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100 days to ICD-10: Where the industry stands

100 days to ICD-10: Where the industry stands | Healthcare and Technology news |

The implementation deadline for ICD-10 is only 100 days away, but lawmakers on Capitol Hill continue to push for transition periods or an outright ban of the code set while surveys reveal that participation in testing still lags. 

Despite numerous delays for ICD-10 in the past, members of the House Energy and Commerce Committee's Subcommittee on Health made clear at a February hearing that they do not want to see the transition delayed yet again.

However, in March, 100 physician groups--led by the American Medical Association--expressed concern in a letter to Acting Centers for Medicare & Medicaid Services Administrator Andrew Slavitt about ICD-10 issues such as testing and lack of contingency planning.

And in the last couple of months both Rep. Diane Black (R-Tenn.) and Rep. Gary Palmer (R-Ala.) have released separate bills that ask for a grace period for the transition. Black's bill would requireend-to-end testing of the transition from ICD-9 to ICD-10 by the Health and Human Services Department, and would provide an 18-month transition period to the new code set. Palmer's bill seeks to provide a grace period of two years during which physicians and other providers would not be "penalized for errors, mistakes and malfunctions relating to the transition."

At the same time, Rep. Ted Poe (R-Texas) takes it even further--his bill wouldn't simply delay the new code set; it would ban its use outright.

Meanwhile, the Coalition for ICD-10 asserts that a grace period would compromise the ability of Medicare to monitor quality of care. In addition, Juliet Santos, ICD-10 principal consultant for Leidos Health, wrote in an opinion piece at ICD-10 Monitor that the grace period could be a massive risk when it comes to audits.

Recently the Centers for Medicare & Medicaid Services said its second round of ICD-10 testing, which involved 875 providers, clearinghouses and billing agencies in April, had an 88 percent acceptance rate. However, a new survey from eHealth Initiative released last week found testing lagging among 271 providers polled. Only 34 percent said they have completed internal testing and just 17 percent have completed external testing.

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ICD-10: Reality and rhetoric

ICD-10: Reality and rhetoric | Healthcare and Technology news |

For healthcare executives and political aficionados following the latest proposed legislation that could affect ICD-10’s fate, it’s time to recognize three critical facts.

First, the proposed bills — one of which aims to kill ICD-10 outright while the other advocates a transition period — are both longshots. Second, and perhaps more important, the previous two fashions in which ICD-10 was delayed were also once considered quite unlikely. And third: Even though another delay could happen, it would be dangerous for payers or providers to bank on that and backburner the conversion.

That’s the reality. Even still, the mere mention of adjusting the ICD-10 compliance deadline sparked a real mess, rhetoric-wise, concerning the transition these past couple weeks.

Incoming president, Steven Stack, MD, trimmed the American Medical Association’s sails last week to steer AMA toward ICD-11 horizons, to which the Advisory Board Co.’s director of revenue cycle solutions rebutted: "a push to go to ICD-11 is really a push to not change at all for at least another five to seven years and most likely longer than that," Healthcare IT News sister site Healthcare Finance reported.

And then there’s the Heritage Foundation. The conservative Washington, D.C. think tank wrote a scathing response to what it considers "weak arguments for ICD-10" and essentially wrapped that around a recommendation that the U.S. "delink the disparate goals of research and reimbursement, and develop a more appropriate coding system that makes the billing process less, not more, burdensome."

Given that Republican Louisiana Senator Bill Cassidy, MD, publicly suggested to Health and Human Services Secretary Sylvia Burwell that delaying the ICD-10 penalty phase, which essentially means continuing to pay for claims coded in ICD-9, was the reasonable thing to do, a grace period is not out of the question, either. We witnessed HHS institute one to smooth the transition to HIPAA 5010, after all, proving the feds can be pragmatic when the situation demands it.

The usual suspects of ICD-10 proponents, meanwhile, have been campaigning all along that #ICD10matters, that ICD-9 is antiquated and out of codes, that a dual-coding period would be akin to yet another delay – thus we need ICD-10. Now.

Regardless of what side you’re on, where rhetoric meets reality is in the fact that we’re barely closer to squashing ICD-10 or instituting a sort of dual-coding transition period than before Republican Texas Rep. Ted Poe or Tennessee Republican Rep. Diane Black mentioned their ideas.

Either of those proposals, in fact, would still have to pass the U.S. House of Representatives and the Senate where, it’s worth noting, the Cutting Costly Codes Act of 2013 withered and lay dormant until Rep. Poe brought it back to life. And then be signed into law by President Obama.

The one action hospital CEOs, CIOs and revenue cycle directors can take now: surveillance.

Don’t stop whatever work you have in motion toward the Oct. 1, 2105 compliance deadline but keep an eye on any cues that might emerge from Congress. Summer recess, for instance, kicks off August 10 this year so if neither bill has progressed by then, there would be a short three weeks between our elected officials’ return to work on September 8 and the long-looming deadline.

This one, folks, just might come down to the wire.

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3 ways Congress could still kill ICD-10

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

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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5 Significant Health IT Trends for 2015

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

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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Major Health IT Events that Shaped 2014 - HITECH AnswersHITECH Answers

Major Health IT Events that Shaped 2014 - HITECH AnswersHITECH Answers | Healthcare and Technology news |

2014 was quite a year. Thinking back to December 2013, I cannot believe that so much has happened. Let’s take a look at the major HIT events that shaped 2014 and what they portend for 2015.

