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Hospitals press HHS on meaningful use

Hospitals press HHS on meaningful use | Healthcare and Technology news |

Their patience wearing thin, a group of leading hospital organizations have implored Health and Human Services Secretary Sylvia Mathews Burwell to publish pending meaningful use modifications sooner rather than later.

In a letter this past week that CC'd Centers for Medicare & Medicaid Services Acting Administrator Andy Slavitt, eight hospital groups urged CMS "to release, in the immediate future," final rule modifications to meaningful use for fiscal years 2015 to 2017.

"The rule is past due, given that it will affect the current program year for meaningful use," according to the letter, co-signed by America's Essential Hospitals, American Hospital Association, Association of American Medical Colleges, Catholic Health Association of the United States, Children's Hospital Association, Federation of American Hospitals,Premier healthcare alliance and VHA Inc.

"Indeed, under current rules, meaningful use applies to fiscal year performance for hospitals. FY 2015 ends on Sept. 30 – fewer than 60 days from now," they write.

CMS recently floated a proposal to shift meaningful use reporting to the calendar year. Even then, however, "the last possible reporting period would begin on Oct. 3," according to the letter.

"Even if reporting is moved to a calendar year, hospitals need the certainty of a final rule now to determine the best reporting period to choose and begin the process of reviewing performance and ensuring they have met all of the revised requirements."

While recent proposed changes to MU, such as a 90-day reporting period for FY 2015 and simplified patient electronic access requirements are appreciated, the hospitals want CMS to quickly "finalize those changes as proposed."

They object to other proposals, however – mandating the e-prescribing of discharge medications, requiring new public health reporting measures – that "would make meeting Stage 2 more difficult."

Not to mention the fact that "given the delay in the release of a final rule, they would be virtually impossible for hospitals to accommodate."

Without quick action from the feds, hospitals "simply will not have sufficient time to understand the new requirements, work with their vendors to purchase and implement new or revised technology that would accommodate them, and invest in the training and work flow changes necessary to meet the new requirements," according to the letter.

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Reflecting on the Clash of Incentives Around “Information-Blocking” in the Push Towards the New Healthcare

Reflecting on the Clash of Incentives Around “Information-Blocking” in the Push Towards the New Healthcare | Healthcare and Technology news |

As Healthcare Informatics reported last month, the Office of the National Coordinator for Health Information Technology (ONC) released a report in early April that highlighted what the federal healthcare IT agency referred to as “information-blocking.” As Senior Editor Gabriel Perna noted in his April 10 report immediately following the release of the ONC document, “The report’s authors and researchers detailed several examples of electronic health record (EHR) developers and health systems blocking health information sharing between each other. The act of information blocking occurs when an entity or person knowingly and unreasonably interferes with the exchange of electronic health information. Examples of this,” he noted, “are charging prices and fees for data exchange; creating terms of a contract that restrict individuals access to their health information; developing health IT in a non-standard way that dissuades information sharing; and developing health IT in a way that locks in information.”

The ONC cited examples in its report of anecdotal evidence

suggesting that “EHR application developers are breaking several of the rules in this regard,” Perna’s report noted. “Using interviews with people at regional extension centers (RECs), the authors detailed complaints from industry sources on how developers are charging fees that make it cost-prohibitive to send, receive, or export electronic health information stored in EHRs. Some EHR developers even charge a substantial transaction fee any time a user sends, receives, or queries a patient’s electronic health information, the report says. The variation in prices reported to ONC suggests that some are taking advantage of the situation.”

In announcing the availability of the report, National Coordinator for Health IT Karen DeSalvo, M.D. noted in a blog on the agency’s website that it is difficult to pinpoint concrete evidence of information-blocking. “The full extent of the information blocking problem is difficult to assess, primarily because health IT developers impose contractual restrictions that prohibit customers from reporting or even discussing costs, restrictions, and other relevant details,” she noted. “Still, from the evidence available, it is readily apparent that some providers and developers are engaging in information blocking,” she said.

