by the President on February 17, 2009 (ARRA 2009). The stimulus package aims at providing $20 billion worth of incentive to qualifying healthcare professionals and hospitals. A large percentage of the fund is given as incentives to hospitals through CMS reimbursement to encourage hospitals to implement Health Information Technology (HIT). Hospitals that demonstrate meaningful use of HIT to improve quality of care especially in an underserved community will be entitled to receive federal contributions (Howel, 2009). Hospitals will be required to submit a clinical quality measure to demonstrate it meets CMS’s guidelines to receive the awarded fund. Qualified hospitals are entitled to receive incentive payment calculated as a base sum of US$2 million given over a four year period (Howel, 2009).
Gotham hospital met the required criteria that entitled it to the stimulus package incentive from 2011 through 2015. However, Gotham has to regularly demonstrate that it meets the specific guidelines set. The Electronic Medical Record (EMR) at Gotham has been in place years before the enactment of ARRA (Stimulus package). Pre stimulus package, Gotham hospital used its HIT strictly for administrative purposes (Rosenthal 2009). The use of HIT at Gotham was aimed at reducing the administrative cost associated with hospital management and insurance claims. The package incentive led to major structural changes that integrated HIT into patient management through electronic medical recording of patients’ data and treatment options to improve quality of care. Integration of EMR into patients care is particularly important in care coordination that will enable the ACO structural units at Gotham reduce inefficiencies. Stake holders involved in the management of diabetes patients in the ACO will have a common data base in which they can access each patient’s clinical data, without having to duplicate care and clinical investigations. This duplicated care often results in avoidable cost and inefficiencies.[isn’t this already in place?]
Furthermore, diabetes patients at Gotham who have access to computers and internet engage in exchange of important clinical data with their physician, this has resulted in improved patient management in this group of patients. However, the major drawback in the Bronx relates to lack of access to computer and internet services by most residents of the Bronx community due to their socioeconomic status. This is particularly true for the underinsured and uninsured in the underserved areas of the Bronx.
Computer literacy level of this cohort is another factor that hampers engagement of EMR in the individualized management of patients with diabetes. Due to the poor educational level and age related factors (most elderly patients lack computer literacy) most inhabitants of the Bronx community do not effectively utilize the health related services provided through the EMR at Gotham. It can be inferred that HIT has not impacted the underinsured and uninsured[rephrase. Has improved health, just not knowledge and literacy] positively in the Bronx even though it has greatly improved the management of insured patients with diabetes who are currently receiving treatment at Gotham. The challenge has remained consistent: How to get patient enrolled in the diabetes program at Gotham in order to benefit from improved care through ACO.
The youth in the Bronx community, however, can be a potential target to effectively utilize HIT in preventing the incidence of diabetes amongst this age group. This group of people has better access to information technology, with a better computer literacy level. With regards to diabetes prevention in this age group, HIT can be an indispensable tool. Valuable information that will lead to prevention of diabetes can be communicated through Gotham hospital Facebook, twitter and other social media to this group. [Examples?]