Affordable Care Act – despite challenges with and state health insurance exchanges, the notion of moving forward with an open insurance marketplace and accountable care got traction. The IT needed to meet the needs of the patient centered medical home, the ACO, and Care Management spawned a new type of software – the care management medical record. Not many products exist and none are mature, but HIMSS was filled with promises of workflow engines, population health, and protocol driven care management tools. 2014 made it clear that the EHR is just a starting point and over time there will be a new generation of tools used by clinicians and non-clinician extenders to keep people healthy, not just record their encounters when they’re sick. Hopefully we’ll see maturing products in 2015.

Meaningful Use/Standards – 2014 was really the first year we could take a look back at the Meaningful Use program. I think we can conclude that Meaningful Use Stage 1 was generally perceived as a positive step, laying the foundation for EHR adoption by hospitals and professionals. Stage 2 was aspirational and a few of the provisions – Direct-based summary exchange and patient view/download/transmit required an ecosystem that does not yet exist. The goals were good but the standards were not yet mature based on the framework created by the Standards Committee. At this point the only way out of the readiness/adoption challenge is to allow more time for the ecosystems to develop by changing the attestation period in 2015 to 90 days. Although Direct/CCDA was a reasonable starting point for 2014, the future belongs to FHIR/REST/OAuth, which are going to be much easier to implement. We need to be careful not to incorporate FHIR into any regulatory program until it has achieved an objective level of maturity/adoption.

HIPAA Omnibus Rule – 2014 saw increased federal and state enforcement of the HIPAA Omnibus Rule with record fines for security breaches at a time when the nature of security attacks became increasingly sophisticated – witness the Home Depot, JP Morgan, and Target breaches as well as denial of service attacks on numerous healthcare and non-healthcare organizations. Healthcare as an industry directed substantial resources toward improving the security protections of their networks in 2014. It will be interesting to look back at this era in several years and ask the question if million dollar fines for stolen laptops/smartphones was a helpful policy or if other enablers such as the evolution of security technologies and culture change were more effective.

ICD10 – ICD10 was delayed until October 1, 2015 and it’s clear that stakeholders are divided about the concept. One the hand, professional coders correctly identify that ICD9-CM is incomplete and does not include several important disease states. On the other hand ICD10-PCS is so complex that it is unlikely clinicians will not be able to produce the documentation needed to justify a code. The cost to the country post implementation in lost productivity will be enormous. If I could ask for a “do over” I would suggest that clinicians use SNOMED-CT to record clinical observations and that in a world of global capitated risk, not fee for service, the notion of using ICD for billing is no longer relevant. ICD was intended as an epidemiological classification, not a billing vocabulary. Only the United States uses ICD for billing and only the United States has proposed ICD10-PCS. 2015 will give us the next chapter in the debate.

In all industries, the concepts of social networking, mobile technology, analytics, and cloud hosting became increasingly important in 2014 for business and personal applications. Healthcare has been slow to adopt these techniques but increasing cost pressures and new business models are motivating healthcare IT departments to embrace cloud services. I believe that 2015 will be a tipping point, with increasing use of social networking concepts for care team communication, smart phones/tablets becoming the preferred tool for clinical work, real time decision support based on analysis of similar patients becoming mainstream, and cloud-based EHRs becoming essential for the agility of merging/changing organizations.

2014 was a year of increasing stress for CIOs, accelerating workflow change, regulatory burden, unquenchable demand for automation, and rapid technology evolution. 2015 may see less new regulatory requirements, more mature products in the marketplace, and an increased role for the private sector to innovate. As always, I remain optimistic for the future and am ready for the challenges ahead.

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An Overlooked Provision of H.R. 4302

An Overlooked Provision of H.R. 4302 | Healthcare and Technology news |

While everyone is talking about Sec. 212 of the Protecting Access to Medicare Act of 2014 (H.R. 4302), which would delay the compliance date of ICD-10 for another year, there is another significant provision in the bill for informatics observers.

Sec. 218 of the temporary Sustainable Growth Rate (SGR) "doc fix" bill, which was passed in the House and Senate and is awaiting Presidential approval, would provide quality incentives for computed tomography diagnostic imaging and promoting evidence-based care. Part of this provision requires the Secretary of the Department of Health and Human Services (HHS) to define clinical decision support mechanisms, determined by various industry stakeholders, that will be used by providers prescribing advanced imaging procedures for Medicare patients.

In a nutshell, says Cindy Moran, a Reston, Va.-based American College of Radiology (ACR) executive vice president of government relations, it mandates ordering physicians to use clinical decision support tools to justify the prescription of those advanced imaging procedures. The provision requires those clinical decision support mechanisms to be used in certified electronic health record (EHR) technology.  Only when the provider informs which clinical decision support mechanism was used to prescribe that study can they receive payment for those services under Medicare.

This evidence-based guideline is a “very important concept,” to Moran and the ACR folks. So much so, they asked for its inclusion in the bill working with various Congressmen and other stakeholders, she says.

They also asked for two other provisions, related to imaging.  One provision forces the Centers for Medicare and Medicaid Services (CMS) to produce data to justify a 25 percent multiple procedure payment reduction on certain imaging procedures provided to the same patient, on the same day, in the same session. The other put a ceiling on the reduction of certain codes.