Given all this, I read with interest a May 20 blog in Health Affairs online by Julia Adler-Milstein on this subject, because of the clear way in which she frames the dynamic tension taking place right now in the industry between the forces that would restrict information for profit or proprietary gain, and those that would advance it for the common good. AsAdler-Milstein, who is an assistant professor of information in the School of Information and an assistant professor of health management and policy at the School of Public Health at the University of Michigan, states very bluntly in her blog, “When it comes to sharing electronic patient health information, public good should trump private gain. While it may seem like an obvious statement, it represents a tectonic shift in the narrative surrounding health information exchange,” or HIE.

As Adler-Milstein notes, “For more than a decade, our federal strategy has largely left HIE to the market under the assumption that, if there is benefit to be created (and estimates suggest that there is), we should see the emergence of ways to capture that benefit. In practice, this means that HIE efforts have sprung up in various health care markets across the country, and where public money has been spent on HIE (largely at state and community levels), it has come in the form of one-time start-up funding, not a commitment of ongoing support or regulatory mandates for HIE participation.”

Here’s where Adler-Milstein really scores a home run on this, in my view: “What has been substantially underappreciated, however,” she writes, “is the fact that, for the key actors needed to enable HIE to occur—provider organizations and vendors—there might be more benefit, or at least more certain benefit, from not doing so. And as a result, these actors may behave in ways that interfere with the free-flow of patient information that is needed to improve health and health care.”

Instead, she says, “With the release of the information blocking report, which was produced in response to a 2015 Omnibus bill request that introduced the term ‘information blocking,’ ONC makes plain that this behavior will no longer be tolerated. This enormously exciting development means we might see real progress after decades of investment that has failed to convert into sustainable approaches to robust HIE. The key to such progress, however,” she warns, “lies in how well we can identify when information blocking is occurring. This will not be easy.”

And in those short paragraphs, we can see some of the core opportunities and challenges moving forward in this critical area. In this arena as in so many others in healthcare, we see a dynamic tension based on conflicting incentives within the U.S. healthcare system. On the one hand, there is broad consensus that data- and information-sharing will be essential to accountable care organization (ACO) development, population health management, bundled payment-facilitated care delivery, patient-centered medical home work, and indeed, every iteration of the new healthcare. Yet at the same time, there are many elements embedded even in those concepts that speak to at least short-term—and certainly arguably, medium-term as well—market advantages that can be gained through data- and information-hoarding.

It is this clash of incentives that we are collectively burdened with at this early stage of the trajectory towards the new healthcare. The rhetoric around healthcare policy right now is all about sharing for common gain, and yet the incentives in the moment are far from purely conducive to—well, purity.

That’s why it’s good to be reminded at times like this by elegantly concise writings like those of Julia Adler-Milstein. Adler-Milsteiin’s blog reminds us what the ultimate prize is, on which we should at least theoretically all be setting our eyes. This is not to engage in the laying of blame on those working for specific market advantage, but rather to affirm the need to continue to push forward collectively as an industry and indeed as a society, towards a more mature healthcare system—one in which all the incentives really all will be aligned. In other words, keep watching this space.

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The Pain (and Gain) of Building a Private HIE in NYC

