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Fixing health care doesn't necessarily need political reform

Fixing health care doesn't necessarily need political reform | Healthcare and Technology news | Scoop.it

It’s very hard to find a product or service that is both lousy and unaffordable. Such expensive duds are usually quickly replaced by cheaper and better competitors. Prior to the Affordable Care Act, health care was becoming more expensive every year while simultaneously becoming less convenient, less personal, and less satisfying. In 2009, I wrote a series of four posts explaining how the health care marketplace reached such a sorry state and offering a suggestion for reform.


Since then, the Affordable Care Act has passed. For many, insurance has become much more affordable, but whether this translates to better or more affordable care remains to be seen. If it results in many patients receiving affordable insurance that very few physicians accept, then the situation will be a repetition of the Massachusetts experience with universal coverage: Everyone has insurance; no one has a doctor.

At the same time, the intrusive and complex bureaucracy that physicians must navigate to collect insurance payments has vastly expanded. Physicians are now coerced into serving as the workforce for Federal plans to collect health care data, cut costs, and make their care increasingly legible to payers but increasingly opaque to patients.

Bear with me for just a few examples. In an ill-advised plan called “meaningful use,” physicians receive incentives for submitting complex reports documenting their use of electronic health records (EHRs). The time and effort required to comply with this program has earned it much scorn from physicians. And the incentives will likely distort the true value of EHRs and inflate their costs.


The International Classification of Diseases (ICD) is the coding system used by physicians and billers to report to insurance companies patients’ diagnoses. In October, the government will update ICD to its tenth version. ICD-10 will contain radically more complexity than its predecessors. It is widely ridiculed for the detail with which diseases must be reported. (Code V91.07XA is for a “burn due to water-skis on fire.”) The transition to ICD-10 was already postponed once, and I predict it will cause much disruption and grief.


My last example is the recently passed sustainable growth rate (SGR) fix which gets rid of the annual congressional scramble to increase Medicare reimbursement to physicians by increasing reimbursement in the short term, but tying reimbursement to outcomes measures in the long term. This is sure to become a data collection and reporting hassle that makes doctors long for the simpler days of meaningful use.

I honestly believe that there has been more bureaucratic complexity added to the typical physician’s life in the last few years than in the twenty years before that. None of it cares for a single patient.


Two weeks ago, my family and I spent ten days visiting New York City. We had a wonderful time. The services that completely transformed our experience were the ride sharing services of Uber and Lyft. We never used public transportation. We never hailed a taxi. For longer trips (and a family of five) this was likely cheaper than train tickets. For shorter trips, it meant not handling cash, never finding bus or subway stops, and never referring to transit schedules.


For years, passengers complained about high taxi prices and poor taxi service, and potential competitors complained about the legalized monopolies given to taxi companies by city governments. But rather than bang their heads against these barriers, companies like Uber and Lyft just started giving people rides.


This was an epiphany to me. I had always assumed that fixing the health care marketplace would mean political reform — undoing the myriad laws that substituted insurance for health care and caused prices to skyrocket, and dismantling the byzantine bureaucracy that physicians must navigate. Now, I understand that political reform is both unrealistic and unnecessary.


Doctors and patients aren’t waiting for political reform. More and more doctors are “going off the grid” to provide excellent care unencumbered by insurance regulations. Concierge primary care is just one example. The Surgery Center of Oklahoma lists on its website the prices for every surgery it offers. The prices are all-inclusive. You won’t get a separate bill from the anesthesiologist, the surgeon, and the facility. And they don’t care what insurance you have because they won’t deal with any insurance company. Other innovative companies are using video conferencing technology to connect patients to doctors thousands of miles away. LUX Healthcare Network (with which I’m proud to be associated) is building a multi-specialty concierge physician network.


I argued six years ago that using insurance for routine care is wasteful. I now realize that attempts at universal coverage and the bureaucracy that comes with it — ICD-10, meaningful use — will never be repealed. This bureaucracy will become the taxi monopolies of health care — increasingly ignored by both doctors and patients and increasingly irrelevant. The successful enterprises in health care will connect doctors and patients and then get out of the way. Like Uber and Lyft they will help patients find the service they want at a price they’re happy to pay, and they will facilitate not regulate the delivery of excellent care.