ACR was one of the few groups to outright support the passage of the SGR “doc fix” bill. It applauded the delay of the ICD-10 mandate as well. Moran said that while the organization didn’t specifically request the delay, she said it will be helpful to the average physician practice, which is overwhelmed by the transition.

Overall, ACR is looking for a permanent fix to the SGR, Moran says. However unlike other advocacy groups, it is pleased with the passage of H.R. 4302.

The ACR wasn’t the only one to applaud those imaging provisions.  The Access to Medical Imaging Coalition (AMIC), which is a nonprofit group that consists of various imaging industry stakeholders, was equally as happy with the bill. In statement, the group said the appropriateness policy is encouraging.

"The best way to support physicians in ordering the right diagnostic imaging scan at the right time is for Medicare to encourage physicians and patients to make treatment decisions that best suit individualized needs and circumstances,” Tim Trysla, executive director of AMIC, said in a release.

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Surviving 2014: The Toughest Year in Healthcare | EMR and HIPAA

Surviving 2014: The Toughest Year in Healthcare | EMR and HIPAA | Healthcare and Technology news |

How bad is 2014 for the healthcare industry? We’ve all read about ICD-10, EHR incentives, Medicare cuts, and the Affordable Care Act. But the most telling moment for me occurred during this year’s HIMSS conference in Orlando. There was quite a bit of B2B enthusiasm, but among the civilians it was mostly a lot of stunned looks and talk about how to get through the year. Here are some of my observations:

ICD-10. CMS has made it abundantly clear there will be no further delays to the October 1 deadline for ICD-10 implementation. This is possibly the most significant change to the healthcare industry in 35 years, affecting claims payment/billing systems, clearinghouses, and private and public software applications. Anyone who provides or receives healthcare in the US will be touched by this in some way.

In a recent poll of healthcare providers conducted by KPMG, less than half of the respondents said they had performed basic testing on ICD-10, and only a third had completed comprehensive tests. Moreover, about 3 out of 4 said they did not plan to conduct tests of any kind with entities outside their organizations.

Incorrect claims denial will be the most likely result. CMS will not process ICD-9 Medicare/Medicaid claims after October 1, and there is a high potential for faulty ICD-10 coding or bad mapping to ICD-9 codes. Error rates of 6 to 10 percent are anticipated, compared to an average of 3 percent under ICD-9. ICD-10 will result in a 100 to 200 percent increase in denial rates, with a related increase in receivable days of 20 to 40 percent. Cash flow problems could extend up to two years following implementation. This will be a costly issue for providers, and a very visible issue for patients.

We advise our clients to be proactive in their financial planning. This should include preparation for delayed claims adjudication and payments, adjustments to cash reserves, or even arranging for a new/increased line of credit. Having sufficient cash on hand to cover overhead during the final quarter of 2014 could be very important, as could future reserves to cover up to six months of payment delays. Companies not in a position to set aside reserves should consider working with lenders now before any issues arise.

Meaningful Use. As with ICD-10, CMS has stated there will be no delays to MU deadlines in 2014. That means providers who have never attested must do so by September 30, or else be subject to penalties in the form of Medicare payment adjustments starting in 2015. Providers who have attested in the past will have a bit longer (until December 31), but the penalties are the same.

There is much dissatisfaction with the government’s “all or nothing” approach to MU, where even the slightest misstep can invalidate an otherwise accurate attestation. While the ONC has proposed a more lenient model for EHR certification in coming years, everything will be measured against a hard deadline in 2014.  CMS is offering some mitigation through hardship exemptions, based on rules that are somewhat broad at this point. Providers should consider applying for an exemption if no other options are available.

We advise against taking shortcuts or rushing to beat the clock on MU. Up to ten percent of eligible professionals and hospitals will be subject to audit, and large hospitals may have millions of dollars at stake. Being prepared for an audit means more than just making sure an attestation is iron-clad; internal workflow and communication are also important. A mishandled audit notification can result in a late response and automatic failure.  Data security should also not be overlooked. Medical groups have failed audits due to lapsed security risk assessments as required under HIPAA.

Medicare Payment Cuts. Medicare Sustainable Growth Rate (SGR) cuts continue to hover over Medicare providers. Enacted by Congress in 1997, the SGR was intended to control costs by cutting reimbursements to providers based on prior year expenditures. But every year costs continue to rise, as do ever-worse SGR cuts (almost 24% in 2015). And every year Congress prevents the cuts via so-called “doc fix” legislation.

In early 2014 there was surprising bi-partisan agreement on a permanent doc fix, whereby Medicare reimbursements would be based on quality measures rather than overall expenditures. However, the legislation was derailed by linking it to a delay of the ACA’s individual mandate. As of mid-March there is still no permanent or temporary solution. Congress will almost certainly intervene to prevent SGR cuts, but by how much is uncertain.

The ACA. As the cost of insurance has increased over the past decade, high-deductible plans have become more and more common. Due to the Affordable Care Act, this trend has become the norm. Media outlets focus on the impact to consumers, and argue about whether more “skin in the game” leads to better choices or less care. What we’re hearing from the front lines is much more concrete: high deductibles are having a negative impact on revenues.