The Pain (and Gain) of Building a Private HIE in NYC | Healthcare and Technology news |
Frat Iqbal, senior manager of information management at New York University’s Langone Medical Center, led off his presentation at HIMSS15 in Chicago with two photos that provided a stark reminder of what happens when information doesn’t flow properly through the healthcare system. They were two pictures of his brother two years apart, one in full health and the other wheelchair-bound and permanently disabled by multiple sclerosis.
“It took two years to diagnose MS as he went from doctor to doctor, lab to lab,” he said. “His life was ruined by inefficiencies in the healthcare system.”
Iqbal said it is a reminder of the importance of improving patient care at the community level, of connecting all the small practices in New York so that data can flow from their offices to specialists, labs and hospitals. 
NYU Langone has been working to build a private health information exchange to link 200 practices and 1,900 clinicians using 26 different EHRs as the state and country work toward building larger exchanges.
The HIE was established in mid-2011 and privately funded by NYU Langone Medical Center. The goal was to become a central repository of clinical information for community providers to review, reference and share data and to provide 360-degree care to patients, Iqbal said.
Anthony Antinori, senior director of clinical affairs IT at NYU Langone, said a private HIE has advantages over a public one. “We can make decisions quickly. We have a small ecosystem of private practices and one governing body. We are local and funded by a private organization, with no federal or state funding required,” he said. The HIE is able to rapidly align itself with the strategic goals of the organizations it is serving, he added.
Instead of dictating which EHRs it would support, NYU Langone decided to work with whatever the providers had. “We left it open. If the EHR has the capability, we will integrate with it. It’s more headaches for us, but we did that for the community,” he said. 
They knew it was going to be challenging, and it has been, Iqbal said. “It is one of the most complicated projects I have ever embarked on,” he said. Interfacing with all those EHRs has been a “project management nightmare,” he added. Project prioritization has been tough, in terms of deciding which data is most valuable to the HIE. A whole team has been focused on privacy and security of the 4 million patient records in the HIE.
There are technical challenges, but more difficult have been cultural changes and setting the right expectations, he said. Many physicians are not inclined to share data and don’t want to change. Most EHRs are designed to retain, not share, information. 
Some providers are resistant to change. They don’t care if more information is available and they don’t want to share information. With these providers, you really have to make them realize the benefit the HIE brings to the table, he said. (Members of the NYU Provider Network are mandated to connect to the HIE.)
Legal and policy issues were a challenge. Getting data sharing agreements vetted by the practices, vendors and NYU Langone’s legal teams took longer than the integration itself. Consent policies are also difficult to work through, he said.
Despite the huge challenges in getting it set up, the HIE offers an array of benefits. Here are a few listed in the NYU presentation:
• Providers gain immediate access to valuable clinical data that provides a more holistic view of patient health when using the HIE;
• Providers will be able to reduce unneeded patient visits and lower the cost of care;
• Providers can begin to embrace the powerful benefits of trend and pattern analysis toward new decision-making frontiers;
• HIE facilitates evidence-based medicine and creates a potential positive feedback loop between health-related research and actual practice.
• Patients can expect improved payment coordination and smoother care transitions
• Duplicative procedures or tests will be reduced and visit satisfaction will be improved when patients opt to participate in the HIE;
• The collection and linking of data across the HIE facilitates extensive and robust community health records that can foster the ability to quickly detect, respond and efficiently prevent threats to public health;
• The HIE will also enhance public health practices at all levels of government through infectious disease case investigation and health surveillance.
The next step, he said, is analytical innovation that will pull together payer data, HIE data and Epic data from the hospital system to get more proactive at recognizing issues and monitoring patients and populations.
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A Strive Towards “Meaningful” Data Exchange in the Midwest

A Strive Towards “Meaningful” Data Exchange in the Midwest | Healthcare and Technology news |

Although the successful exchange of health data has been a struggle in most U.S. regions, a commitment to the free flowing of information on a patient’s history—regardless of what local healthcare facility they have been at—has helped spur health information exchange (HIE) in the Midwest.

Indeed, the Lewis and Clark Information Exchange (LACIE) is one of the first fully operational, multiple-state HIEs in the country, providing patient information to healthcare systems and providers in Kansas and Missouri. Getting the HIE up and running to a point where it could successfully exchange data required a few key elements, starting with getting hospitals on board that were willing to share data. To this end, in the last 18 months, LACIE announced two major connections: first with the Kansas Health Information Network (KHIN), another major HIE in Kansas. This was a significant moment for data exchange in the Midwest, as in the past, the two organizations had failed to reach an agreement on sharing data.

