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CMS Finalizes 2016 Medicare Payment Rules for Physicians, Hospitals & Other Providers

CMS Finalizes 2016 Medicare Payment Rules for Physicians, Hospitals & Other Providers | Healthcare and Technology news | Scoop.it

The Centers for Medicare & Medicaid Services (CMS) issued final rules this week detailing how the agency will pay for services provided to beneficiaries in Medicare by physicians and other health care professionals in 2016 that reflects the administration’s commitment to quality, value, and patient-centered care. Payment rules for the 2016 calendar year for End-Stage Renal Disease Prospective Payment System, the Hospital Outpatient Prospective Payment System, Home Health Prospective Payment System, and the Physician Fee Schedule were all finalized this week.


“CMS is pleased to implement the first fee schedule since Congress acted to improve patient access by protecting physician payments from annual cuts. These rules continue to advance value-based purchasing and promote program integrity, making Medicare better for consumers, providers, and taxpayers,” said CMS Acting Administrator Andy Slavitt. “We received a large number of comments supporting our proposal to allow physicians to bill for advanced care planning conversations and we are finalizing this rule accordingly.”

Key policies finalized in the 2016 payment rules include:

  • Finalizing the Home Health Value-Based Purchasing model. This model, authorized under the Affordable Care Act, is designed to improve health outcomes and value by tying home health payments to quality performance. All Medicare-certified home health agencies that provide services in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee will participate in this model starting January 1, 2016. Compared to the proposed rule, the maximum payment adjustment in the first year of the model was reduced from 5 percent to 3 percent. This was part of the Home Health Prospective Payment System final rule.


  • Finalizing updates to the “Two-Midnight” rule. The rule clarifies when inpatient admissions are appropriate for payment under Medicare Part A. This continues CMS’ long-standing emphasis on the importance of a physician’s medical judgment in meeting the needs of Medicare beneficiaries by providing clearer guidelines and a more collaborative approach to education and enforcement. This was part of the Hospital Outpatient Prospective Payment System final rule.
  • Finalizing the End-Stage Renal Disease Quality Incentive Program. The End-Stage Renal Disease final rule will apply payment incentives to dialysis facilities to improve the quality of dialysis care. Facilities that do not achieve a minimum total performance score with respect to quality measures, such as anemia management, patient experience, infections, and safety, will receive a reduction in their payment rates. 
  • Beginning the new physician payment system post the Sustainable Growth Rate (SGR) formula and supporting patient- and family-centered care. This is the first final Physician Fee Schedule final rule since the repeal of the SGR formula by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Through the final rule, CMS is beginning implementation of the new payment system for physicians and other practitioners, the Merit-Based Incentive Payment System, required by the legislation.
  • Finalizing provision to empower patients and their families regarding advance care planning. Consistent with recommendations from a wide range of stakeholders and bipartisan members of Congress, CMS is finalizing its proposal that supports patient- and family-centered care for seniors and other Medicare beneficiaries by enabling them to discuss advance care planning with their providers.
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Where big data falls short

Where big data falls short | Healthcare and Technology news | Scoop.it

Big data and analytic tools have not yet been harnessed to bring meaningful improvement to the healthcare industry.

That's according to a new report from the National Quality Forum outlining the challenges to making health data andanalytics more usable and available in real time for providers and consumers.


Whereas big data has supported improvement in certain settings, such as reducing ventilator-acquired pneumonia, data analytics has been largely overlooked in the area of healthcare costs, even though this data can inform and assess efforts to improve the affordability and quality of care.


What's more, effective data management is necessary for the success of other incentives to enhance care, such as payment programs, as providers need timely information to understand where to improve and track their progress.


NQF found multiple challenges to making better use of health information, such as interoperability and linking disparate data sources, leveraging data for benchmarking, providing the ability to gather data directly from patients and de-identify it to generate knowledge, and the need to ensure that the data itself is trustworthy.


Then there's the matter of electronic health records software. "While greater EHR adoption is positive, these records do not contain all of the data needed for improvement," the report said. NQF pointed to operational or clinical data not captured in an EHR, such as the time a nurse spends caring for a particular patient or the time to transfer a patient from surgery to a post-operative recovery unit to a hospital room, as common examples.


The report noted there have been many ongoing attempts to develop interoperability between EHRs and clinical data sources recording patients' experiences and outcomes. Beyond linking healthcare data, however, "there is a need to learn from data spanning other determinants of health, as the most significant and sustained individual and population healthimprovements occur when healthcare organizations collaborate with community or public health organizations."


NQF also highlighted a widespread need to appreciate the value of nonfinancial incentives, such as peer and public reporting, in improvement initiatives.


"Overall, there was a desire to move from a retrospective approach of quality metrics and analytics to one that uses real-time data to identify potential challenges and gauge progress," the report said.


The report was supported by the Peterson Center on Healthcare and the Gordon and Betty Moore Foundation, the initiative was spurred by a 2014 report by the President's Council of Advisors on Science and Technology that called for systems engineering approaches to improve healthcare quality and value.

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Three Tips for Hiring Better Front-Desk Staff

Three Tips for Hiring Better Front-Desk Staff | Healthcare and Technology news | Scoop.it

Many practices really struggle with hiring and training a front-desk person (the person who will create that all-important first impression for your practice). The struggles are real; most offices budget near-minimum wage for this position and seem to have difficulty finding the right person to handle the huge responsibility of this position.


My go-to answer for this problem is to pay a little more in salary to recruit for this position. It's true; you often get better quality applicants if you can raise the hourly rate of pay for this vital position. It can be difficult to find a professional with the type of experience you are looking for if you only pay a low hourly rate.


But if you can't find the extra money to increase salary, what other options are available that won't necessarily cost more? Here are some options:


1. Rearrange responsibilities.

Perhaps you should take away appointment scheduling from the front desk, as there are often face-to-face patients requiring more attention. Calls could be redirected through an automated PBX system to another staff member.


2. Search for candidates with a high attention to detail.

This is as simple as giving applicants specific instructions to follow. If they don't follow those instructions in the application process, exactly, then don't even give them a second look. After all, if they are responsible for the first impression in your office, they should be diligent in making the optimal first impression to you.


3. Hire for personality and train the skills.

You can't train someone into a bright, sunny, and welcoming demeanor. So hire for personality, attitude, and work ethic — the skills and other aspects of the job can be taught.


It doesn't have to cost you more money to find the perfect front-desk staff member. There are great candidates out there to meet every budget, who will help you create stellar front-desk first impressions.

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Do doctors really hate Obamacare?

Do doctors really hate Obamacare? | Healthcare and Technology news | Scoop.it

Anti-Obamacare critics often claim that “every” physician they know hates Obamacare. For instance, pediatric neurosurgeon and GOP Presidential candidate Dr. Ben Carsontold Fox News that “he’s spoken to hundreds of doctors throughout the country about the Affordable Care Act, and not one of them ‘liked’ President Barack Obama’s signature health care law.”

Doctors hate Obamacare, it’s alleged, because it authorizes government to “control” the practice of medicine and impose “rationing” of care, thereby harming patients.  The conservative Examiner website quotes a New Jersey family physician, Dr. John Tedeschi as saying, “Just as a guitar string has to be tuned, so does a person’s health to get the right tone. The government has taken away, or refocused the intelligence part of the tuning, and has just about destroyed the creative, or compassion component. Now, with Obamacare, we are left with an incompetent mechanism that does not have the best interest of the patient in mind.”  An ER physician quoted in the articles said that the “storm of patients [created by Obamacare] means when they can’t get in to see a primary care physician, even more people will end up with me in the emergency room.”

There is no question that some doctors (mainly conservatives) hate Obamacare, and if they were the only ones you talked to (like the ones who apparently talked to Dr. Carson), you might think that all doctors feel the same way. But the reality is that — surprise, surprise! — primary care physicians’ views are just like the rest of us, split by their partisan leanings.


A new survey by the respected Kaiser Family Foundation found that 87 percent of Democratic-leaning physicians view Obamacare favorably, while the exact same percentage of GOP-leaning physicians view it unfavorably. Independent doctors split 58 percent unfavorable to 42 percent favorable.  Because there were more GOP and independent physicians among the survey respondents, the overall breakdown of primary care physicians’ views on the ACA is  52 percent unfavorable to 48 percent favorable.  Yet only 26 percent of all primary care physicians viewed the law “very unfavorably. “  So it might be said that just one out of four primary care physicians “hate” Obamacare.

And a deeper dive into the survey results directly refutes the contention of anti-Obamacare doctors that the law is leading to poorer quality, physicians turning away patients, or longer waits for appointments:


  • Most primary care physicians say that quality has stayed the same: 59 percent said that their ability to provide high-quality care to their patients has stayed about the same, while 20 percent said it has improved, and 20 percent said it has gotten worse.
  • More primary care physicians report that Medicaid expansion has had a more positive impact on quality than a negative one: “When asked more specifically about the expansion of Medicaid under the ACA, nearly four of 10 providers (36 percent of physicians and 39 percent of nurse practitioners and physician assistants) said the expansion has had a positive impact on providers’ ability to provide quality care to their patients. About two of 10 said it has had a negative impact, and the remainder said it has not made a difference, or they are not sure.”
  • Ease of getting same-day appointments is about the same as before the ACA: “Overall, about four of 10 primary care providers said almost all their patients who request a same- or next-day appointment can get one; another quarter said most of their patients can get such appointments” which is largely unchanged from 2009 and 2012.
  • Most continue to accept new patients: “A large majority of primary care providers (83 percent of physicians, 93 percent of midlevel clinicians) said they are currently accepting new patients . . . A survey conducted in late 2011 through early 2012 found that 89 percent of primary care physicians were accepting new patients and 52 percent were accepting new Medicaid patients.  This indicates that while physicians’ rates of accepting new patients overall may have declined slightly since the ACA coverage expansions went into effect, acceptance rates for Medicaid have remained about the same.”


When asked specifically about their views on the impact of the Affordable Care Act on five dimensions, the ACA fared well, with one exception (costs to patients).


  • Access to health care and insurance in the country overall: 48 percent positive, 12 percent no impact,  24 percent negative, and 14 percent not sure.
  • Overall impact on practice: 31 percent reported no impact, 23 percent a positive  impact, 36 percent negative  and 9 percent not sure.
  • Quality of care their patients receive: 50 percent reported no impact, 18 percent positive, 25 percent negative, and 6 percent not sure.
  • Ability of the practice to meet patient demand: 44 percent no impact, 18 percent positive, 25 percent negative, and 10 percent not sure.
  • Cost of health care for their patients: 17 percent no impact, 21 percent positive, 44 percent negative, and 16 percent not sure.


However, “physicians’ responses to questions that mention the ACA by name are deeply divided along party lines. For example, by a three-to-one margin, physicians who identify as Democrats are more likely to say the ACA has had a positive (44 percent) rather than a negative (15 percent) impact on their medical practice overall. Republican physicians break in the opposite direction by about seven-to-one (57 percent negative, 8 percent positive).”

The survey also does not support the contention that the ACA is contributing to primary care physician dissatisfaction with practice and burn-out:


“Even though providers with different political affiliations do not share views about the Affordable Care Act, a large majority of primary care providers (83 percent of physicians and 93 percent of nurse practitioners and physician assistants) — both Republicans and Democrats — reported they are very or somewhat satisfied with their medical practice overall. The changing environment does not appear to be affecting overall provider satisfaction even among providers who see a larger share of Medicaid patients or work in Medicaid expansion states. Indeed, current satisfaction levels are slightly higher than what was reported by primary care physicians before the ACA. In 2012, 68 percent of primary care physicians reported they were very satisfied or satisfied with practicing medicine.”


Interestingly, Democratic physicians (56 percent) are more likely to recommend a career in primary care than Republicans (39 percent)  or Independents (40 percent).