Very few people understand their liabilities under a typical health insurance plan. Last year George Loewenstein, a health-care economist with Carnegie Mellon University, published a survey showing that only 14 percent of respondents understood the basics of traditional insurance policies. At the same time, hospitals report that about 25 percent of bad debt originates from patients who are currently insured. With millions of new enrollees in high-deductible plans and an ongoing economic slump, the situation can only get worse.

The ACA had a further impact by reducing the amount of Disproportionate Share Hospital (DSH) charity funds available, based on a projected increase in insurance coverage.  But with some states not participating in Medicaid expansion, combined with an increase in patients lacking the knowledge or resources to manage large medical expenditures, the reduction in funds comes at exactly the wrong time.

Providers can cope by adjusting revenue cycle processes. For example, new programs should focus on estimating patient liabilities pre-arrival, educating the patient at check-in, and instituting proactive billing/collection at the point of service. In general, providers must pay more attention to the self-pay process, focusing on patient education and offering transparent, easy-to-use billing and payment methods.

Value Modifier. This program has not been a worry for most providers thus far. Not because it won’t have an impact on revenue, but because they don’t know about it. A little-known provision of the ACA, the Value-Based Payment Modifier mandates adjustments to Medicare reimbursement based on quality and cost measures. The program is being phased in, and so far has applied only to group practices of 100 or more Eligible Professionals (EPs). In 2014, smaller groups of 10 or more EPs will be subject to the legislation. These groups must apply and report to the program by October 1. Otherwise, they will be subject to a 2 percent cut in Medicare reimbursements starting in 2016.

One of the most important aspects of the program is its definition of “eligible professional” when defining the size of a group practice. For the purposes of Value Modifier, eligible professionals include not only physicians but also practitioners and therapists. That means that a practice with 8 physicians, a nurse practitioner, and a physical therapist would qualify as a practice with 10 EPs.

Value Modifier is part of the growing trend toward quality-based reimbursement. Even commercial payers are considering some version of the program. The scoring calculations are complex and poorly understood, so we advise clients to get up-to-speed as soon as possible. Groups with high quality and low cost will receive incentives rather than cuts, with additional upward adjustment for services to high-risk beneficiaries. Groups that are not paying attention may be surprised by an additional hit to revenue in 2016. In addition, quality scores will eventually be published to the general public on the Physician Compare website.  Sub-par or missing scores could have a negative financial impact on a practice.


These are only the most high-profile impacts to the healthcare industry during the current year. Much else flows from them: changes to workflow, to computer systems, to financial expectations. Tremendous pressures are coming to bear within a limited timeframe.  We’re seeing an industry in the midst of tectonic change, with 2014 as the fault line. It’s unclear whether these disruptions will be for better or worse. But there certainly will be winners and losers, and those who plan ahead are most likely to survive.

Brionn Nettles's curator insight, July 11, 2019 12:58 PM
 health care was in a tough spot in 2014. there were many budget cuts which caused a large amount of concern with civilians. many jobs were lost which also causes a decline in the effectiveness of health care and the health of the nation. this effects the economy because there is an imbalance some where and it needs to be fixed urgently.
AACS Atlanta's comment, October 18, 2019 2:28 AM
If you have been charged with a DUI, or if the DUI charge was reduced to reckless driving, the state of Georgia will most likely require you to attend a 20-hour Risk Reduction Program. For detail for directions!

House Committees Back 2015 ICD-10 Implementation Deadline |

House Committees Back 2015 ICD-10 Implementation Deadline | | Healthcare and Technology news |
House Energy & Commerce and Rules Committees have voiced their support for the 2015 ICD-10 implementation deadline.

An important committee within Congress is holding fast to Oct. 1, 2015, as the ICD-10 compliance deadline, according to a joint statement from the House Energy & Commerce and Rules Committees.

“As we look ahead to the implementation date of ICD-10 on October 1, 2015, we will continue our close communication with the Centers for Medicare and Medicaid Services to ensure that the deadline can successfully be met by stakeholders,” said Representatives Fred Upton (R-MI) and Pete Sessions (R-TX). ”

The statement comes after members of the Senate and House of Representatives decided against including a two-year ICD-10 delay in a 2015 Congressional $1 trillion spending bill despite calls from the likes of Medical Society of the State New York and other provider association.

Based on feedback following the most recent one-year delay, the chairs of these committees see value in keeping the current 2015 ICD-10 transition date in place:

This is an important milestone in the future of health care technologies, and it is essential that we understand the state of preparedness at CMS. Following the most recent delay of ICD-10, we heard from a number of interested parties concerned about falling behind or halting progress. We would like to acknowledge and thank these organizations and individuals for opening up this dialogue and expressing their thoughts and concerns regarding this issue. It is our priority to ensure that we continue to move forward in health care technology and do so in a way that addresses the concerns of all those affected and ensure that the system works.

Renewed debate about the need for another ICD-10 delay began last month.

On November 12, the Coalition for ICD-10 — which includes the American Hospital Association (AHA), American Health Information Management Association (AHIMA), and College of Healthcare Information Management Executives (CHIME) — wrote Congress last month requesting no more ICD-10 delays, describing previous postponements as significant and costly disruptions to healthcare organizations and the industry as a whole.

Later that month, a letter penned by the Medical Society of the State of New York was circulating among members of Congress, which specifically called on members of the House Energy & Commerce Committee to include the two-year ICD-10 delay as part of “must pass piece of legislation during the upcoming Lame Duck Session in 2014.”