A few months after that, LACIE announced that patients' electronic medical records (EMRs) were being securely shared with Tiger Institute Health Alliance (TIHA) in Columbia, Mo. In total, LACIE is now connected to 17 hospitals in two states in addition to three accountable care organizations (ACOs), the two aforementioned regional HIEs, multiple private HIEs, and the Kansas City Metropolitan Physician Association (KCMPA), a large independent physician group with 80 clinics and 350 providers. The 24 different EMRs those organizations use have been connected via a hub that has been put in place from Cerner, says Mike Dittemore, the executive director for LACIE. Dittemore says that LACIE connects to that hub so it doesn’t have to do all of the independent connections, leading to greater efficiencies and cost savings.

However, getting different provider organizations on board has not been easy, Dittemore admits. “There are always challenges with provider participation, and one of reasons we had the strategy to work with hospitals and get them on first is that we felt if we did a good job with them, that would spur participation from others. The best marketing out there as far as HIEs go is word of mouth by providers who actually use it,” he says. What’s more, LACIE’s board of directors consists of several physicians, including multiple CMIOs of organizations in the Kansas City area. “That’s really helped us, having these physicians have conversations with other providers or their clinics and talk to them about why it’s important to share this information and participate,” says Dittemore. “They can show other [providers] the value by being able to not tie up so much staff in administrative time in tracking information down that already exists in the HIE.”

Still, there are additional challenges for independent providers who have all kinds of mandates and rules they are struggling with, in addition to low reimbursement rates, Dittemore notes. “So we try to have a price point that works for them, and we also have found some grant funds through the Office of the National Coordinator for Health Information Technology (ONC). In Kansas, we used some of those funds to help folks to connect, but it’s always an uphill climb to get individual providers on board. We do think that if we can get in and meet with clinic managers, maybe not the providers themselves, but a trusted person they go to, and show them the value, getting these smaller providers on board might not be as hard,” he says.

One of these physicians on LACIE’s board is board chair, Gregory Ator, M.D. CMIO and practicing physician at the University of Kansas Hospital. Ator says that as of late, LACIE has become much more focused in getting smaller practices on board. “It’s been a great experience, it’s very refreshing to see all of these large organizations that are not competing around the ‘this is my data and you can’t have it’ concept, but rather the ‘let’s compete around quality of care and let information freely flow’ concept. That’s been quite refreshing, and moving forward we’re looking at the next tier of smaller physician practices,” Ator says.

LACIE further attempts to make the exchange process more doable by not charging organizations a fee to connect. “We have always believed in connecting to other HIEs, be it community, regional, or state. But we don’t pay other organizations to connect nor do we charge others to connect to us,” Dittemore says. “LACIE is a public type of entity. We think that’s why it’s here, for the spirit of moving information regardless of where they reside. We have been adamant about that, but not all facilities feel the same way. So that’s been a barrier,” Dittemore notes.

Making HIE Valuable

Currently, LACIE is consistently seeing 100,000 queries per month going through the HIE, and according to Dittemore, one of the things that really helps provide value to its providers is getting robust information trading rather than just checking a box. “If checking a box is what you want, our HIE won’t be for you. We’re about the meaningful trading of information,” he says.

To this end, all of LACIE’s connected providers are encouraged to share radiology reports, discharge reports, clinic visits, and any summaries, Dittemore adds. “What we have found is that when you have that type of information above and beyond the continuity of care document (CCD) or consolidated-clinical document architecture (C-CDA), it really provides a great platform for providers to go in and look at the information and find out what is really going on with patients in those last visits,” he says. “We want to try to get rid of the fax machine, or reduce its use by as much as possible. Having this robust information available does help providers to move onto other duties like taking care of patients. They become valuators rather than investigators,” says Dittemore.”