I know that many conservative primary care doctors have a strong and principled objection to Obamacare, believing  passionately that it gives the government too much power and the physicians, and their patients will be hurt as a result.  I (and ACP) may not agree with them, but I respect their views, and their right to make their case to their colleagues and to the public.


But the Kaiser Family Foundation survey shows us that the anti-Obamacare doctors do not represent the views and experience of most primary care doctors on the front lines, never mind “all” of them.  Doctors (at least those in primary care, who knows about surgeons?) clearly don’t “hate” Obamacare.  Rather, more of them see Obamacare as doing some good things, like improving access; and doing not as well on other things, like lowering costs to patients.  Much of what they do and see in their practices remains unchanged by it, for good or bad.


And that strikes me about right, Obamacare is making many things better, but there is a lot more that needs to be done to improve quality and access, lower costs to patients, and sustain and support primary care.  Of course, such nuances do not make for as good a headline or political talking point as “Doctors Hate Obamacare.”

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Epic at work on new tech to avert falls

Epic at work on new tech to avert falls | Healthcare and Technology news | Scoop.it

Healthcare IT giant Epic is working on a clinical decision tool aimed at helping healthcare providers reduce the risk of falls in unsteady patients. The technology is expected to be ready and available to Epic's EHRclients by year's end.


Longtime Epic customer Kaiser Permanente will roll out the tool at its facilities across the country and will also make its evidence-based falls prevention program widely available to other health systems and health plans.

The technology is called STEADI, an acronym for Stopping Elderly Accidents, Deaths & Injuries. The tool is being designed based on CDC's guidelines for falls assessment. The goal is to make it easier for healthcare providers to screen for falls, intervene to reduce risk and provide follow-up care.


The announcement came at the end of a White House Fact Sheet released this morning regarding The White House Conference on Aging, which President Barack Obama is hosting today.


The sweeping conference agenda focuses on issues facing Americans as they plan for retirement. Many of the measures proposed build on the Affordable Care Act and on efforts to improve Medicare and Medicaid.


"In a year that marks the 50th anniversary of Medicare, Medicaid and the Older Americans Act, as well as the 80th anniversary of Social Security, the White House Conference on Aging is an opportunity to recognize the importance of these programs, highlight new actions to support Americans as we age and focus on the powerful role that technology can play in the lives of older Americans in the decade ahead," the White House announced.

Federal data to be released

The Administration announced that by September 2015, federal data sets relevant to aging and to elderly Americans would be made easily available on Data.gov, the repository for the U.S. government's open data. This resource will continuously be updated with datasets on aging, much like it is for other important Administration priorities such as climate, public safety and education. 

Health IT efforts

Like Epic's several of the planned initiatives surrounding the aging initiative have healthcare IT underpinnings. These are put forward by the private sector:


  • As part of its annual HackFest, LeadingAge, an association of 6,000 not-for-profit organizations and businesses representing a broad field of aging services, will partner with Hewlett-Packard using HP's 3D immersive computing platform and Federal open data to challenge innovators to create technology-driven tools to improve the lives of older adults and their families.
  • The employer coalition ReACT (Respect a Caregiver's Time), Care.com and the Massachusetts Institute of Technology are joining forces to generate the tools employers need to effectively support employees who are caregivers. MIT and Care.com will jointly conduct a case study based on MIT's approach to employer-supported elder care. 
  • Uber is announcing pilot programs in Florida, Texas, Ohio, Arizona and California that will partner with senior community centers and other advocates to provide free technology tutorials and free or discounted rides to older Americans to increase access to transportation options and support mobility and independence.
  • Airbnb has conducted research to support and understand the experience of older Americans in their travels and in their use of technology and is partnering with communities to enhance accessibility and the user experience for older populations. 
  • Walgreens has made advancements in its digital technologies to connect individuals with its telehealth services provider, which offers 24/7 access to U.S. board-certified doctors.  Seniors also can track their health behavior with personal wellness smartphone technologies from Walgreens and WebMD.
  • Peapod has adopted "best in class" Web accessibility standards to ensure that all individuals, including those with disabilities and those who are unable to shop at traditional stores, can use its website and mobile applications. 
  • Honor, a tech-enabled company that matches seniors with care professionals, will offer $1 million in free home care across 10 cities in the country and work with established care providing organizations in those communities to ensure this care goes to helping older Americans. 
  • The University of Washington's School of Nursing and the HEALTH-E (Home-based Environmental Assisted Living Technologies for Healthy Elders) initiative are introducing an Aging and Technology Laboratory, which includes hardware and software tools to support participatory design of technology for older adults.  The laboratory will allow scientists, engineers, and others to engage older adults and their families to accelerate the generation of new solutions to support aging.
  • The Stanford Center on Longevity will develop a State of Longevity Index to be released in early 2016 that will measure how well the U.S. is doing to improve the prospects for long-term well-being in financial security, physical health, social connectedness, educational attainment, and age-friendly communities. 
  • IDEO is announcing the launch of "The Powerful Now," a project to build a cross-sector collaboration around positive aging for all.


Among the planned government initiatives are.


  • Facilitating state efforts to provide workplace-based retirement saving opportunities: About a third of the workforce lacks access to a workplace retirement plan, the White House notes. That's why, in every budget since taking office, the President has put forth proposals to provide access for 30 million Americans to workplace-based retirement savings by requiring employers not currently offering a retirement plan to automatically enroll their workers in an IRA.  But in the absence of Congressional action, the states are leading the charge.
  • Launching Aging.gov – today: The intent is to provide older Americans, their families, friends and other caregivers, a one-stop resource for government-wide information on helping older adults live independent and fulfilling lives.
  • Modernizing federal rules that affect long-term care, healthy aging and elder justice: Steps announced today include: a new Centers for Medicare and Medicaid Services proposed rule to update, for the first time in nearly 25 years, the quality and safety requirements for more than 15,000 nursing homes and skilled nursing facilities to improve quality of life, enhance person-centered care and services for residents in nursing homes, improve resident safety, and bring these regulatory requirements into closer alignment with current professional standards.
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Texas Gov. Signs Bill for Expanded Health Data Interoperability

Texas Gov. Signs Bill for Expanded Health Data Interoperability | Healthcare and Technology news | Scoop.it

Texas Gov. Greg Abbott has signed a bill into law to promote improved and expanded health data interoperability for Texas public health.


House Bill 2641 helps better define health information exchange (HIE) within Texas statute and aims to ensure that all public health systems are able to exchange health information securely, in accordance with applicable national data exchange standards. The bill was signed into law by Gov. Abbott on June 19 and will take effect September 1, 2015.


Authored by state representative John Zerwas, M.D., an anesthesiologist from Houston, the new law also allows health-related information to be transmitted through local health information exchanges to the appropriate state public health agencies, a critical provision for technology innovators working to facilitate the secure exchange of health data.


The bill is called “Ken’s Bill” after Dr. Ken Pool, M.D., who was president of the board of directors of the Texas e-Health Alliance when the bill was drafted. TeHA is credited with pulling together a broad coalition of stakeholders—hospital associations and medical associations, among others—that saw the bill through to passage.


“HB 2641 is an important step towards making sure that we are empowering providers to get the most out of their investments in health information technologies, and in moving our state health care data systems into the modern era” Representative John Zerwas, M.D., author of the bill, said in a statement.

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Getting a checkup will be very different in the not-so-distant future

Getting a checkup will be very different in the not-so-distant future | Healthcare and Technology news | Scoop.it

Sometime in the not-so-distant future, getting a checkup will be very different.


When the doctor writes down your symptoms, it will be cross-checked with others in your area, making it easier to identify outbreaks and epidemics sooner. If you complain of shortness of breath, your phone’s heart rate monitor will instantly report how well your heart has functioned over the last month. Those readings then could be aggregated with others in your community, revealing hidden trends. As your doctor thinks about the best treatment for you, big-data analysis will help her assess how various options have worked for others with similar histories and body chemistry.


This is the promise of big data in healthcare. And, it’s not just while you’re at the doctor. Medical research and findings are now being combined into massive searchable databases, making it easier to assess and compare results. Databases can absorb terabytes worth of disparate data, including things like the weather. This will make it clearer whether it’s the drug — or something extraneous like humidity — that’s making people feel better.


But all this is in its infancy, with the sector moving slowly and cautiously. The Affordable Care Act now mandates that doctors switch to electronic health records when they treat Medicare patients. So far, they’re not especially sophisticated.

“Electronic health records right now are only collecting about 100 megabytes of data per patient, per year,” says Dale Sanders, senior vice president of strategy at Health Catalyst, an analytics firm. “Most patients, if they knew how poorly informed healthcare was from a data perspective, would be really disappointed.”


Health Catalyst is one of a number of companies — big and small — working to change that, seeing the immense potential to both improve care and save money. US healthcare industry expenditures are approaching $3 trillion annually. The McKinsey Global Institute estimated in 2013 that deploying big data could create $100 billion in value every year across the healthcare industry.


In Pittsburgh, a major hospital system teamed up in March with the city’s biggest universities to advance big-data analytics in healthcare. As part of a consortium, Carnegie Mellon University is working on artificial intelligence that draws on databases of studies and health records.


Andrew Moore, Dean of Carnegie Mellon’s School of Computer Science, imagines a day when his phone gives his doctor a more accurate report on his health than he can himself.

“If he or she asks me, ‘have you been getting out of breath much lately?’ and I say, ‘I don’t think so,’ at that point I would like my cell phone to chime in and say, ‘yes, you have, actually, Andrew,'” he says. “That would be awesome for me and the physician.


Moore expects the systems to be able to trace hospital-borne infections back to a specific piece of equipment or patient. Or, some might make it possible to diagnose a rash with a smartphone photo.

The Pittsburgh Health Alliance plans to spend $10-$20 million a year on its big-data collaboration. Carnegie Mellon joins with the University of Pittsburgh Medical Center and the University of Pittsburgh on the project, and UPMC already takes in info from 200 sources.


And big data has the potential to become big business. In 2013, investors put nearly $200 million into analytics and big-data startups, according to research firm Gartner. There have been similar size investments in digital medical devices and personalized medicine. The government is investing millions in analyzing medical databases, too. That’s not to mention health-tracking research and products from the likes of Apple, Google, and FitBit.


“Hospital systems realize that healthcare is becoming more and more an information technology business,” Moore says.


For all the excitement over big data’s potential for personalized medicine and better public health, it’s not without obstacles and risks. Moore worries about security, knowing that any breach of privacy will threaten public acceptance of the whole industry.


Sanders of Health Catalyst thinks the real promise of big data is improving the basics of healthcare. “We keep attaching big data to these moonshot kinds of expectations,” he says. To Sanders, big data isn’t a revolution. It’s a way to improve the fundamentals of care, like reducing hospital-borne infections.


“Reducing variability in care and reducing over treatment of patients is probably the most important place for any organization in healthcare to start,” he says.


And perhaps the biggest challenge for big data is culture. Doctors and hospitals tend to be understandably cautious and skeptical about adopting new technology, waiting for it to be sufficiently proven safe and effective. But as analytics improve, and the pressure to bring down the cost of healthcare builds, most agree big data will become a big deal in medicine.

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Practices Should Prepare for Payer Consolidation

Practices Should Prepare for Payer Consolidation | Healthcare and Technology news | Scoop.it

We live in a very exciting time in the healthcare industry. Regardless of how you feel or think about decisions that are made on the government level, healthcare is in a period of controlled chaos right now.


With the potential merger of Anthem and Cigna and Aetna and Humana, or Assurant closing its doors on its health insurance business, things are about to get really interesting for medical practices. Arming yourself with as much information as possible is key to not just surviving financially, but thriving in this new environment.

Let's take Assurant, for example. They've decided that doing business in the healthcare arena and competing against the dominant healthcare insurance companies was far more expensive than expected. What does this mean for your practice? If you have patients that use Assurant as their medical insurance, it's a great idea to step in and take control of those accounts, now. Create a waiver for Assurant patients that explains what is going on, what to expect from their plan, and how they can still see you with a new insurance plan. The waiver should also state that in the event Assurant does not pay the medical claim, patients will be responsible for the allowed amount, and they will have to pay out of pocket if it is a PPO Plan. If the plan is an HMO, and Assurant does not pay, the practice is not allowed to place a PR (patient responsibility) to the patient and will lose that money.