This led to a swift response by a group of eight health system and hospital associations writing Senate and House leadership and asking for additional ICD-10 delays to be ignored, again as a result of the “billions of dollars in extra costs” caused by the previous delay.

As Susan Davis of USA Today reported yesterday, Congress was staring a Thursday deadline to put in place a “stopgap funding measure” to keep Congress running.

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ICD-10 Data: Why U.S. healthcare needs to move on from ICD-9 coding | ICD10 Watch

ICD-10 Data: Why U.S. healthcare needs to move on from ICD-9 coding | ICD10 Watch | Healthcare and Technology news |

When ICD-10 opponents say there is no benefit for patient care, they're refusing to connect  data to healthcare. It's not hard to see why.

It's not like physicians can see a patient recover as their symptoms are documented. So there's no clinical reason why U.S. healthcare needs more data.

Except data isn't medicine. It doesn't work that way. It accumulates over time to give healthcare professionals a picture of how treatments and diagnoses develop. That data can give physicians better ideas on how to treat their patients.

How much ICD-10 data do we need?

It's hard to understand why U.S. healthcare needs data on turtle and jet engine injuries. Except someone with a medical degree argued for the inclusion of some "bizarre" codes.  But those kinds of diagnosis codes are relatively few. There are more important specifics to focus on:

  • Much of the specificity is due to laterality (right or left side).
  • Also the new details included in the codes will help link symptoms and identify patients at risk of developing serious health problems.
  • The precision allows for better tracking of care after the initial patient encounter. The information can be used to develop better care after treatment.
  • Such specificity will help identify fraud, waste and abuse in medical claims. "Was  the  same  procedure  performed  twice?  Were  conflicting  claims  filed  for  the  same  patient?"

And the better, more precise the data will help physicians make better decisions because they can see trends if they look at healthcare data.

How much time do we need for ICD-10 data to matter?

Again, the problem with this is that it's going to take time to realize those benefits. Physicians and patients like short-term benefits. Take your medicine and you start to feel better in days or weeks. But it could take years to see these benefits.

All the knowledge that physicians use to diagnose and treat patients took years or decades or centuries to accumulate. Medicine is the result of careful study that takes time. And ICD-10 codes will help them accumulate data that leads to new treatments.

Will ICD-9 codes kill anyone?

Not likely. But medical uncertainty can. And it's practically impossible to connect that with a lack of specificity in ICD-9 codes.

Just a little more specificity has got to help.  And maybe ICD-10 codes can give us enough information about what we do not know that U.S. healthcare can advance treatment.

It's a big maybe that comes at a cost for medical practices. But physicians deal a lot in maybes when they diagnose patients. Let's use ICD-10 codes to get rid of a few maybes.

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Son's ICD-10 Software Helps Save Dad's Solo Practice

Son's ICD-10 Software Helps Save Dad's Solo Practice | Healthcare and Technology news |

Nitin Desai has the kind of medical practice you don't see much anymore. Desai, an internist, is the only physician in the practice in Columbus, Ga. His patients are like family; they know the staff personally and even have the doctor's cell phone number. Desai's wife, Bhavna Desai, is the practice manager, and his sons, Parth and Koosh, grew up in and around the practice, cutting the grass, helping out in the office, and developing a love for the practice of medicine that would led them both to medical school.

Sadly, increasing regulations and requirements for health information technology are making it more and more difficult to keep this kind of practice afloat. "I was under a lot of pressure to sell out to a hospital or join a group of other doctors," said Desai. "It is seriously hard to maintain a solo practice these days." Coming so soon after installing an EHR, the requirement to switch to ICD-10 was the last straw for Desai. Running a medical practice as a family business just didn't seem possible any longer.

Parth Desai, a first-year student at Mercer University School of Medicine in Macon, Ga., learned early about the business side of medicine. When he was just 16, health problems forced his mother to take a break from her duties as office manager. Parth stepped in to help out. His computer skills came in very handy, since neither of his parents is very computer savvy. When Parth heard about the ICD-10 transition, he knew that he could help with that, too.

Parth and his best friend, Will Pattiz, a computer programmer with experience developing training platforms and e-learning courses, built software that creates ICD-chart templates and converts codes from ICD-9 to ICD-10. For the 70 percent of codes that have one-to-one matching, conversion requires little more than the click of a button. For the 30 percent that are more complex, "You can go through and edit, fill in the codes you use, and customize as you go," Parth explained.

The pair's "ICD-10 Charts" software is quite valuable, with many practices seeking an easy way to convert to the new coding system. But Parth isn't aiming to make money from his software; he just wants to help his dad. "Dad has always helped me," he says simply.

One lesson Parth did not miss growing up in the heart of a community-focused medical practice was the imperative to help others. Parth and Pattiz have made the software available free on the Web [at] for anyone who can use it. In addition, the Physicians Foundation, a nonprofit organization dedicated to advancing the work of physicians practices, has stepped in to fund the project. With the foundation's support, additional free resources, including free coding training, will be available soon. "The Physicians Foundation is also helping us spread ICD-10 Charts throughout the country so that the project can benefit as many struggling practices as possible," said Parth.

Meanwhile back home, Nitin Desai says his son's software has made a noticeable difference in his practice's bottom line. "We're okay for now." And in the long run? "The chances are very high," says Desai, "that the boys will come home and join the practice."