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5 Significant Health IT Trends for 2015

5 Significant Health IT Trends for 2015 | Healthcare and Technology news | Scoop.it

While I know meaningful use (stages 2 and 3), electronic health record (EHR) interoperability, ICD-10 readiness, patient safety and mobile health will all continue to trend upwards with great importance, the five areas that I strategically see growing rapidly in 2015 are focused on the consumerism of healthcare, personalization of medicine, consumer-facing mobile strategies, advancements in health information interoperability including consumer-directed data exchange and finally, innovation focused on tele-health and virtual care.

While all of these trends can be independent of each other and will respectively grow separately, I see the fastest growth occurring where they are combined or integrated because they improve each other. It’s like a great marriage where the spouses make each other better and usually more successful because of their unity. I see the same occurring in 2015 and why I am so bullish on these integrated opportunities and innovations.

Here are the 5 top trends:

  1. Treating the patient as a consumer: This is due to numerous factors but a significant driver is the shift in various CMS regulations and incentives that have care providers and healthcare organizations focused on increased patient engagement as well as patient empowerment to improve communication, care coordination, patient satisfaction and even discharge management with hospitals. As a result of an increased focus on improving the patient/consumer experience, 65 percent of consumer transactions with healthcare organizations will be mobile by 2018, thus requiring healthcare organizations to develop omni-channel strategies to provide a consistent experience across the web, mobile and telephonic channels. I have already begun to see this in hundreds of area hospitals and practices in Georgia and know it is occurring across the country.
  2. Personalized medicine: While this concept is not new, the actual care plan implementation as well as technology and services innovations supporting this implementation is being driven quickly by the increased pressure for all care providers to improve quality and manage costs. You will see this increase dramatically once Congress passes SGR Reform that received bipartisan and bicameral support last Congressional Session and Congressional leaders are poised to take up this legislation again in the next month. The latest statistics show that 15 percent of hospitals will create a comprehensive patient profile by 2016 that will allow them to deliver personalized treatment plans.
  3. Consumer-facing mobile strategies: To control spiraling healthcare costs related to managing patients with chronic conditions as well as to navigate new policy regulations, 70 percent of healthcare organizations worldwide will invest in consumer-facing mobile applications, wearables, remote health monitoring and virtual care by 2018. This will create more demand for big data and analytics capability to support population health management initiatives. And to further my earlier points, the personalization of medicine relies on additional quality and population health management initiatives so these innovations and trends will fuel each other at faster rates as they become more integrated and mature.
  4. Consumer-directed interoperability: Along with the evolution of the consumerism of healthcare, you will see the convergence of health information exchange with consumer-directed data exchange. While this has been on the proverbial roadmap for many years, consumers are getting savvier as they engage their healthcare and look to manage their increasing healthcare costs better along with their families’ costs. Meaningful use regulations for stage 3 will drive this strategy this year but also just the shear demand by consumers will be a force as well. I am personally seeing a lot of exciting innovation in this area today.
  5. Virtual care: Last but certainly not least, tele-health, tele-medicine and virtual care will be top-of-mind in 2015. The progression of tele-health in recent years is perhaps best demonstrated by a recent report finding that the number of patients worldwide using tele-health services is expected to grow from 350,000 in 2013 to approximately 7 million by 2018. Moreover, three-fourths of the 100 million electronic visits expected to occur in 2015 will occur in North America. We are seeing progress not only on the innovation and provider adoption side but slowly public policy is starting to evolve. While the policy evolution should have occurred much sooner, last Congressional session we saw 57 bills introduced and as of June 2013, 40 out of 50 states had introduced legislation addressing tele-health policy. I see in every corner of the country that care providers want to use this type of technology and innovation to improve care coordination, increase access and efficiency, increase quality and decrease costs. Patients do as well so let’s keep pushing policy and regulation to catch up with reality.

While the headlines this year will be dominated by meaningful use (good and bad stories), ICD-10, interoperability (or data-blocking), and other sensational as well as eye-catching topics, I am extremely encouraged by the innovations emerging across this country. We are starting to bend the cost curve by implementing advanced payment and care delivery models. While change and evolution aer never easy, we are surrounded by clinicians, patients, consumers, administrators, innovators and even legislators and regulators who are all thinking and acting in similar directions with respects to healthcare. This is fueling these changes “on the ground” in all of our communities. This year will be as tough as ever in the industry but also, a great opportunity to be a part of history.


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3 ways Congress could still kill ICD-10

3 ways Congress could still kill ICD-10 | Healthcare and Technology news | Scoop.it

As the U.S. House of Representatives inked the latest episode in the sustainable growth rate saga, many eyes of the industry were watching to see whether anything related to ICD-10 landed among that bill’s pages.