Aetna and Assurant have similar fee schedules, so suggest to your patients to look into individual Aetna plans, to ensure that you will retain those patients and not lose revenue if you are contracted with Aetna. You will also need to really follow up with those claims and make sure that Assurant is paying you. I have seen them use a delaying tactic of denying a claim with the code CO95 (plan procedures not followed), which basically means they are sending your claim to a different claim address than what was provided to you at the time of benefit verification.  


As far as the pending mergers, I really love it when this happens. I'm particularly fond of the companies that have been courting each other lately. With the possible Aetna/Humana merger, Aetna will be able to add a lot more patients to their network. It will position them as a real player and earn them much needed respect within the market. I still have some overall issues with both Aetna and Humana, but merging them together should ease some of those issues.


The Anthem/Cigna cat-and-mouse game going on is particularly interesting. Cigna claims they're worth more than $184/share, and said no to Anthem's last purchase attempt. But Anthem is not giving up. Cigna used to be a premium plan until they teamed up with American Specialty Health. They have basically cut reimbursements to providers in half (if you signed up under their new network, otherwise you are seeing Cigna patients out of network), and implemented a time-consuming authorization process that eats away at whatever profit your practice may have left over from the reimbursement cuts. They implemented this over the course of the last year, or so. Working with Anthem is pretty cut and dried: What you see is what you get, with no hidden agendas. Anthem requires few to no pre-authorizations, allowing you to see your patient and maybe make a few bucks.


Just taking a few moments and reading up on what is going on in the healthcare industry today is really key to insuring your practice is not caught off guard. Always be learning, always be aware. There are multiple newsletters you can sign up for that will drop a daily or weekly e-mail into your inbox that will help you keep up.

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Under Healthcare Reform, Where Do Practicing Physicians Go From Here?

Under Healthcare Reform, Where Do Practicing Physicians Go From Here? | Healthcare and Technology news | Scoop.it

It’s a fascinating time these days in healthcare, on so many levels. And discussions in the past week—mine and others’—have only underscored that fact.


First, there was my breakfast and interview with Scott Weingarten, M.D., the senior vice president and chief clinical transformation officer at Cedars-Sinai Health System in Los Angeles. Reconnecting with Scott Weingarten reminded me once again of what a vortex we’ve been flying into and through, lately in our industry. Southern California is one of the more advanced managed care markets in the U.S., and yet even there, change has proven to be challenging for physicians. And if anyone is in a position to know just how challenging all this is, it is Dr. Weingarten. As he told me a week-and-a-half ago, when asked what the key to helping physicians move forward to optimize care is, “It’s a combination of things. I think physicians want to do the right thing. They went to med school to help patients; they’re trained in the scientific method. And they need to know that what they’re doing is scientifically valid. If you can’t convince physicians that something is the right thing to do for patients, they’re not going to do it.”


Weingarten, who practiced for years as an internist before he went into administration at Cedars, then co-founded Zynx Health (which provides evidence-based guidelines), and then came back to Cedars two-and-a-half years ago,  told me this: “ I used to be a practicing physician; and if someone couldn’t convince me something was right for my patients, I wouldn’t do it, either. So they need to understand that all of this is good for their patients; and they need to understand all the changes taking place at the national and local level; and also to understand how change will help them better take care of their patients.”


Weingarten believes that the MACRA (Medicare Access and CHIP Reauthorization Act of 2015) law that eliminated the SGR (sustainable growth rate) problems under Medicare, and which mandates either participation in the new Merit-based Incentive Payment Program, or MIPS, or participation in alternative payment models, which push practicing physicians forward quickly, once they figure out their options. “We provide them with those resources to help them, because it’s very hard for physicians in small practices,” he noted, of his organization’s clinical transformation and performance improvement work at Cedars-Sinai, because “with MIPS—in 2019, physicians will either need to participate in alternative payment models, or in MIPS. Beginning 2019, they’ll get a 5-percent annual bonus for participating, whereas there could be up to a 9-percent downside under MIPS in Medicare reimbursement over time, and that could be very difficult for the physicians.” And of course, “A lot of physicians are trying to figure out what alternative payment models mean for them,” he noted, “so we try to explain to them what’s going on and what it means.”


Not every physician is practicing in an integrated health system like that of Cedars-Sinai, where senior executives are working assiduously towards clinical transformation—and even have a senior vice president for clinical transformation, in Scott Weingarten. Joseph Valenti, M.D., an obstetrician-gynecologist who practices at the Denton, Texas-based Caring for Women practice, recently told HCI Associate Editor Rajiv Leventhal, that physicians like himself are becoming stressed by some aspects of healthcare reform. Asked why he believes that some doctors are wary of joining accountable care organizations, Dr. Valenti said, “I think that a lot of physicians are not completely convinced that the data is out there to demonstrate that they could potentially develop the savings necessary, and prevent hospital admissions and readmissions. Much of the healthcare spending that is extreme right now is in hospitals, not clinician offices,” he said, “so the concern is, can you keep this person out of the hospital? Also in terms of Medicare ACOs, you’re going to be assigned 5,000 patients at least, and they could be the sickest patients out there, so there is no guarantee that you can make them well enough and be assured that they don’t need to come back to the hospital. So maybe you can’t demonstrate shared savings. And the ACO stats prove this; one-third of them are working, one-third are breaking even; and one-third are leaving the program. “


Meanwhile, electronic health records and other clinical information systems are fascinating in this context, because they are absolutely essential to moving forward on value-based care delivery and payment and clinical transformation, but the implementation of an EHR/EMR itself is really, as everyone says, “table stakes”—that go-live is only the first step in a very long process for physician practices. “As Dr. Valenti expressed it to Rajiv, “This is the story with EMRs—no one has compelled them to simply ‘come up to snuff.’ The concern is that I will put my whole future in the hands of this IT system, and maybe it will work but maybe it won’t. The cost of this for us was over a quarter of a million dollars, and we’re not as satisfied as we should be given the cost. We can’t believe the number of bugs and glitches with it,” he said. “There are eight providers in our group, and we do like the ability to access our EMR from anywhere when a patient calls middle of night. I wouldn’t go back to paper, even though I know a lot of doctors actually would—many have been jaded by EMRs that were not well supported and cost them a ton of money and time. I call these things unfunded mandates—things we must do but no one is funding anyone to do them.”


All these issues were definitely on the minds of the CMIOs and other medical informaticists gathered in Ojai, California last week for the annual AMDIS Physician-Computer Connection Symposium. There are so many “to-do’s” when it comes to optimizing the use of clinical information systems in order to really accomplish the clinical transformation that will be required to fundamentally reengineer the U.S. healthcare system in the coming years. As Doug Fridsma, M.D., Ph.D., of AMIA (the American Medical Informatics Association) noted in his AMDIS address, physician documentation processes need to be seriously revamped; regulations need to be made more focused in their approach; there needs to be greater transparency around EHR functions; and clinical IS innovation among vendors must be encouraged.


Referring to his association’s recently published “EHR 2020” report, Fridsma said of himself and his association with regard to the policy recommendations made in the report, “We said, if you’re going to focus regulation and increase transparency and encourage attempts to simplify documentation, make sure to keep your patient at the center, as the North Star.”


I think that that comment will be very important going forward, particularly with regard to helping physicians in practice to do the very difficult work of transforming patient care to improve outcomes around both care quality and cost.


Certainly, Scott Weingarten and his colleagues at Cedars-Sinai know that. Their challenge is to figure out how to optimally leverage IT tools to support physicians in creating their own clinical transformations while also contributing to broader processes of transformation across their integrated health system. And they’re learning as they go, in terms of ACO and population health development.


So here’s the thing: Scott Weingarten, Joseph Valenti, and Doug Fridsma are all very, very smart doctors. They’re all trying to do what they can in their organizations to move their organizations forward, and in some way, to move the physician community, and U.S. healthcare, forward.


And all this change-making is inherently, and inevitably, messy. Because for U.S. healthcare to successfully move into its next phases of evolution, we will need for federal policy mandates, private health insurer initiatives, hospital, medical group, and health system efforts, and individual physicians’ delivery process changes, all to move forward, in some broadly coordinated way. And yet, the reality never matches the theory—thus Dr. Valenti’s legitimate complaints about some of the challenges facing practicing physicians. In particular, he is quite right that demanding accountability from physicians for outcomes that are partly actually the responsibility of patients, is problematic.

Yet it is still in everyone’s interest for individual physicians in practice, whether solo (though few are left in true solo practice anymore) or in organized groups, to feel themselves to be a part of change, and to be “self-change agents,” as it were. And good medical practice governance, and good IT governance, will be essential to any such advances.


So how physicians move forward under healthcare reform (public and private alike) is a question that concerns all of us in healthcare. But only time will tell as to exactly how it all plays out. So stay tuned, because the kinds of discussions that I and my fellow editors at HCI have been having in the past couple of weeks speak to some of the deeper issues facing our entire industry. Personally, I can’t wait to see exactly how everything plays out. It certainly will be a fascinating next couple of years!

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More patients could soon be seeing a virtual "doc in a box"

More patients could soon be seeing a virtual "doc in a box" | Healthcare and Technology news | Scoop.it

For many people, getting an appointment to see their doctor can be challenging. And if you don’t have a doctor but need to see one, it can take weeks to months to get one of those coveted new patient slots.

As a result, “Doc in a box” and urgent care clinics have taken off across the country. And as with everything else in healthcare, that trend has gone digital. And this year, the success of two companies in particular could make this a breakout year for the virtual doctor visit.

Teladoc

Teladoc made headlines this week with a very successful IPO that saw share prices go up 50% in the first day of trading. Teladoc is a company that offers on-demand doctor visits to patients through their smartphones, computer, or regular old phone for under $50. Basically, you put in a request for a consultation to Teladoc and they connect you with a board certified internal medicine, pediatrics, or family practice physician. Teladoc boasts that patients get connected with a physician in under 10 minutes.


Teladoc offers members an EHR that is basically a patient-provided medical history. Consulting physicians review that record and get a history from the patient. If needed, they can e-prescribe medications to a local pharmacy.


Patients can sign up directly for Teladoc and pay out of pocket if they want. Health plans and companies are also contracting with Teladoc to provide this service to their members and employees in the hopes of averting more expensive urgent care and ER visits.

Doctors on Demand

One of this years most successful digital health companies is Doctors on Demandwhich, according to StartUp Health, has raised $50 million in just the first six months of 2015.


Doctor on Demand offers video visits to patients through their smartphone or computer. Like Teladoc, Doctor on Demand offers consults in general medicine and pediatrics. They are more varied in their physician pool; for example, their highlighted medical physicians include preventive medicine, emergency medicine, and internal medicine physicians. A really interesting feature here though is that they also offer mental health consults with psychologists and lactation support with certified lactation consultants.


Patients sign up directly with Doctor on Demand. Visits with a medical physician or pediatrician cost $40; visits with a psychologist or lactation consultant range from $40 to $95. And as with Teladoc, companies and health plans are signing directly with Doctors on Demand to provide that service to their employees and members.


The support that these two companies have garnered this year is a strong sign that this area is poised for some serious growth.

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Demand for Advanced Practitioners Will Continue to Grow

Demand for Advanced Practitioners Will Continue to Grow | Healthcare and Technology news | Scoop.it

Like the rest of Americans and people around the world, I eagerly awaited the Supreme Court decision on King v. Burwell. The decision, which shifts the direction of the healthcare reform debate, also affirms the demand for physicians, especially family-practice-trained physicians, and other advanced practitioners, such as PAs, NPs, and CRNAs, will continue to skyrocket.