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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 |

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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ICD-10 Propels CAC Market to Reach $3.5B by 2019

ICD-10 Propels CAC Market to Reach $3.5B by 2019 | Healthcare and Technology news |
The computer-assisted coding (CAC) market has played a significant role in advancing the accuracy of patient data in EHRs by reducing coding errors. With the coming ICD-10 transition, CAC will continue to grow. This market has helped healthcare costs drop in recent years and stimulated greater productivity and efficiency of healthcare facilities across the world.

A press release from market research company states that the global computer-assisted coding market is expected to grow 16 to 17 percent by 2019. Both the coming ICD-10 integration and meaningful use requirements within the healthcare sector are driving the gains in the CAC market.ICD-computer-pen

This particular sector is growing due to regulatory compliance measures set by the Centers for Medicare & Medicaid Services (CMS) and the Big Data stemming from medical facilities. There is also a growing demand for better quality of services and greater accuracy in the healthcare market.

Complex ICD-10 coding requirements as well as the move toward reducing medical spending propel the computer-assisted coding sector further. Consolidation in healthcare along with new technological innovation bring a greater need for computer-assisted coding solutions.

There are a few issues that keep the sector from advancing even more such as lack of awareness of new technologies and the hesitation of some providers from integrating innovative health IT processes.

Nonetheless, providers trust that computer-assisted coding improves accuracy and outcomes in the healthcare setting. The American Health Information Management Association (AHIMA) interviewed data management professionals to find out their take.

“The positive impact to productivity and accuracy often can be seen within days of the implementation go-live, in both the inpatient and outpatient settings,” Ann Chenoweth, MBA, RHIA, senior director of industry relations for 3M Health Information Systems, told AHIMA. “CAC solutions often incorporate workflow capabilities, which allow even greater improvements to productivity.”

North America shares the biggest segment of the growth in the computer-assisted coding division with Europe and Asia-Pacific following behind. Both ICD-10 integration, the expansion of healthcare IT tools, and other technological developments have pushed computer-assisted coding forward in North America.

Over the next four years, the Asia-Pacific region represents the largest impact on computer-assisted coding growth due to a rise in investments, a growing need for better healthcare, and the stimulus of government programs.

The increase in insurance claim reimbursement, greater affordability of medical services, and a rising number of healthcare providers in bigger cities are all driving the market growth of CAC in the Asia-Pacific region of the globe. Countries like China, India, and Brazil are especially seeing this surge.

According to a press release from the market research firm MarketsandMarkets, the global computer-assisted coding market is predicted to reach $3.5 billion by 2019. The report conducted divides the CAC market by application, solution, end user, mode of delivery, and topographical territories.

One major reason for the financial growth in this sector is the transition from ICD-9 to ICD-10 in the North American healthcare sphere set to take place by October 1, 2015. For example, computer-assisted coding is leading to the incorporation of ICD-10 diagnosis and procedure codes in payment billing and insurance reimbursements. Improved healthcare IT infrastructure is also leading to larger market share of computer-assisted coding in North America.

Over the next four years, expect to see the global CAC market reach $3.5 billion and grow at least 16 percent.
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ICD-10, Meaningful Use among AMA's top issues of 2015

ICD-10, Meaningful Use among AMA's top issues of 2015 | Healthcare and Technology news |

Implementation of ICD-10 ranks among the top 10 issues for physicians to watch in 2015, according to a list published by the American Medical Association.

The list notes that myriad regulatory requirements, which take time away from patient care, are among physicians' greatest frustrations. Relief from the multiple government mandates was among the three "Congressional Asks"--formal requests that HIMSS made to Congress in September to advance health IT.

The list also includes pushing for solutions to the one-size-fits all Meaningful Use program, continuing efforts to repeal the sustainable growth rate (SGR) formula, tackling prescription drug abuse, transforming medical education, and increasing professional satisfaction and sustainability of practices.

AMA President Robert Wah, in an address to the organization's House of Delegates in November that referenced "Star Wars," made jokes about the new code set, saying that the association wants to "freeze it in carbonite." The speech drew the ire of the ICD-10 Coalition.

Though another ICD-10 delay never materialized in a $157 billion fiscal 2015 spending bill passed in December, the National Physicians' Council for Healthcare Policy and the Texas Medical Association continue to push for a two-year delay.

AMA doesn't see any more delays as likely, and is urging practitioners to ensure they are prepared for implementation of the new code set, offering help through planning tools, guides and training.

AMA has pushed for end-to-end ICD-10 testing, which the Centers for Medicare & Medicaid Services announced would take place from Jan. 26-30, April 26-May 1, and July 20-24.

Last month, CMS revealed that acceptance rates during the November ICD-10 acknowledgement testing week improved to 87 percent. More acknowledgement testing will take place from March 2-6 and June 1-5. Acknowledgement testing is open to all electronic submitters and they receive electronic confirmation that the claims were accepted. End-to-end testing is limited to a smaller sample of submitters who volunteer and are selected to take part.

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Precyse to create 1,000 new coding jobs | Healthcare IT News

Precyse to create 1,000 new coding jobs | Healthcare IT News | Healthcare and Technology news |

Precyse, performance solutions and Vermont HITEC, a not-for-profit education center, are partnering to fill Precyse’s current and future medical coding workforce development needs in Vermont.