Expanding on the notion of meaningful data exchange, Ator notes that fax machines are how providers are doing HIE right now, and what’s more is that Direct also has issues with people’s addresses as well as its own technological problems. “I am an Epic customer at KU, so we have a number of Cerner operations in town as well as Epic operations, and when you log into Epic for instance, we can go out to the HIE and search for a patient, at which point a very robust matching algorithm kicks in and we get textual documents presented in reverse chronological order. Operative notes, progress notes and discharge summaries are all within Epic without a separate log-in,” Ator explains. “Our providers don’t have to dig through exchange formats such as CCDs and CCDAs to see it in a meaningful manner. And that’s Cerner shop looking at Epic and vice versa,” he says.

Value to providers is further seen in the form of impacting patient outcomes. According to Ator, the strongest use case now is in the ER. “The patients here in a big city circulate around the EDs, and it’s fabulous to have the notes as it was was signed from an organization right down the street that a person might have checked into,” he says. “So we have seen improved outcomes around the ED, and the literature backs that up. I think that it is clear there is benefit in ED world, but rest is bit too soon to call,” Ator says.

Dittemore also says that value has been seen on the care management side. Kansas City has multiple medical facilities and acute care facilities, but even more non-acute facilities, he says. Just because a patient happens to go to a provider or an urgent care clinic that they have affiliation with, they might not go there for all care, and that’s something that needs to be seen in the HIE, he says. Also with specialists, making sure to ensure patients have done the appropriate follow up and have been to specialists allows care managers to see if that has happened and if not, find out why, Dittemore says. “Was it a transportation problem, an illness or what? It gives them something to go off of when they reach back out to the patient. Care managers have seen great value in this to manage that care between multiple facilities that might not be financially related to one other. That’s been rewarding,” he says.

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Proposed 2016 Budget to Build on Benefits of Meaningful Use |

Proposed 2016 Budget to Build on Benefits of Meaningful Use | | Healthcare and Technology news |

Several divisions within the Department of Health & Human Services (HHS) are charged with making use of the federal agency’s proposed fiscal year 2016 budget to expand the benefits of meaningful use by ensuring interoperability and health information exchange.

As part of the President’s FY 2016 budget request proposal, HHS will receive $83.8 billion in discretionary funding which is for the most part directed at implementing and sustaining the Affordable Care Act. That being, meaningful use is a priority for three departments within the federal agency, with $92 million dollars earmarked to support interoperability and meaningful use.

First in all, the Agency for Healthcare Research & Quality is tasked with devoting $20 million of its total $23 million FY 2016 budget to 55 grants focused on providing evidence to justify the sizeable national investment in health IT to improve the quality, safety, and effectiveness of healthcare across the country.

“This portfolio operates in close coordination with other federal health IT programs in order to leverage resources and maximize their impact,” the authors of the HHS budget brief explain. “For example, this research creates the evidence base and data that are utilized by the HHS Office of the National Coordinator for Health Information Technology to inform Meaningful Use Stage 3.”

Speaking of the ONC, that federal agency has the greatest number of meaningful use-related obligations to fulfill during the next fiscal year with its $92 million in funding. “In FY 2016, ONC’s investments will reflect a greater focus on interoperability through standards development, certification, and governance structures to support the requirements of Meaningful Use Stage 3,” the brief indicates

The ONC’s responsibilities fall into five categories:

Standards, interoperability, and certification: Focusing on the investments the federal agency must make into health IT standards development, certification, and pilot testing of interoperability initiatives with an emphasis on leveraging Stage 3 Meaningful Use.

Policy development and coordination: Expanding of ONC’s certification program to provide regulatory guidance for healthcare organizations and providers ineligible for meaningful use incentives.

Governance of health information exchange: Transitioning to a governance approach to ensure that HIEs and the exchange of health information adhere to a common set of policies, standards, and practices that a consistent with health data security and privacy.

Adoption, utilization, and meaningful use: Providing technical assistance federally through rather than through local resources.