The Association of American Medical Colleges (AAMC) studies the supply and demand of physicians, and indirectly, other providers who perform services in the healthcare system. The most recent report discusses research and findings within the lens of Affordable Care Act (ACA) initiatives and programs having been underway for several years.


The summary essentially reinforces the need to train more physicians, and clinicians such as PAs, NPs, and CRNAs. The ACA has increased the demand for providers at all levels, over previous predictions, and that demand will only continue to grow as more patients continue to enter the healthcare system.


Key findings in the report were as follows:


• The AAMC predicts a projected shortfall between 12,500 to 31,100 primary-care physicians by 2025, while demand for non-primary care (specialty) physicians will exceed supply by 28,200 to 63,700 physicians. This has significant impact especially on PAs, in that we practice in teams with physicians.


• Expanded medical coverage achieved under ACA, once fully implemented, will likely increase demand for healthcare providers, especially those in primary care, by about 2 percent over the current increased demand resulting from changing demographics.


• Due to new data and the dynamic nature of projected assumptions, the projected shortfalls of physicians in 2025 are smaller than shortfalls projected in the earlier study. The lower ranges of the projected shortfalls reflect the rapid growth in supply of clinical providers such as PAs, which have helped to close the gap between physician supply and demand.


• The critical role PAs play in patient care delivery has implications for all providers on the healthcare team. Right now, we cannot train physicians, PAs, and NPs fast enough to meet the demands of the healthcare system.


The AAMC concluded that additional study is needed to determine the impact that providers like PAs have on the supply and demand of physicians. As always, hindsight is 20/20, and the AMCC recognized the limitations and caveats of making predictions about the supply and demand of all members of the healthcare delivery team. Areas of future recommended study included physician retirement patterns, changing wants, needs, and preferences of young physicians, the evolution of clinician staffing patterns, and the effect of payment models.


Speaking for PAs, all of the above areas of future research are important to my profession, especially in the area of retirement. As a growing profession, we are experiencing the first major cohort of PAs approaching retirement. However, as the demand for providers increases, demand for PAs is also skyrocketing due to our rigorous education in the medical model — similar to physicians — and our training in team-based care (on which many new models of care delivery depend).


As PAs practice medicine in nearly every setting and every specialty and subspecialty, our future continues to be tied to the present and future supply and demand challenges confronting our health system. To meet the ever-expanding demand and reflect the realities of today's U.S. healthcare system, it is more important than ever to modernize laws and regulations to allow PAs to practice to the fullest extent of their education and abilities.

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Doctors, Not Patients, May Be Holding Back mHealth Adoption

Doctors, Not Patients, May Be Holding Back mHealth Adoption | Healthcare and Technology news | Scoop.it

Clearly, mHealth technology has achieved impressive momentum among a certain breed of health-conscious, self-monitoring consumer. Still, aside from wearable health bands, few mHealth technologies or apps have achieved a critical level of adoption.


The reason for this, according to a new survey, may lie in doctors’ attitudes toward these tools. According to the study, by market research firm MedPanel, only 15% of physicians are suggesting wearables or health apps as approaches for growing healthier.


It’s not that the tools themselves aren’t useful. According to a separate study by Research Now summarized by HealthData

Management, 86% of 500 medical professionals said mHealth apps gave them a better understanding of a patient’s medical condition, and 76% said that they felt that apps were helping patients manage chronic illnesses. Also, HDM reported that 46% believed that apps could make patient transitions from hospital to home care simpler.


While doctors could do more to promote the use of mHealth technology — and patients might benefit if they did — the onus is not completely on doctors. MedPanel president Jason LaBonte told HDM that vendors are positioning wearables and apps as “a fad” by seeing them as solely consumer-driven markets. (Not only does this turn doctors off, it also makes it less likely that consumers would think of asking their doctor about mHealth tool usage, I’d submit.)


But doctors aren’t just concerned about mHealth’s image. They also aren’t satisfied with current products, though that would change rapidly if there were a way to integrate mobile health data into EMR platforms directly. Sure, platforms like HealthKit exist, but it seems like doctors want something more immediate and simple.


Doctors also told MedPanel that mHealth devices need to be easier to use and generate data that has greater use in clinical practice.  Moreover, physicians wanted to see these products generate data that could help them meet practice manager and payer requirements, something that few if any of the current roster of mHealth tools can do (to my knowledge).


When it comes to physician awareness of specific products, only a few seem to have stood out from the crowd. MedPanel found that while 82% of doctors surveyed were aware of the Apple Watch, even more were familiar with Fitbit.


Meanwhile, the Microsoft Band scored highest of all wearables for satisfaction with ease of use and generating useful data. Given the fluid state of physicians’ loyalties in this area, Microsoft may not be able to maintain its lead, but it is interesting that it won out this time over usability champ Apple.

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Are We Getting Closer to the Top of the HIE Mountain?

Are We Getting Closer to the Top of the HIE Mountain? | Healthcare and Technology news | Scoop.it

Two weeks ago, I finally completed the long, enduring process of buying my first home in Hoboken, N.J. The journey, from start to finish, took months to complete, the money put into it was substantial, and the paperwork and effort to try to make sure that everything went smoothly (Does it ever when it comes to real estate?) was rigorous, to put it kindly.


One of the strangest parts about this process, from a personal standpoint, is that I won’t be living in the home! Instead, I see it as an investment opportunity that I hope will pay off in the long run. Will it? It’s hard to say as of right now—the real estate market will dictate how it works out for me in the future, and it might be years and years down the road until I know if it was a savvy move or not.


The quick lesson here: sometimes in life, it takes a really long time to see tangible results for the efforts that we have put in. This couldn’t be more accurate when it comes to health information exchanges (HIE). The investment that our country has put into developing and maintaining HIE platforms has been gigantic, in the form of half a billion dollars, yet many naysayers believe that the return on that investment might never come.


To date, it’s been pretty hard to argue with them. Interestingly enough, I actually blogged about this very issue back in December, referencing a study from the Santa Monica, Calif.-based research organization RAND Corporation which found that due to the lack of evaluation on HIEs in the U.S., simply put, it has been too difficult to determine if they have been successful or not.  It’s too early to judge them, the researchers of that report found. “There are likely other health information exchange organizations in the country that are being used, and some may be having an impact. But, if they exist, they haven't been evaluated,” Robert Rudin, lead author of the study and an associate policy researcher at RAND, said at the time.


Recently, I read another review on HIEs, one that had similar conclusions to the RAND study in terms of early evaluation, although this study had a more optimistic outlook. This latest report, “The benefits of health information exchange platforms: Measuring the returns on a half a billion dollar investment,” from Niam Yaraghi, a fellow in the Washington, D.C.-based Brookings Institution’s Center for Technology Innovation, studied the effects of accessing patient information through an HIE platform on the number of the laboratory tests and radiology examinations performed in two emergency departments in Western New York in 2014, via the region’s HIE, HEALTHeLINK. While Yaraghi readily admits that true HIE benefits won’t be realized until more providers join HIE platforms, and subsequently share data, he sees that there is significant potential.


Yaraghi’s analysis looked at two groups of patients in the ED, one group whose care involved querying HEALTHeLINK’s database of clinically relevant information from a patient’s medical history, and the other group whose care did not involve an HIE query. The study revealed that querying the HIE’s database is associated with significant utilization reduction in ED settings. In the first ED setting, querying the database is associated with respectively, a 25 percent and 26 percent reduction in the estimated number of laboratory tests and radiology examinations. In the second ED setting, querying the HIE’s database is associated with a 47 percent reduction in the estimated number of radiology examinations.


In his conclusion, Yaraghi writes, “The efforts by Congress, patient advocacy groups, and most importantly the shift towards value-based payments promise complete interoperability in the near future. After more than a decade of concerted national efforts, we are now on the verge of realizing the returns on our investments on health IT. HIE platforms have the potential to leverage the national investments on interoperability and radically improve the efficiency of healthcare services.”


Comparatively speaking, the aforementioned RAND study found no evidence showing whether or not health information exchanges are on track as a potential solution to the problem of fragmented healthcare. “It is pretty well established that the U.S. healthcare system is highly fragmented,” RAND’s Rubin said. “Lots of studies over the years, including some recent studies, have shown that a typical patient visits doctors in many different practices. Frequently the doctors don't have the patient's previous medical information. There is no sign of that problem getting better, and in fact it may get worse if medicine continues to become more specialized.”


Indeed, as Yaraghi notes, getting providers on board and increasing the volume of data available on the HIE platform will be the key moving forward. “A RHIO (regional health information organization) without data is an expensive yet empty glass of water,” he writes.  “At the beginning, RHIOs could help physicians have a better understanding of the patients’ condition as much as an empty glass could help them quench their thirst.” Undoubtedly, as HIE organizations look to get providers more involved and willing to share data, the providers themselves are looking for more out of the HIEs. A recent report from NORC at the University of Chicago, funded by the Office of the National Coordinator for Health Information Technology (ONC), found that providers highlight the potential for HIE to ease access to actionable data that integrates data from across the care continuum and provides clinicians with information at the point of care to improve care delivery and care coordination.


At the end of the day, it’s all about value, as with most things in life. If the general public values my condo in Hoboken, and I get renters to pay me to live there, I’m almost certainly going to see a return on my investment. Similarly, if physicians across the U.S. see value in HIEs, the federal government will eventually see a return on their investment as well, in the form of lower healthcare costs and better patient outcomes. As Yaraghi writes, “This is the first study in which access to an HIE platform was provided to all of the patients in a treatment group, while the care of the others in the control group did not include querying an HIE platform.” I hope that this research serves a stepping stone for moreresearch in this area—and down the road, a return on our enormous expenditure into health information exchanges.

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Could Well-Implemented IT Help Reverse Primary Care Physicians’ Skepticism Over the New Healthcare?

Could Well-Implemented IT Help Reverse Primary Care Physicians’ Skepticism Over the New Healthcare? | Healthcare and Technology news | Scoop.it

It was fascinating to read a new issue brief from the New York-based Commonwealth Fund published August 5, on primary care providers’ (both primary care physicians’ and mid-level practitioners’) perceptions of new payment models in healthcare.


The Commonwealth Fund, a “private foundation that aims to promote a high performing healthcare system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults,” had issued the brief, entitled “Primary Care Providers’ Views of Recent Trends in Health Care Delivery and Payment,” based on a survey of 1,624 primary care physicians and 525 mid-level clinicians (nurse practitioners and physician assistants).


The abstract to the issue brief notes that “A new survey from The Commonwealth Fund and The Kaiser Family Foundation asked primary care providers—physicians, nurse practitioners, and physician assistants—about their experiences with and reactions to recent changes in health care delivery and payment. Providers’ views are generally positive regarding the impact of health information technology on quality of care, but they are more divided on the increased use of medical homes and accountable care organizations. Overall, providers are more negative about the increased reliance on quality metrics to assess their performance and about financial penalties. Many physicians expressed frustration with the speed and administrative burden of Medicaid and Medicare payments. An earlier brief focused on providers’ experiences under the ACA’s coverage expansions and their opinions about the law.”


The core findings of the survey were that primary care physicians, far more than mid-level practitioners, expressed considerable skepticism about the new healthcare delivery and payment models, in particular the two that were asked about specifically—accountable care organizations and patient-centered medical homes; though those PCPs who had worked under ACO or PMCH arrangements were far more likely to agree that they offered the potential for improving the quality of care delivery to patients being cared for under those types of arrangements.


As to why a strong plurality of primary care physicians have negative perceptions of the potential for the value-based outcomes measures embedded in ACO and PCMH arrangements to improve quality and efficiency, Melinda Abrams, The Commonwealth Fund’s vice president for delivery system reform, told me, “To be honest, we don’t know why they don’t like the quality measures; we only know there’s a fair bit of dissatisfaction with the quality measures. When we asked physicians whether they thought the increased use of quality measures was impacting their ability to provide high-quality care, 50 percent were negative on that, and only 22 percent were positive. We also asked, are you receive quality incentive-based payments? That reflected the entire group, but even among those receiving incentive payments based on quality, 50 percent felt it was negative, and only 28 percent felt it was positive.”