The two organizations are now recruiting candidates for the first session of the medical coding education program to train candidates as at-home medical coders for Precyse. The program is a collaborative effort involving the U.S. Department of Labor, Vermont Department of Labor, Vermont Agency of Commerce, Vermont HITEC and Precyse.

Vermont HITEC has partnered with businesses to employ more than 1,000 individuals in the healthcare, information technology and advanced manufacturing fields. The medical coding positions allow Precyse colleagues to work from home.

The Precyse program offers a combination of no-cost education and the advantage of working from home while receiving a competitive wage and full benefits. This presents an opportunity for those living in rural regions of Vermont with limited career opportunities, and is a great option for those who are looking for a fresh start with a new career, as no prior healthcare experience is needed for candidates to apply to the Precyse program.

The program is offered at no cost to applicants who reside in Vermont. Candidates who have been unemployed for an extended period of time are encouraged to apply, as the educational program and apprenticeship is specifically designed to support Vermonters who are pursuing a significant career
an industry leader in health information management change or have been out of the work force, or who are recent graduates struggling to find a job.

"Vermont residents are in need of opportunities for higher skill jobs at higher wages. This program is a great example of how Vermont State government, the healthcare industry, and our non-profit sector can collaborate to bring living-wage jobs to Vermont," said Vermont Gov. Peter Shumlin, in announcing the program.

"This training program – with guaranteed jobs at the conclusion – is the right way to invest our state’s training money, as it has both immediate gains and long-term sustainability for our Vermont economy and citizens," he added. "I am pleased to see pre-apprenticeship, apprenticeship and on-the-job training programs being used successfully in our state to match and educate motivated, hardworking unemployed and underemployed Vermonters with good-paying career opportunities."

"Vermont HITEC, in partnership with the State of Vermont, provides Vermonters with the education they need to thrive professionally in rewarding careers," comments U.S. Sen. Patrick Leahy, in a press statement. "The healthcare industry is one of the fastest growing sectors in our economy. I am pleased to see pre- apprenticeship, apprenticeship and on-the-job training programs being used successfully in our state to match and educate motivated, hardworking unemployed and underemployed Vermonters with good- paying career opportunities."

Potentially 15 individuals will be selected for the 10-week education program with Precyse through an extensive recruitment process, officials say. This education will prepare individuals to take the medical coding certification exam, issued by the American Academy of Professional Coders. Upon graduation from the program, participants will fill one of the open medical coder apprentice positions. All positions will receive full wages and benefits.

“Our team is excited to partner with the State of Vermont and Vermont HITEC on this initiative,” said Chris Powell, CEO of Precyse, in a news release. “But for the economic growth incentives offered by the state and the state funding to cover the costs of the education, Precyse would continue its practice of hiring these jobs in other states and outsourcing overseas. This partnership will help us to enhance our medical coding services for the healthcare industry while providing Vermont residents exciting and rewarding careers. It’s a win-win.”

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How Healthcare Organizations Can Turn Big Data Into Smart Data

How Healthcare Organizations Can Turn Big Data Into Smart Data | Healthcare and Technology news |

Only a very small percentage of healthcare organizations today seem to be leading the way in healthcare data analytics, while the vast majority are very early in the business intelligence (BI)/analytics process, or haven’t even started. As a result, organizations seem to see big data as something that’s off in the very distant future; for most of them, anything outside of five years is almost nonexistent, says Shane Pilcher, vice president at the Bethel Park, Pa.-based Stoltenberg Consulting.

It is important to remember that big data is more than just a sea of information; it is an opportunity to find insights in new and emerging types of data and content.  So what are hospitals and healthcare organizations forgetting in their paths for eventual success with big data? According to Pilcher, the answer is “smart data.” In the below interview with HCI Assistant Editor Rajiv Leventhal, Pilcher talks about the difference between big data and smart data, strategies for collecting the right data, and advice for physicians in getting on board with the movement.

When you say “smart data,” what do you mean? How does smart data differ from big data?

The data that organizations are collecting today that they will be using for big data are going into this black hole (usually the data warehouse) somewhere. They are happy that they’re collecting it and preparing for when big data finally does come around to their organization, but if they aren’t careful and if they don’t monitor what they’re recording, the quality and quantity of the data when it’s to be used five years from now will not be sufficient enough. These organizations might think that they have five years of historical data to start their analytics, but in reality, the data is often not of the quality or quantity, or even the type, that is needed. That’s the smart data—that step that focuses on the type of data that they have, the volume of data, and also the validity of that data. You have to make sure that what you’re collecting is what you’re expecting.

Do healthcare organizations recognize this need?

Big data is a common theme with CIOs at healthcare organizations everywhere—they know it’s coming. However, there are CEOs at their hospitals who hear about “big data” at conferences and have no idea what it is, yet they will still come back and tell their CIOs that they “have to be doing big data.” And thus, it’s left in the lap of CIOs. But for the CIOs, they have Stage 2 of meaningful use and ICD-10 coming [for many providers, Stage 2 is here already], so they are not in the best place to be dealing with big data. So for the most part—except for about 5 percent of organizations out there, they tend to move it to sideline. It’s like looking at the side view mirror on your car and not seeing the message, “images are closer than they appear.” They see big data reflected, but it’s a lot closer than what they’re thinking. For the places that have limited resources and time, this is something that is being pushed to the side until they can get to it down the road.