Consumer eHealth: Enabling consumer access to electronic health information in a convenient and secure way.

Although the Centers for Medicare & Medicaid Services (CMS) are the architects of the EHR Incentive Programs, their role in promoting the benefits of meaningful use is not as pronounced as either AHRQ’s or the ONC’s.

With a FY 2016 budget of $970.8 billion, meaningful use only features as a part of the major planned activities for CMS under the Improving Medicare Post-Acute Care Transformation Act of 2014. The EHR Incentive Programs are intended to help improve prevention coordination and patient outcomes.

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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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Meaningful use numbers show signs of life, groups still lobby for relief | Healthcare IT News

Meaningful use numbers show signs of life, groups still lobby for relief | Healthcare IT News | Healthcare and Technology news |

Stage 2 meaningful use attestations have shown big improvements recently, but many providers are still struggling. With her Flex-IT Act gaining traction in the House, Rep. Renee Ellmers, R-N.C., along with 28 fellow members of Congress, have called on HHS Secretary Sylvia Burwell to offer relief in the form of a shorter 90-day reporting period.

The American Medical Association, meanwhile, is "appalled" that more than half of eligible providers will face penalties in 2015.

Speaking before the ONC's Health IT Policy Committee this past week, Elisabeth Myers, policy and outreach lead at CMS's Office of eHealth Standards and Services reported some drastic Stage 2 improvements.

Hospitals, which had managed to log just 840 attestations through October, doubled that number between Nov. 1 and Dec. 1 – with 1,681 success stories as of the beginning of the month.

Eligible providers, meanwhile, managed another 5,000 successful attestations over the month – from 11,478 through Nov. 1 to 16,455 by Dec. 1.

For a program that seemed on such shaky ground as recently as this fall, those numbers are heartening. Still legislators and industry groups would like to see more. And a three-month reporting period in 2015, rather than a full year, would be one way to see even more success, argues Ellmers, along with more than two dozen, mostly-Republican colleagues, in a Dec. 16 letter sent to HHS.

"We remain convinced that program success hinges on addressing the 2015 reporting period requirements," Ellmers wrote, asking that HHS "immediately provide" a shortened, 90-day reporting period in 2015, "which would give providers much-needed time to safely and effectively implement certified technology and continue their 'meaningful use' journey."

Full-year reporting will "complicate the forward trajectory" of the program and "jeopardize the $25 billion in federal investment made to date," she wrote.

"Our constituents remain concerned that the pace and scope of change have outstripped the capacity of our nation’s hospitals and doctors to comply with program requirements," wrote Ellmers, who co-sponsored the Flex-IT Act this past September, in answer to outcry over CMS holding fast on its 365-day reporting period – a move that "disregarded recommendations made by the vast majority of healthcare stakeholders."

On Wednesday, CHIME President and CEO Russell P. Branzell issued a statement in support of the letter.

CHIME, he said, "applauds the leadership" Ellmers and her colleague, Rep. Jim Matheson, D-Utah, "have shown on this important, bipartisan issue and are pleased their colleagues recognize how essential meaningful use is in the modernization of the nation’s healthcare delivery system."

He added that December data from CMS showing that about half of the nation's physicians will receive penalties in 2015, "only validate our calls for increased program flexibility."

Indeed, that penalty data had the AMA hopping mad on Wednesday.

The AMA, said President-Elect Steven J. Stack, MD, is "appalled" by the news that more than 50 percent of eligible professionals will face penalties under the meaningful use in 2015.

That's "a number that is even worse than we anticipated," he said.

"The AMA supported the original HITECH legislation and we have provided extensive and constructive feedback to the administration to help fix the meaningful use program, but few changes have been made," wrote Stack.

The penalties faced by docs under meaningful use "are part of a regulatory tsunami facing physicians, apart from the flawed Sustainable Growth Rate formula, that could include cuts from the Physician Quality Reporting System, the Value-based Modifier Program and the sequester, further destabilizing physician practices and creating a disincentive to see Medicare patients," he added.