Still, as the issue brief’s abstract noted, “The survey results indicate that primary care providers’ views of many of these new models are more negative than positive. There are exceptions: health information technology gets mostly positive views and medical homes receive mixed opinions with a positive tilt. With regard to HIT, our study indicates that primary care providers generally accept the promise of HIT to improve quality of care even if previous research shows they dislike the process of transitioning from paper-based records.8 Our survey results also may reflect clinicians’ earlier exposure to certain models and tools. National adoption of electronic health records received a boost from the Health Information Technology for Economic and Clinical Health (HITECH) Act of the federal stimulus package of 2009, while the four primary care specialty societies announced a joint statement regarding medical homes in February 2007, several years before passage of the Affordable Care Act.”


“Our results show that 50 percent of primary care providers say that healthcare IT is improving the quality of care they provide,” Abrams told me. “And what we’ve learned from other studies is this: other studies have found that providers generally accept the promise of HIT as a concept, even as they dislike the process of transitioning to electronic from paper. Our specific question was on the impact of their ability to provide high-quality care to their patients. It’s a more general question than about the transition. We weren’t asking about the transition. So half of physicians and two-thirds of mid-level providers see the advance of health IT as having a positive impact,” she noted.

What is inevitable is that clinicians, but most especially primary care physicians, will be demanding a great deal from the clinical and other information systems that are being implemented now to facilitate accountable care, population health management, and patient-centered medical home-based care.


As Abrams put it to me, “There’s nothing in the survey findings that would indicate that increased success with IT would improve their views of ACOs and medical homes; our findings don’t show that. But I would suspect that, to fulfill the promise of ACOs and PCMHs requires ease of use of IT and the data from that technology, the more they learn to use technology effectively to optimize patient care, yes, I believe they will become more positive about ACOs and patient-centered medical homes, yes. And more pieces will help them embrace ACOs and PCMHs.”


So such interpretations of survey data only help to reinforce what seemed apparent already: that healthcare IT leaders are facing a gigantic opportunity/risk proposition ahead of them, when it comes to clinical and other information systems supporting accountable care and population health management. Physicians, and primary care physicians in particular, are looking to those systems to carry them to the “promised land” of greater clinical effectiveness and practice efficiency, and to help them master the intricate challenges of succeeding in carrying out risk-based contracting in a high-pressure, high-stakes environment.


And this is in an environment in which we all know that the IT solutions offered by vendors, both major and smaller, still leave some things to be desired, and that tremendous amounts of customization are being required to make population health, analytics, clinical decision support, and other systems needed to make pop health and accountable care work, are being poured into those systems.


So the next few years inevitably are going to be filled with tension for healthcare IT leaders, as healthcare IT professionals work to get all the foundations, and the details, right, with those systems. But the light at the end of the tunnel is this: that, as primary care physicians become adept at using the increasingly-adept solutions that will be applied to population health- and accountable care-based clinical practice, primary care physicians’ perceptions not only of those tools, but of value-based care delivery and payment itself, will get better over time. And that will definitely significant for all of us, as we pursue the new healthcare in earnest.

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Digital Solutions the Key to Behavioral Health's Future

Digital Solutions the Key to Behavioral Health's Future | Healthcare and Technology news | Scoop.it

Behavioral health is often regarded as the Cinderella of healthcare. It’s a specialty that is poorly funded and rarely at the cutting edge of service innovation or therapeutic breakthroughs. The health economic burden is huge and the life expectancy of people with a serious mental illness is substantially reduced. Behavioral health conditions are difficult to treat, monitoring outcomes is challenging and, if treatment is sub-optimal, risk is high. All in all, it’s not a very happy story.


Behavioral healthcare has been hampered by many things, including the clinical consultation process. Compare a psychiatric consultation with the clinic visit of a respiratory physician; he listens to a patient’s chest and takes a spirometer reading to assess progress. The cardiologist checks the patient’s heart murmur and blood pressure, and the gastroenterologist runs some labs and examines the patient on the couch. Behavioral healthcare lacks comparable quantitative measures to assist diagnosis, assess disease severity, and monitor treatment response. Clinicians can use rating scales to evaluate psychiatric symptoms, but they take time to administer in the clinic. So, we talk to our patients to assess progress and to detect subtle signals and changes. Of course, we complete a physical examination from time to time and we watch our patients as we talk to them, but the backbone of a routine psychiatric follow-up is a structured conversation and questions — not a physical exam, not labs.


It’s this characteristic of behavioral healthcare that will enable Cinderella to shed her rags and step into the limelight. Health informatics is providing a unique and wonderful opportunity for psychiatric care, and it’s a break-through that is not available on the same scale to other specialties because they don’t “just talk.”


Digital health technologies offer the potential for close and cost-effective, long-term remote monitoring of patients with mental health disorders. Smartphone applications and patient-facing Web portals enable patients and caretakers to assess and report status to the clinical team on a regular basis from home. Behavioral health is ideally suited also for telehealth assessments and therapeutic interventions; enabling rapid, cost-effective, efficient, and convenient care delivery.


The potential impact of a digitally-enabled behavioral health ecosystem is enormous.


Remotely collected data, or patient reported outcomes (PRO), using apps and Web portals allow clinicians to intervene early in response to signs of deterioration or troublesome side effects. This reduces relapses and avoids the associated events that are hugely costly in human and economic terms; hospital admissions, absence from work, suicide, violence, breakdown of social networks and relationships, and so on. Data collected in “real-time” is not subject to the biases of how the patient is feeling at the time of the three monthly clinic visits when the clinician asks, “How have you been since I last saw you?” Rich and detailed information can be collected longitudinally that would be impossible to obtain retrospectively, and it can be automatically plotted, analyzed, and summarized to support decision making. Technologies that empower patients improve engagement. A patient caseload can be triaged to prioritize appointments according to the “live” clinical need, facilitating population-based care.


All this is based on talking and answering questions. No labs, no physical exam. So, all you innovative behavioral healthcare professionals out there, prepare to go to the ball. We may even marry the prince.

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A Potential Change to Stark Regs. Affecting Docs

A Potential Change to Stark Regs. Affecting Docs | Healthcare and Technology news | Scoop.it

On July 8, 2015, CMS issued the proposed 2016 Physician Fee Schedule (“Proposed Rule”), which was published in the Federal Register one week later.  Among many provisions within the proposed rule were ones that could possibly impact the physician self-referral regulations (“Stark”). This included the following:


• Recruiting advanced practitioners may become easier under CMS’ proposal to establish a new Stark exception for payments made by a hospital, Federally Qualified Health Center (“FQHC”), or Rural Health Center (“RHC”) to a physician to assist in the recruitment and employment of non-physicians.  This would allow the recruitment of PAs, NPs, and other mid-levels, as long as they become bona fide employees of the physician or physician practice receiving the support and if they are employed to render primary care services. CMS’ proposal would limit the financial support to two years, but the exception would otherwise be similar to the current recruitment exception.


• Easing technical issues and confusion is another goal of the Proposed Rule’s changes to Stark, particularly as it relates to CMS’ Voluntary Self-Referral Disclosure Protocol. Some clarifications that are proposed, which will be beneficial to providers include:


  a. Clarifying that a “writing” or “written agreement” does not actually require a single formal contract. This means that a series of contemporaneous documents that could demonstrate the course of the parties’ conduct could meet this “writing” requirement, depending on the facts.


  b. Providing 90 days (instead of the current 30 days) to obtain missing signatures to an agreement, regardless of the reason the parties failed to obtain the signatures in a timely manner.


c. Allowing a holdover arrangement as long as it continues on the same terms and conditions as the original compliant arrangement and payment remains fair-market value throughout the holdover period.


• CMS proposes to allow timeshare leases under a new exception for lease arrangements involving the non-exclusive “timeshare” lease of space, equipment and personnel.  Arrangements would qualify if certain requirements are satisfied, and as long as the arrangement does not involve advanced imaging equipment, radiation therapy equipment, or clinical /pathology laboratory equipment. This exception would not be available to non-hospital/ physician organizations (such as IDTFs and clinical labs) and the space must be used predominantly.


One other non-Stark item in the Proposed Rule that may be particularly interesting to physicians is a change to the “incident to rules.” These  provisions allow services provided by auxiliary personnel to be billed as though furnished by a physician or other provider if direct supervision is provided (except chronic and transitional care management, which now requires only general supervision).  Although many physicians already grapple with proper use of these rules, CMS now proposes to require “that the physician or other practitioner who bills for ‘incident to’ services must also be the physician or other practitioner who directly supervises the auxiliary personnel who provide the ‘incident to service.’”  


Under the current regulations, the billing physician or other practitioner need not be the supervising physician or other practitioner.  This rule may complicate scheduling among providers and make the provision of transitional care management and chronic care management less cost-effective, since these services currently only require general supervision. Furthermore, the proposed changes are not in keeping with efforts to reduce health care costs and increase efficiencies.

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Apps, sites can't replace your doctor

Apps, sites can't replace your doctor | Healthcare and Technology news | Scoop.it

There's a warning out today for those who go online or to apps to figure out why they have an upset tummy or nagging cough or occasional chest pain. Symptom checkers, those tools that ask for information and suggest a diagnosis, are accurate only about half of the time.

The finding is from a Harvard Medical School study that reviewed 23 sites, such as WebMD, the Mayo Clinic and DocResponse. One third listed the correct diagnosis as the first option for patients. Half the sites had the right diagnosis among their top three results, and 58 percent listed it in their top 20 suggestions.

Dr. Ateev Mehrotra, one of the study's authors, urges patients to be cautious when using these tools.

"These sites are not a replacement for going to the doctor and getting a full evaluation and diagnosis," he says. "They are simply providing some information on what might be going on with you."

About a third of U.S. adults use the sites, although not necessarily in place of going to the doctor.

Some of the diagnostic questions are also used by nurse triage phone services.

    Mehrotra says, these online tools are about as accurate as the call-in lines offered by many insurers and physician groups. "[They are] better than just a random Internet search," he said.

    Researchers entered the symptoms of 45 patients from vignettes used to train medical students. The Mayo Clinic's first online diagnosis was right only 17 percent of the time, but had the correct diagnosis on a list of 20 in 76 percent of cases. Dr. John Wilkinson, who works on Mayo's symptom checker, says the tool directs patients to medical research and prepares them to talk to their doctor.

    "We're always trying to improve but if most of the time the correct diagnosis is included in the list of possibilities, that's all we're attempting to do," he says.

    The diagnosis accuracy rate for physicians is 85 to 90 percent. But Jason Maude, who runs a high performing tool called Isabel, says he does not want a Web versus doctor showdown.

    "The whole point is not to set the patient against the doctor or replace the doctor, but to make the patient much better informed and to ask the doctor much better questions, and then together they should do a much better job," he says.

    Isabel ranked well in the study, showing the correct answer more than 40 percent of the time in the first diagnosis and 84 percent in the top 20 answers. Those high results, Maude says, may be because the site lets patients type in their own description of symptoms. They might describe a "tummy ache" or "stomach cramps" rather than the more clinical choice of "abdominal pain" used by many online symptom checker tools. And Isabel asks just two or three questions before patients describe their problem, as compared to sites that ask patients to click through 20 questions — steps Maude said may discourage use.

    Clarifying how and why patients use these tools is critical, say the study's authors. They could reduce unnecessary office visits or inform patients as they talk with their doctors. But for some, the tools may encourage people to seek unnecessary care.

    Mehrotra says patients used symptom checkers more than 100 million times last year, a fact that may stun some physicians.

    "While most doctors know patients are going to the Internet to search for medical advice, in terms of these symptom checkers, I've been surprised that few of my colleagues even knew they existed," he says.

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    Why Hasn't Mobile Moved Medicine Further Yet?