A collective sigh of relief followed the House’s passage of the Medicare Access and CHIP Reauthorization Act this past week when that alphanumeric acronym was nowhere to be found. Instead, the House bill promises to finally fix the looming 21 percent reduction in what Medicare pays doctors.


But make no mistake: Just because it’s not in the House bill doesn't mean ICD-10 is entirely safe from further delay. 

Here are three potential ways Congress could postpone the code set conversion all over again.


1. Senate rejection. Currently on a break, the U.S. Senate is slated to vote on the SGR bill during the week of April 12, and while the legislation sailed through the House, the fact that the Senate held off on voting could prove to be telling. A spokesperson for Senate Majority Leader Mitch McConnell (R-KY) told The Hill that the Senate’s vote was delayed because there was at least one objection on the Republican side. Should the Senate reject the bill and kick it back to the House, who knows whether ICD-10 would find its way into another attempt. If that sounds like an impossibly long shot, consider that almost no one saw provision 212 in the Protecting Access to Medicare Act of 2014 coming; 212 is the brief mention prohibiting Health and Human Services from enforcing the compliance deadline prior to Oct. 1, 2015.


2. Resurrection. The Protecting Access to Medicare Act was hardly the first bill guilty of attempting to stall the code set conversion. Before that was the Cutting Costly Codes Act of 2013, sponsored by Sen. Tom Coburn (R-OK), who also tried to weave an amendment into the farm bill, dubbed the Agriculture Reform, Food, and Jobs Act of 2013, of all places. Senator Coburn retired at 2014’s end, but a loose coalition of Congress members including Sen. Rand Paul (R-KY), Sen. John Barasso (R-WY), Sen. John Boozman (R-AR) and Rep. Ted Poe (R-TX), among others, have been outspoken against ICD-10 and any one of them could potentially try to stop it from happening whether by resurrecting the Costly Codes Act, slipping a provision into an ostensibly unrelated piece of legislation, or a completely fresh approach.


3. A new surprise twist. It would be an understatement to suggest that many jaws dropped in startled amazement when Rep. Joe Pitts (R-PA) included the now-notorious provision 212 in the Protecting Access to Medicare Act and both the House and Senate subsequently passed it without so much as a single verbal mention of ICD-10. What remains unclear a year later is exactly how provision 212 landed there in the first place. Was it the Centers for Medicare and Medicaid Services? That was perhaps the most intriguing rumor swirling 12 months ago, but not the only one. Another was that Pitts was acting as a lone wolf on behalf of one or more of the specialty medical societies that were 16 of Pitts' top 20 published donors at the time. We may never really know the truth. But the more substantive lesson is that something could happen again – as quickly and as oddly as it all occurred last year.

Granted, this time around the groups in favor of ICD-10 are organized better, more vocal and are proactively monitoring Congress in ways they were not last year, while industry opponents – most notably the American Medical Association and, to a lesser extent, the Medical Group Management Association – are considerably quieter in their dissent. And the House Energy and Commerce Subcommittee on Health, which Pitts chairs, gave just about every indication in a hearing earlier this year that it will not push back ICD-10 again.

But with the SGR matter not yet settled, other proposed bills lurking on the House and Senate floors, and even a few politicians outspoken against ICD-10, it’s simply unwise to think that ICD-10 proponents are insulated from another out-of-the-blue surprise.

What's a hopsital or health system to do? How do you keep moving toward the Oct. 1, 2015 compliance deadline knowing that Congress could change it again? Comment below.



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Hospitals want Congress to keep ICD-10 on track

Hospitals want Congress to keep ICD-10 on track | Healthcare and Technology news | Scoop.it

Any attempts to delay, again, ICD-10 compliance would be a waste of time and money, and should be opposed, eight healthcare organizations--including the American Hospital Association and the Premier healthcare alliance--stressed to members of Congress in a recent letter.

ICD-9 is "outdated" the organizations said, and ICD-10 would enable providers to keep up with medical advances.

"The [most recent] delay added billions of dollars in extra costs," the organizations said. "Many of our members had to quickly reconfigure systems and processes that were prepared to use ICD-10 back to ICD-9. Newly trained coders who graduated from ICD-10 focused programs were unprepared for use of the older code set and needed to be retrained back to using ICD-9. ... This results in a doubling of costs that are not productive."

An ICD-10 delay was not included in the proposed "Consolidated and Further Continuing Appropriations Act, 2015" to fund the government, which is also being referred to as the "cromnibus" bill. The proposal is expected to be voted on by Congress later today.


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