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Future of interoperability is here | Healthcare IT News

Future of interoperability is here | Healthcare IT News | Healthcare and Technology news |
Hard to believe, but it has been a decade since the George W. Bush administration created the Office of the National Coordinator for Health Information Technology and issued a challenge to the healthcare industry that it should be seamlessly interoperable by the year 2014.

The initiative outlined some bold ideas and served as motivation for an industry that lagged behind in information technology development. And while the initial vision of a completely interoperable healthcare system may have had an off-the-mark time frame, experts agree that it got the machinations spinning in the right direction.

“To me, interoperability should be about that seamless flow of information,” says Joy Huntington, RN, clinical specialist at Roper St. Francis Healthcare in Charleston, S.C. “In reality, we’re not experiencing it at this particular point – we’re still in siloes electronically and gaps still exist. We’re not where the pundits thought we should be, but we can see now that they weren’t realistic in their expectations. That doesn’t mean we haven’t made substantial progress – we have in many ways.”

Currently Roper St. Francis has “a higher degree of interoperability than most,” Huntington says, as the inpatient and outpatient sectors “have some degree of interoperability.” The ER has its own system apart from the enterprise because it operates in its own self-contained environment, she says.

“We needed documentation that was easier to use, more specific and customizable,” Huntington says. “What we managed to do is let clinicians in the enterprise see and share the patient’s information, which they can view and validate.”

Looking back 10 years, Kirk Larson, regional CIO of Healthcare for Sunnyvale, Calif.-based NetApp, says the 2004 initiative helped to push healthcare out of its IT lethargy.

“Before that, organizations were content not to be interoperable,” he says. “That was OK because it was the norm and there was no pressure to change. Now as meaningful use is well into Stage 2, progress is not only encouraged, but mandated.”

If there is one place where interoperability has taken hold, it’s with health information exchanges, Larson says.

“They may not be eloquent, but they achieve the spirit of interoperability,” he says. “They can access data at the point of care and that makes a difference.”

More than EHRs

The impetus for the ONC’s creation and subsequent 10-year interoperability assignment focused on electronic health records and the seamless exchange of patient information among healthcare entities. And though that remains the chief concern, interoperability has various dimensions of functionality, says Zane Schott, vice president of business development for Salt Lake City-based BlueStep.

“You don’t need an EHR to be integrated,” he says. “There are so many organizations in post-acute and long-term care that are still running paper. Even so, they have the ability to be interoperable because with the MDS (Minimum Data Set) they have to produce files that can be sent to CMS electronically. We can lift that piece of information and submit it to an HIE or hospital based off the MDS so that even without an EHR they can be interoperable.”

A key reason why providers in the post-acute sector are still dealing with paper is that they were not included as eligible for ARRA funds and therefore are not involved in the meaningful use push.

“What this means is that, ironically, seniors are being left behind in the interoperability initiative,” he says, “and that is tragically unfair.”

‘Cross pollination’

Connectivity with payers is another important aspect of interoperability, which is the bailiwick of Cambridge, Mass.-based Pegasystems. While the company serves most of the major health plans, it also focuses on government agencies, health systems and life sciences.

“It’s a great pollination of ideas from retail verticals to financial services,” says Elizabeth Hart, industry principal for healthcare. “We target the different pain points and verticalize them for the customers we sell to, but also extend from those so that you can start a CRM system and call center and build an enrollment system out of that.”

Hart concedes that despite gains, healthcare is still reliant on 30-year-old legacy systems that don’t have the functionality needed to make interoperability a reality.

“Traction is being made, but it is still not moving at the pace we need,” she says. “A lot of it has to do with the fact that there is more data coming out with in-home monitoring and mobile devices that weren't envisioned from the old systems and existing EHRs. We end up wrapping around those systems to give them the capabilities and capacity they need.”