    Why Hasn't Mobile Moved Medicine Further Yet? | Healthcare and Technology news | Scoop.it

    The advent of the smartphone and mobile "apps" has opened the floodgates in hospital and clinic settings. With the ease of communication and newfound ability to access the web in the palm of our hand, the world has grown smaller for everyday users. Given its current host of systemic predicaments, the medical industry has justifiably shifted its attention to these new technologies to rectify inefficiencies.


    Mobile technology raises expectations for health care consumers with the obvious prospect of improved communication between providers and patients. From having your physician's prescriptions on-the-go to being able to rapidly authorize medical record transfers in emergent situations, a promising solution to chronic issues obstructing submaximal care is at our doorstep.


    Why, then, have we not reached our full potential? StartUp Health reported a burgeoning digital health sector with $6.9 billion in funding over 551 deals in 2014. Mobile health savvy health insurance company Oscar has captured significant market share with a whopping $320 million of funding and 40,000 members to date. While these strides prove consumer and investor belief in mobile technology, few applications have proven valuable to stakeholders' stringent criteria despite the sheer number of available applications.


    No single firm has demonstrated an intimate knowledge of the medical industry with delivery of high-quality tools that engage users. The lack of a clear winner in this noisy space has stunted broad adoption. For this reason, heavyweights in the technology industry like Google, Amazon, Facebook and Apple are exciting new entrants to the mobile health scene. In addition to the modular infrastructure offered by these established giants, the greatest value is their proven track record in customer validation and the user experience.


    Established technology firms are by no means a shoe-in to win. The inherently low barrier to entry in the mobile health space is a double-edged sword. Though sparse quality control mechanisms are responsible for the sheer volume of subpar apps, they are also the reason why no innovator can be excluded from disrupting the space with the help of hired digital development shops. Excluding the fundamental challenges of operating within the health care industry (i.e. security and compliance standards), the delay in realizing the impact of mobile health technology can be distilled to four fundamental failures.


    First, the end user is often forgotten. Often times, hospitals will excitedly reveal a mobile app that provides useful information but has such a poor interface that consumers fail to engage. Fewer apps have engaged users better than Instagram with over 300 million monthly active users. Instagram represents an exceptional product stakeholders in digital health care should not trivialize and learn from greatly. With two-thirds of the Americans owning a smartphone, the problem today is less so the access to digital tools than it is the actual engagement with them.


    Second, the balance scale tilts heavily towards "wellness" and less towards "care." Though the return on investment for a mobile app may be greater for a healthy user willing to pay to track health and fitness metrics, those who actually need the increased vigilance in our health system are patients suffering from chronic disease or recovering from surgery. From the perspective of optimizing health outcomes and preventing frivolous costs, the attention needs to shift to vulnerable populations stressing the system. Furthermore, some insurance companies incentivize members by providing mobile apps under the moniker of "mHealth;" this terminology runs the risk of misleading individuals into skipping preventive care visits with their doctor. These apps should optimize medical management in the appropriate clinical context through physician supervision with appropriate FDA regulation as an "mCare" effort instead. The FDA already applies a risk-based approach for assessing mobile medical apps considered accessory to regulated medical devices or transformational into a regulated medical device. More of this patient-centered innovation is needed to solve our system's real issues.


    Third, we fail to play to the strengths of smartphones in medicine. Smartphone technology is fundamentally advantageous because users have the freedom to move and communicate without restriction. Given that outcome metrics for the fields of orthopaedic surgery and rheumatology are predicated on physical mobility and patient-reported response to interventions, smartphone technologists should target these specialties first to realize benefits of afflicted patients in real-time. Joint replacement is one of the most common surgical interventions in the world, and being able to track steps taken, or the steps not taken, using the phone's native pedometer has the potential to alert a surgeon of post-operative complications in advance. The current strategy is focused on creating the best apps for the fittest individuals, but the most impactful technologies would be directed towards streamlining assurances of patient safety and physical activity for those with musculoskeletal conditions.


    Finally, collaboration is lacking. Smartphones track and store the "small data" of millions of potential patients. When put together, the data tells a greater story. Numerous insidious diseases, from major depression to ovarian cancer, could be detected earlier and managed better when sharing our stored mobile data. While there do exist standout organizations like Fitbit which offer an open developer API, the current landscape is not set up to exchange user data. One such organization that recognizes the meaningful macroscopic conclusions that can be drawn from sharing mobile data is Open mHealth. Founded on the value of facilitating the sharing, storage, and processing of mobile data using an open infrastructure, Open mHealth has already made great strides among individuals with diabetes and veterans with PTSD.


    Today, the smartphone is one of the greatest commercially available technologies. With emerging wearable devices like Apple Watch and Jawbone, who knows what our go-to device will be tomorrow? Thus, validation of mobile technology in medicine cannot hinge on today's version of devices. The evidence supporting application of mobile technologies to the medical workflow must maintain modularity and iterative capacity. One example of modular capacity is Apple's open source ResearchKit. Though in a perfect world Apple and Google would have partnered to cover nearly all smartphone users, ResearchKit has the laudable benefit of availability across all current and future iOS devices. Thus, validation is needed just once for survivorship of mobile technology in medicine to be ensured.


    The potential for mobile technology in medicine is great, but the current landscape is not yet set up to transform the health care industry. There exists no reliable winner in the marketplace because either our goals are misaligned or our focus has been misplaced. If the objective is to help the well become more well, then we are thriving. However, if we choose to unbridle the capability of mobile technology in medicine by remembering the end user, helping the suffering, playing to the strengths of our resources, and enabling collaboration, we are on the precipice of a truly transformational era in modern medicine.

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    In Colorado, a Collaboration Around Healthcare Technology

    In Colorado, a Collaboration Around Healthcare Technology | Healthcare and Technology news | Scoop.it

    Across the country, technology and clinical leaders are figuring out ways to try to promote greater interoperability of healthcare data. For seemingly everyone, it’s been an uphill climb and a steep learning curve. In the U.S., there have been pockets of success; some states are at the forefront of true data exchange, while others aren’t quite as mature.


     In one of these pockets is Colorado, where the Denver-based Colorado Regional Health Information Organization (CORHIO) recently announced that its health information exchange (HIE) has grown in number of users by 111 percent, with the amount of data available in the network having grown by 118 percent in the past year. That marks the third consecutive year of triple-digit growth rates for the organization, which, as of a few months ago, encompasses 5,705 active providers/users, 47 connected hospitals, and with more than 223 million clinical messages having been sent.


    To this end, also in Colorado are the Englewood-based Centura Health (with hospitals also spanning across Western Kansas) and the Aurora-based University of Colorado Health (UC Health), two organizations that will be represented at the iHT2 Health IT Summit in Denver on July 21 (the Institute for Health Technology Transformation, iHT2, is a sister organization of Healthcare Informatics under our corporate parent organization, the Vendome Group LLC). At the conference will be a panel on “Strategies to Advance Interoperability,” where Steve Hess, CIO at University of Colorado Health and Dana Moore, senior vice president/CIO and managing director, service center, at Centura Health, among others, will address the most effective models and mechanisms for exchanging data.


    In Aurora, University of Colorado Health came together as a unified system about three years ago when all of its IT components collapsed into one core set which included the Verona, Wis.-based Epic Systems as the organization’s core electronic health record (EHR), Hess says, who says the health system’s HIE strategy is multi-faceted. “We do offer hosting Epic for independent community practices that want to use our EHR for their own continuity of care and clinical collaboration needs,” Hess says. “We also use a built-in HIE, Epic’s Care Everywhere, to exchange records, and that works very well for Epic-to-Epic health information exchange. We have exchanged records with systems in all 50 states using that methodology,” Hess says.


    UC Health is also a part of CORHIO, and that’s where a lot of statewide collaboration has occurred. “There is exchange of not only demographics, labs and discharge summaries, but also immunization and public health interfaces through the HIE,” Hess says. “We are on a journey of health information exchange, and we’re fairly early on that journey. Exchange is happening but the next generation functionalities of orders and results, exchanging CCDs (continuity of care documents), things like that, are still in the early stages,” he says.  “In the meantime, we collectively look at technology not as a competitive advantage but a way to help patient care, doctors, and nurses across the state and beyond. We know our organizations will compete in terms of quality and service and other things, but we’re trying out best not to compete with technology.”


    Meanwhile, at Centura Health, Moore says that the organization initially started its own private HIE in 2005 with a company that is now part of Cerner’s arsenal, but wasn’t even an established vendor at the time. Once CORHIO came around, however, Centura quickly migrated over. “We didn’t want to have a competing product and wanted to promote collaboration within the state. When CORHIO was in its infancy, Steve [Hess] and I were frequently helping them build its model,” Moore says. Then, in 2006, Centura installed the Westwood, Mass.-based MEDITECH EHR across its acute care facilities first, eventually expanding into ambulatory and home care. Now, Centura, which did receive Healthcare Information and Management Systems Society (HIMSS) Stage 7 designation, is in the process of switching over to Epic, Moore notes.


    Bringing the Data to the Doctor


    For both UC Health and Centura, the key to successful health IT adoption and electronic data exchange is that this time around, the HIE brings data into the physician’s workflow so he or she doesn’t have to leave that workflow to see the data. “Success is always relative, and one of the big issues with HIE in Colorado five or 10 years ago was workflow,” Moore says. “Clinicians had to go out of their workflow and try to find the patient. From a user standpoint, it wasn’t successful. The advancements we made getting HIE in their workflow have proven that we are leaps and bounds from where we were,” he says.


    Hess agrees that keeping clinicians in the workflow that they use predominantly is crucial. “With CORHIO’s and Epic’s tools, the idea is to bring the data within the workflow of the doctor rather than make them go out of it. There has been a lot of interface work around that,” he says. As such, UC Health has approximately 800,000 records exchanged electronically each year, Hess says, noting that examples of the data being exchanged include complete patient records, CCD summaries, electronic lab results, and immunization and syndromic surveillance exchange.


    Despite successes at both organizations, Hess and Moore understand that there is still a ways to go before true interoperability is achieved. For one, Hess says that not having universal patient identifiers will continue to be a struggle for everyone. “A big part in what all these things require is knowing which patient is which,” he says. “Having to pull our different medical record and encounter numbers and hope/make sure that we’re sending data on the right patient is a struggle that might never be solved in our lifetime.”


    Hess adds that if you think about the old way of exchanging records where one facility called another and got a 36-page fax of patient data sent over, oftentimes the person trying to pull the clinically relevant data from that fax wasn’t the doctor. “As a result, sometimes that data would go ignored,” Hess says. “So now our struggle will be separating the noise from the gold. If we get 10 CCDs on 10 different encounters across four different care settings, how do we take all that data and turn it into information for the clinicians? I don’t want to have a bunch of CCDs acting like a stack of a paper on a fax machine,” he says.


     This, Hess says, is the next big hurdle, what he calls “HIE 3.0.” He says, “We need to figure out how to stratify the data and present it in manner that allows clinicians to do the right thing with it. If we’re not careful we can overwhelm them and they could potentially ignore the data like they did with the faxes.”


    Moore adds that another pitfall is getting providers on board to the HIE. While he notes that most of the major hospitals in Colorado are on CORHIO, there are still some that are not, and that’s a problem, he says. “Also, we talk about CORHIO and that is great, but we have hospitals that border the state too; we actually have a hospital in Kansas right now,” he says. “It’s great that Epic talks across all 50 states, but getting all of these HIEs to talk to each other has been a big challenge, which is ironic since that’s what they’re designed to do.”

    Moving forward, a major part of the solution is collaboration on the part of providers as well as vendors, Moore says. “A lot of the onus is on the providers, as we need to be the ones at table bringing people together and removing roadblocks. Vendors respond to the market, so if we as providers—their ultimate customers—demand collaboration and exchange, then they’ll have to respond,” he says.  He adds that close-minded vendors are also part of the problem. “This vendor needs to exchange information with this one and you try to bring two competitors to the table. That’s not easy,” he says.