How can organizations better ensure they are collecting the right quantity and quality of data?

First, you need to start developing your strategy now. Using the standard data models and approaches other industries are using doesn’t necessarily translate to healthcare IT. The amount of data, the data structure, and the data model is off the chart compared to even something as large as automotive manufacturing—the complexity isn’t even comparable. You have to develop as you go. The biggest thing I can suggest, as this industry is developing and our tools are growing, is to develop those peer networks with other healthcare leaders that are already further down the road than you. About 5 percent of healthcare organizations are right now in “stage two” of the data maturity model where they could start looking at predictive and prescriptive approaches to data. Those that are on the forefront of data analysis and intelligence are going to be critical to the rest of the industry following along. So learn from and use your peers.

And again, the quality of the data is critical. Organizations often think that they initiated the data collection, it’s implemented, and it’s working, so they turn to next project, thinking that when they’re ready, they will have it there in the warehouse. But then when it gets closer to the time to use the data, they don’t have the quantity that they thought they had. If you are collecting the wrong information or it’s incorrect, when you do your analysis, you will get wrong results and not even know it. Decisions could be devastating because your data was inaccurate leading to wrong analysis.

So you also need to assess the data on a regular basis constantly and ensure that what you think you’re collecting is actually what you’re getting. Then you can depend on the accuracy of that data when it’s time to start analyzing. Being able to analyze unstructured data for trends is very difficult, almost borderline impossible.  Yet, about 80 percent of hospitals expect to use unstructured data in their data warehouse. Turning that data into structured data, or finding a tool that can do that for you with accuracy, becomes a huge push. If organizations are not prepared for that, they are racing against time at the last minute.

You need to trust the accuracy of your data. You know that your electronic health record (EHR) is collecting certain data and dumping into the data warehouse. But is anything happening with that transfer of data that is changing it in any way? Is it remaining accurate? Was it accurate to begin with? I wouldn’t say there is an issue of incorrect data in EHRs, but people can’t 100 percent say, “Yes, it’s ready to be analyzed.”

What are some other challenges organizations are facing with big data?

Time and money are the two big ones, of course. Everyone has a limited amount of time, with more projects and initiatives than time to do them in. And dollars are tight for healthcare organizations, so the things that tend to be more in the future get less priority when it comes to budgeting than things needed for today.

But staffing is also a problem—having trained staffs who know how to analyze and know how to approach intelligence processes can be challenging. A 2012 CHIME CIO survey, from last September, found that 67 percent of healthcare CIOs were reporting IT staff shortages. The issue is that organizations either didn’t have enough staffers, or didn’t have anyone internally with that skill set. At the end of the day, almost all organizations are having problems making up a BI department.

What is your advice to helping physicians get on board with big data?

This is definitely adding to the challenge for physicians. In many cases, a lot of them can view EHRs as taking up more of their time and causing more of a workload rather than being more efficient. Often, that is accurate. EHRs do not save you time, not at the beginning. And that’s why physicians tend to be resistant; they understand the need for meaningful use dollars, and that has pushed them in the direction, even though they have been reluctant to go there in the past.

But the day we can take that information and turn it into a tool for them to better take care of their patients, creating better outcomes at a lower cost, will be a benefit to all of the efforts and work they have been doing. That is why hospitals that have implemented BI initiatives; rather than just focus on the financial, they have to focus on the patient care strategies and initiatives. Because it’s not until then do doctors see a purpose for their extra work and start to get on board.

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Will Congress delay ICD-10?

Will Congress delay ICD-10? | Healthcare and Technology news |
Dive Brief:
  • As physician groups lobby for another ICD-10 delay, the AHA fired a shot across Congress' bow to disavow them of the notion that another delay would be a good idea. The AHA's strongly-worded letter, addressed to congressional leaders in both houses, stated that thousands of hospitals would spend billion of dollars if ICD-10 is delayed yet again.
  • According to HHS figures, the most recent one-year compliance delay until October 2015 has already cost HIPAA-covered institutions between $1.1 billion and $6.8 billion. Hospitals that were ready for the October 2014 date have had to overhaul systems they just finished overhauling for ICD-10, change software and retrain new ICD-10 coders in ICD-9.
  • "We urge Congress to avoid any further delays of this needed coding update," the letter stated. "ICD-9 is outdated and ICD-10 is needed to keep up with advances in medicine and ensure accurate payment."
Dive Insight:

Hospitals seem to have gotten their way: The $1-trillion omnibus spending legislation revealed Tuesday does not include a delay. Our bet is that while Congress hasn't included a delay in the budget bill, they will find a way to extend the existing deadline. Many of those in Congress just got re-elected, and they will find they have to dance with the girl who brought them.

Physician groupsstill suffering sticker shock over the ICD-10 transition costs for their practices—have been pushing Congress to include another 2-year delay in the budget bill being prepped for a vote this week. In the meantime, hospitals that have already taken it on the chin once over ICD-10 compliance are pooling their resources to convince Congress to stick to the October 2015 schedule.

Signed by just about every hospital association and advocacy group in the US, the letter was intended as a show of force to Congress. By doing it in public, however, the hospitals just demonstrated how worried they really are about another delay. In politics, special interests and legislators tend to talk issues in private. When they take their grievances public like this, it means that the backroom conversations and behind-closed-doors lobbying didn't work.

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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 |

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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