    As such, according to Hess, a lot of vendors see their technology as a competitive advantage. Organizations that do this, rather than use their service or quality as the advantage, are slow to the collaboration table because they don’t want to level the playing field, Hess says. “But we all need to do things in similar ways, and our service and quality will be what brings doctors and patients to us. We need vendors and providers to say ‘we need to level the technology playing field.’ We really need to push that. When someone who is influential goes off that path and starts to do things differently, we get in trouble,” Hess says.

    Moore adds that while nationwide interoperability efforts such as CommonWell have popped up, they might not be in it for the greater good as much as some people think. “I’m not necessarily buying that it’s for the greater good, but rather for a competitive advantage or a response to Epic’s Care Everywhere [product]. It would be great if all the vendors got together to make HIE transparent across all platforms without a third party, as that would make everyone’s life easier. But I don’t see that happening. I see them continuing to compete to try to gain market share,” Moore says.


    Nonetheless, Hess warns that complete consolidation on one EHR vendor such as Epic or Cerner wouldn’t good either, as that could stifle innovation. “Some of these vendors are expensive and will never get into the small hospitals, the moms-and-pops,” he says. “We have to come up with better ways to share data. This is a journey; if you look back on HIE five years ago compared with today, people would be amazed with the progress. At the same time, we all wish it would be easier,” he says.


    Back in Colorado, Moore notes that the healthcare IT leaders in the state meet quarterly, pick up the phone often, and collaborate to ensure the residents of the state get the absolute best care from a technology standpoint. “We want to make sure that the tools we provide our providers with are the absolute best,” he says. Hess, who has been in the state for six years after living in the Mid-Atlantic region, adds that the penetration of robust, mature adoption of health IT in care setting is pretty deep in Colorado. “Without that deep maturity level the collaboration conversations would be much harder,” Hess says. “The combination of the collaboration that goes on and the health IT adoption is a pretty powerful formula.”

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    How New Jersey Public Policy Fails Primary-Care Physicians

    How New Jersey Public Policy Fails Primary-Care Physicians | Healthcare and Technology news | Scoop.it

    We live in a very exciting time in the healthcare industry. Regardless of how you feel or think about decisions that are made on the government level, healthcare is in a period of controlled chaos right now.


    With the potential merger of Anthem and Cigna and Aetna and Humana, or Assurant closing its doors on its health insurance business, things are about to get really interesting for medical practices. Arming yourself with as much information as possible is key to not just surviving financially, but thriving in this new environment.

    Let's take Assurant, for example. They've decided that doing business in the healthcare arena and competing against the dominant healthcare insurance companies was far more expensive than expected. What does this mean for your practice? If you have patients that use Assurant as their medical insurance, it's a great idea to step in and take control of those accounts, now. Create a waiver for Assurant patients that explains what is going on, what to expect from their plan, and how they can still see you with a new insurance plan. The waiver should also state that in the event Assurant does not pay the medical claim, patients will be responsible for the allowed amount, and they will have to pay out of pocket if it is a PPO Plan. If the plan is an HMO, and Assurant does not pay, the practice is not allowed to place a PR (patient responsibility) to the patient and will lose that money.


    Aetna and Assurant have similar fee schedules, so suggest to your patients to look into individual Aetna plans, to ensure that you will retain those patients and not lose revenue if you are contracted with Aetna. You will also need to really follow up with those claims and make sure that Assurant is paying you. I have seen them use a delaying tactic of denying a claim with the code CO95 (plan procedures not followed), which basically means they are sending your claim to a different claim address than what was provided to you at the time of benefit verification.  


    As far as the pending mergers, I really love it when this happens. I'm particularly fond of the companies that have been courting each other lately. With the possible Aetna/Humana merger, Aetna will be able to add a lot more patients to their network. It will position them as a real player and earn them much needed respect within the market. I still have some overall issues with both Aetna and Humana, but merging them together should ease some of those issues.


    The Anthem/Cigna cat-and-mouse game going on is particularly interesting. Cigna claims they're worth more than $184/share, and said no to Anthem's last purchase attempt. But Anthem is not giving up. Cigna used to be a premium plan until they teamed up with American Specialty Health. They have basically cut reimbursements to providers in half (if you signed up under their new network, otherwise you are seeing Cigna patients out of network), and implemented a time-consuming authorization process that eats away at whatever profit your practice may have left over from the reimbursement cuts. They implemented this over the course of the last year, or so. Working with Anthem is pretty cut and dried: What you see is what you get, with no hidden agendas. Anthem requires few to no pre-authorizations, allowing you to see your patient and maybe make a few bucks.


    Just taking a few moments and reading up on what is going on in the healthcare industry today is really key to insuring your practice is not caught off guard. Always be learning, always be aware. There are multiple newsletters you can sign up for that will drop a daily or weekly e-mail into your inbox that will help you keep up.

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    Many docs come to work sick

    Many docs come to work sick | Healthcare and Technology news | Scoop.it

    Many doctors, nurses, midwives and physicians assistants come to work sick even through they know it puts patients at risk, a new survey suggests.


    Many said they don’t call in sick because they don’t want to let colleagues or patients down by taking a sick day, and they were concerned about finding staff to cover their absence.


    At the Children’s Hospital of Philadelphia, Julia E. Szymczak and colleagues analyzed survey responses collected last year from 536 doctors and advanced practice clinicians at their institution.


    More than 95 percent believed that working while sick puts patients at risk, but 83 percent still said they had come to work with symptoms like diarrhea, fever and respiratory complaints during the previous year.


    About 9 percent had worked while sick at least five times over the previous year. Doctors were more likely than nurses or physicians assistants to work while sick.


    Analyzing their comments, the researchers found that many report extreme difficulty finding coverage when they’re sick, and there is a strong cultural norm to come in to work unless extraordinarily ill.

    The findings are reported in JAMA Pediatrics. The researchers were not able to respond to a request for comment by press time.


    Sick health care workers present a real risk for patients, especially ones who are immunocompromised, like cancer patients or transplant patients, said Dr. Jeffrey R. Starke of the Baylor College of Medicine in Houston, who coauthored a commentary on the new study.


    “Most of us have policies restricting visitation by visitors who are ill, we screen them for signs or symptoms,” Starke told Reuters Health by phone. “Yet we don’t do the same thing for ourselves.”


    Most hospitals do not have a specific policy restricting ill healthcare workers, and developing and enforcing these policies may help address the issue, he said.


    These policies should put the decision about who is well enough to come into work into someone else’s hands, not the doctor’s, Starke said.


    Aside from spreading illness in the hospital, sick doctors likely perform worse on the job than healthy ones, he said.

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    Obstacles Ahead: One OB/Gyn’s Skeptical Views on Healthcare Reform

    Obstacles Ahead: One OB/Gyn’s Skeptical Views on Healthcare Reform | Healthcare and Technology news | Scoop.it

    As a result of the federal government’s push towards a value-based healthcare system, physicians and other providers are under increasing pressure to find ways to improve patient health outcomes and reduce costs. One way the feds seek to address these goals is through accountable care organizations (ACOs); in January, the Obama administration said it wants 30 percent of traditional Medicare fee-for-service payments tied to a quality-driven, alternative payment model, such as an ACO.


    Nonetheless, research shows that physicians remain uncertain about the structure and effectiveness of these paradigms. Prior to the U.S. Department of Health and Human Services’ (HHS) aforementioned announcement regarding value-based care, the 2014 Physicians Foundation Biennial Physician Survey released last December found that while physicians are informed about ACOs, they are still not convinced of their effectiveness. The survey from the Foundation, a nonprofit organization focused on supporting physicians in sustaining their medical practices and navigating healthcare reform, found that: a majority of physicians (52 percent) do not participate in ACOs; more than a third (36 percent) of physicians believe ACOs are unlikely to increase quality and decrease costs; 31 percent of physicians are unsure about the structure or purpose of ACOs; and 19 percent of physicians believe the quality/cost gains will not justify organizational cost effort.


    According to Joseph Valenti, M.D., board member of the Foundation and a practicing obstetrician/ gynecologist at the Denton, Tx.-based Caring for Women practice, plenty of physicians are having their fair share of problems with the process that is behind ACO arrangements, and on a larger scale, the entire shift to value-based care. Valenti, who has 13 years experience in the private practice arena, recently spoke with HCI Associate Editor Rajiv Leventhal about these physician challenges, and what he thinks can be done to better the system. Below are excerpts of that interview.


    Why are physicians uncertain about ACOs?


     I think that a lot of physicians are not completely convinced that the data is out there to demonstrate that they could potentially develop the savings necessary, and prevent hospital admissions and readmissions. Much of the healthcare spending that is extreme right now is in hospitals, not clinician offices, so the concern is, can you keep this person out of the hospital? Also in terms of Medicare ACOs, you’re going to be assigned 5,000 patients at least, and they could be the sickest patients out there, so there is no guarantee that you can make them well enough and be assured that they don’t need to come back to the hospital. So maybe you can’t demonstrate shared savings. And the ACO stats prove this; one-third of them are working, one-third are breaking even; and one-third are leaving the program.


    How do you suggest the process improve?


    Well, I don’t think that ACOs are the only way to increase quality and decrease costs. Many of those same things can be accomplished by an MSO (management services organization) with negotiation with an insurance company—without the ACO component. As far as ACOs in general, it will be hard to entice people to get people involved in one especially if there will be a potential downside. When they structured these things, they had different tiers, and the highest shared savings also involves some loss of money if you go the other way, and that’s a problem.


     I think one of the other problems is that because when the government mandated electronic medical records (EMRs), they didn’t mandate that they would be able to communicate with each other. This EMR transition has been really difficult for a lot of people; our survey verifies that many are unhappy with them. They like their ability to access information from anywhere, but the transition over is difficult. They’re not happy that it doesn’t communicate with other doctor or that the informatics doesn’t match exactly match what insurance companies and Medicare want with regards to reporting. As a result, many practices can’t even stay open.  ACOs by their very nature involve consolidation, and not everyone is thrilled with the pace of patient care and what that might mean for consolidation. So I think the difficulty is that in convincing people to go an ACO, no one has completely convinced anyone thus far that it will enhance care markedly for patients. Physicians are really uncertain about that.


    What would be your pros and cons for joining an ACO?


    We have never been approached to become an ACO, though I think the concern about shared savings is that if you’re already doing a really good job managing patients, and you are doing it as efficiently as you can, where is the savings going to be? People are having a hard time grappling with that. I think the savings are in hospitals, but of interest, I don’t see the hospitals getting rid of things where they get paid two to three times as much to do something in hospital as we get paid in the office. The incentives are really backwards in some ways to incentivize them to get involved, especially for those who are already practicing medicine as well as they can. Now if you have a very large group of Medicare heavy patients, and you have the ancillary help and midlevel practitioner help to follow up constantly, then you can do that. But that’s often not the case.


    Another problem that the Affordable Care Act (ACA) failed to address was poverty. It doesn’t address many of the social determinants of why people are compliant or non-compliant. If patients have to choose between heating their house or buying prescription meds, what will they do? Will they be compliant with their meds? No. But do people want to be well? Yes. Do patients want to be compliant? Largely yes, but they can’t always afford to do so. Poverty is actually the largest social determinant of good health, and we are seeing that in the research we are currently doing. We spend less on the front end but more on the back end. Other countries do the opposite. ACOs address the back end, but they don’t address the front end. And that’s where a lot of the problems begin.


    How has your practice’s experience with IT been?


    Like all of us, we initially started on paper in 2001 when our practice started. We transitioned very early to an EMR, but that EMR company went out of business three months later, so it was money down the drain. When you get into an EMR, there is no guarantee the company will be there later. The transition also slows your practice down for six months, so it’s an enormous loss in revenue, similar to what we could be seeing with ICD-10. The second EMR we got into promised us something that it couldn’t deliver on, so we got into a lawsuit with them and ended up settling.


    Now with our third EMR, GE Centricity, we are doing well on that but we just got an update for ICD-10, and you’d be amazed with how many codes are not in there, including very common ones. This is the story with EMRs—no one has compelled them to simply “come up to snuff.” The concern is that I will put my whole future in the hands of this IT system, and maybe it will work but maybe it won’t. The cost of this for us was over a quarter of a million dollars, and we’re not as satisfied as we should be given the cost. We can’t believe the number of bugs and glitches with it. There are eight providers in our group, and we do like the ability to access our EMR from anywhere when a patient calls middle of night. I wouldn’t go back to paper, even though I know a lot of doctors actually would—many have been jaded by EMRs that were not well supported and cost them a ton of money and time. I call these things unfunded mandates—things we must do but no one is funding anyone to do them.


    Overall, how do you feel about the shifting of the healthcare landscape?


    I’m not okay with the way it’s being done. I am okay with value-based care—excellent medical care is cost-efficient care. The more thorough you are, the more knowledge you have, the more diagnostically correct you are, the less likely you are to spend more money, the better your patients will be. We can’t control patient behavior though. Where is their responsibility? If a patient is supposed to come in and get a mammogram every year but hasn’t gotten one in 10 years, what can I do about that? I can’t make them go. You aren’t being reimbursed adequately for a lot of these patient engagement strategies, and as insurance payments keep going down and doctor’s costs in the office keep going up, how are physicians supposed to spend extra time to do those things? It’s a perverse system. From 2000-2010, Medicare payments to doctors went up 3.5 percent in 10 years. To hospitals, payments to hospitals went up 30 percent. That’s where the cost savings are supposed to be—the system is slanted towards hospitals. The ACA is largely based on keeping people out of the hospital. You’re trying to incentivize a group that is already being de-incentivized. It’s a strange way to do things.

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    Google health wristband is more than a "me too" wearable

    Google health wristband is more than a "me too" wearable | Healthcare and Technology news | Scoop.it

    Google announced last week that they’ve developed a clinical grade health tracking wristband for use in medical research and clinical trials. In other words, the Google health wristband won’t show up on Amazon or in Walgreens. And that’s one of the most interesting things about it.

    News of the device has been widely reported, generally with enthusiasm. Details on the device, developed out of the Google X group, are still scant however and it seems to be in relatively early phases of validation. According to Bloomberg, the device will measure heart rate, heart rhythm and skin temperature. It will also capture environmental information like light exposure and noise levels.


    Clinical trials testing the device’s accuracy are set to begin this year with as-yet unnamed academic partners. I imagine, though, that partners in Google’s Baseline project like Duke and Stanford will play prominent roles.


    Perhaps the most striking thing about the device and Google’s plans here is their intent to (1) do validation studies and (2) seek regulatory approval from the FDA as well as European regulators. While the field of health tracking wearables has taken off in recent years, we’ve generally been left to speculate on the accuracy of devices like those from Fitbit based on small studies. Most skirt FDA oversight by marketing their devices as intended for general wellness rather than for the management of specific health conditions.


    Google appears to be taking a completely different approach here. They are developing a multi-functional wearable that will not only capture all kinds of health data but will also have evidence supporting it’s accuracy. And with Google’s seemingly endless access to information, it would be interesting to see the information captured through this device combined with other data streams. For example, arrhythmia or pulse oximetry data captured by the device could be correlated to air quality or allergen information.


    This approach contrasts and in some ways complements Apple’s approach to health. Through HealthKit, Apple created a common language for how health data captured by wearables is recorded by their connected apps and makes it shareable. And throughResearchKit, clinicians can more readily deploy clinical studies using these devices. However, when it came to Apple’s own wearable – the Apple Watch – the health sensors don’t have validation data and avoided regulatory oversight by sticking with “general wellness” as their intended use. Clinical research will rely more heavily on compatible validated sensors like iPhone connected blood pressure monitors.


    It will be interesting to see what sensors Google ultimately packs in here. If theirglucose-tracking contact lens is any indication, we can expect some creative & novel additions to this device.

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    Baxter's curator insight, August 13, 2015 1:36 PM

    Last year when Isabelle (my co-founder) and I attended the Samsung Digital Conference in San Francesco, 'wearables' like this watch and digital health were all the rage.

    And they still are.

    Our app will help not only users to manage their specific health conditions, but also give these devices more MEANINGFUL reasons to be worn than just collecting data after data after data (how many times do you need to see how far you walked today?).

    When these devices pick up a rise in your heart rate/ rhythm and skin temp, they can send you a subtle warning and remind you to breathe. You can then queue up the breath most relevant to your situation (like the interview breath, or first date breath). Your vitals return to normal range, and you're more relaxed, and no doubt you'll perform better in the situation

    Breath-Takingly simple practices for every occasion.

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    Five Reasons the Future for Private Practice Is Bright

    Five Reasons the Future for Private Practice Is Bright | Healthcare and Technology news | Scoop.it

    I believe the future remains bright for private practice. While market indicators a few years ago were interpreted by many in the industry as signaling the demise of private practice, more recent data suggests the move away from private practice has not only leveled off, but may move back toward more independence.

    Here are five reasons why private practice will remain healthy for the foreseeable future:


    1. The trend of hospitals buying physician practices is not as strong as it once was.


    While it's true that hospitals and integrated delivery systems have purchased physician practices since well before Congress passed the Affordable Care Act in 2010, some hospitals also have lost money on these acquisitions. Some say the losses total as much as $100,000 per physician, per year. Also, some physicians are not happy being employed by these larger systems.


    2. New practice models help physicians stay independent.


    Patient-Centered Medical Homes, for example, allow physicians to organize care to meet patients' needs in a way that was not possible in the past. Recognizing that the center-of-care has shifted to patients, providers and insurers are investing in systems to meet patients' needs and boost patient satisfaction scores. One reason for this shift has been the focus on delivering more preventive care under the ACA, a factor aimed at keeping patients well rather than simply treating them when they're ill. And patients want to keep their doctors, meaning they'll follow them wherever they go.


    3. Accountable care organizations (ACO) are another option for physicians seeking to remain independent.


    Physicians can contract with ACOs or do as some large physician groups have done and form their own ACOs. Either way, these organizations allow physicians to stay in private practice while focusing on improving care. Some ACOs offer shared-savings contracts that let physicians reap the benefits if they keep costs below a target amount calculated at year's end.


    4. Health insurers are emerging as physician partners.


    In the recent past, health insurers have not had much of an opportunity to affect whether a doctor or physician group sells out to a hospital. But since the ACA became law, health plans have changed how they pay physicians to support the transition from volume-based reimbursement to value-based care. Developing financial incentive programs to get doctors to focus on keeping costs down and quality up have taught health insurers that physicians can and should be considered partners in care delivery.


    5. Health plans also recognize that physicians deliver care in low-cost settings.


    Hospitals and health systems are much more expensive sites of care. The fact that physicians keep costs down is perhaps the most critical success factor for any health plan or health system. Cost has always been the most important factor for individuals buying insurance plans on the health insurance exchanges and for employers buying health insurance for their workers and family members.


    For all these reasons, I believe physicians have a large and maybe even a growing role to play in any reformed health system. Of course things have and continue to drastically change for physicians today, but it's safe to say the sky is not falling for those in private practice.

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    Mobile has put patients in the driver's seat. Here's how.

    Mobile has put patients in the driver's seat. Here's how. | Healthcare and Technology news | Scoop.it

    Many people used to believe that Facebook was an extremely defensible business and that it would be almost impossible for another social network to compete.

    It has grown to an enormous scale with massive troves of data and more than 1.5 billion monthly users. The thinking around their defensibility was that because all of your friends and photos and updates are already stored on Facebook, it would be tedious and unnecessary to switch to another social network. Everything you need is there. Why go somewhere else?

    Facebook did have quite a bit of defensibility back when the predominant access point to the service was the desktop web. Moving your data to a new social network was painful and impractical. But now that the main access point to social is our mobile phone (more than half of Facebook’s traffic comes through mobile) things have changed dramatically.

    We now carry around all of the key elements of a social network on our cell phones. Our phones carry our location, our photos, and our address book and allow us to message anyone at no cost from anywhere in the world. With the click of the touchscreen, we can view and connect with all of our friends on a new social network and instantly recreate our social graph. We can take a photo and instantly send it to a multiple social networks. We can easily join different social networks with different groups of friends focused around different needs. The friction of leaving Facebook and joining a new network has disappeared. This wasn’t possible with the desktop web, or it was at least much more difficult.


    As a result of the increasing use of mobile, we’ve seen lots of new social networks emerge. (There are now dozens of social networking apps with 1 million+ downloads in Apple’s App store, including Kik, WhatsApp, Tumblr, Google+, Instagram, Snapchat and many others.)

    This increased use of mobile has reduced the friction of launching a new social network to near zero and, as a result, has shifted ownership of data away from the network and back to the individual. Trying to own the data and lock-in the consumer is no longer a viable strategy.

    Facebook is well aware of this and has adjusted by rapidly buying up many of these new networks. We’ll likely see more acquisitions like these in the months to come.


    Over the last several years, large health care provider organizations and health care software vendors have been employing a similar strategy to that of Facebook. Health systems have been growing by buying up ambulatory, community-based sites and employing doctors to build out giant systems that can offer clinical services across the entire continuum of caregiving the patient no reason to go anywhere else. In parallel, providers and software vendors have been creating a single patient record (including blood tests, physician notes, imaging and other data) that flows across the entire provider organization and can be easily shared with providers across the system. This avoids all of the classic frustration associated with having to fax your x-rays from one provider to another. Everything exists on the web in one single record. Providers then roll out a patient-facing portal that lays across the patient record where the patient can access all of their data (mostly through the desktop Web).


    The strategy is simple. Providers are telling the patient to 1) stay with us because we do everything, and you don’t need to go anywhere else; and, 2) you can’t go anywhere else because we have all of your data.


    But as we saw with Facebook, now that a consumer’s primary entry point to the web is their mobile phone, this strategy has some flaws.

    Not only do our phones enable messaging and carry our location and address book and photos, they can also carry data on our movement, our sleep, our heart-rate, the prescriptions we’re taking, our body temperature and, with the use of implanted devices, much, much more. This real-time data that we carry on our phones is arguably more valuable than the data stored in our clinician’s patient record that only gets refreshed while we’re sitting in the examination room.

    Increasingly, providers will own some patient data but the patient will own more data and better data.


    Like Facebook, health care providers are trying lock in their customer by owning the data. But the increasing use of mobile has changed the game. Just like social network users can effortlessly syndicate their own data out to multiple social networks, a patient will be able to syndicate their real-time clinically relevant data out to multiple providers, regardless of which system they’re associated with.

    Mobile has put patients in the driver’s seat.


    Meanwhile, with the emergence of home care and telehealth and urgent care clinics and apps and implants that manage more serious and chronic conditions, in many ways health care has actually become more fragmented. The traditional providers may be consolidating, but new players are creating new channels for care and causing more fragmentation across the industry. Where and when and how care is delivered is being completely reshaped.


    But unlike Facebook, large health care providers can’t buy their way out of this conundrum. First, because they don’t have enough cash (most are non-profits with microscopic profit margins) and second because health care is local. Health systems are no longer just competing with the hospital across the street; they’re competing with web services that are available to the global market.


    As a result, large provider organizations are going to have to consider new ways of providing value and will have to select which segments of patients they want to serve.


    In short, they can’t own the patient because they can’t own the data.

    The idea of locking the patient into one network of providers was always a bit flimsy. But the strategy was somewhat understandable. A lot of this was driven by the trend towards value-based payments and the convenience of ‘owning’ a patient under that model.


    But the lessons of Facebook are clear. Locking up the data is not a path to success.


    Social networks and health care providers must focus on what they do best and focus on serving the consumer they want to serve and abandon their attempts to win by owning data that isn’t theirs to own.

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