A new ‘connection’

The hallmark event for interoperability is the IHE North American Connectathon, which will be held Jan. 26-30 at the Cleveland Convention Center and HIMSS Innovation Center in Cleveland. The sponsors are enthused with the new venue after 15 years in Chicago.

“Cleveland’s state-of-the-art Convention Center and Global Center for Health Innovation – called ‘The Globe’ by the locals – has provided Cleveland with the opportunity to become an epicenter for healthcare and innovation,” said Celina Roth, HIMSS manager of informatics and staff liaison to the IHE. “Together these two venues are creating a new renaissance in downtown and revitalizing the city.”

The IHE Connectathon is a cross-vendor, live, supervised, and structured testing event with more than 100 participating vendors and 600-plus engineers and IT architects. All these organizations and IT experts converge on-site for one week of interoperability testing and problem resolution. Participants test their products against multiple vendors using real-world clinical scenarios contained in IHE's Integration Profiles.

With implementation of IHE Profiles growing, IHE USA has introduced new programs, such as a new one-day technical program called Connectathon 101. It will be offered on Tuesday, Jan. 27, to help engineers gain a full understanding of the Connectathon testing process, experiment with the testing tools, and work one-on-one with industry experts. Engineers who complete the session leave prepared to participate in next year’s IHE North American Connectathon 2016.

“While EHR usage has increased significantly, the interoperability necessary to achieve continuity of care, population health, patient management and clinical quality improvement is not yet realized,” Roth says. “Interoperable health IT has made strides in many areas like ePrescribing, but widespread progress remains slow.”
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How New Prices and Payments are Changing the Way We'll Receive Healthcare under the Affordable Care Act

How New Prices and Payments are Changing the Way We'll Receive Healthcare under the Affordable Care Act | Healthcare and Technology news |

In the wake of the recent King v. Burwell Supreme Court decision to uphold subsidies for the 34 state health insurance exchanges under the Affordable Care Act, it's worth understanding why losing them would've made insurance for nearly 6.4 million Americans unaffordable. It boils down to two numbers: the cost of delivering care and the rate that hospitals are paid to do so.

Most physicians are currently paid under a 'fee-for-service' model, a flat sum for each individual test or procedure provided to a patient. It's no surprise then that the number of prescribed tests has skyrocketed over the past two decades as hospitals attempt to increase revenue. For any given condition, the United States both orders and spends more on unnecessary screens and treatments than any other country on Earth, often with no better outcome for the patient. An MRI in the United States costs five times as much as the same MRI in France.

Most countries negotiate with healthcare providers to set rates at acceptance levels. Prices are either directly set by the government or are negotiated upon by providers and insurers prior to delivering care. In both instances, the price of healthcare is generally much lower than that of the United States, where, outside of public programs like Medicaid and Medicare, providers can usually charge whatever they can get away with to make up for the high costs of pharmaceuticals and medical devices. Furthermore, the amount paid for a given service is identical regardless of whether the outcome is good or bad. Imagine going to a restaurant and paying the same amount for a meal that left you satisfied and another--that you likely didn't order but were given anyways--that gave you food poisoning. That's how fee-for-service works.

The lack of accountability on the quality of care compounded with a healthcare financing model that rewards hospitals for increasing volume, not value, was a recipe for disaster, causing healthcare spending to jump to nearly 20% of GDP, but left the rate of increase in life expectancy in the dust compared to Europe and Japan.

The U.S. first tried to address rising healthcare costs in the 1990s through a model known as 'global capitation'. Providers were paid a single pre-defined sum to cover all treatment for each patient. If a physician or healthcare organization delivered care to a patient at a cost less than the sum it received, it turned a profit. If it overshot the sum, it lost money. While this model rewarded physicians for spending less, it did nothing to reward physicians for improving outcomes. As a result, physicians had a financial incentive to avoid expensive treatment plans and costly patients, resulting in poor quality care.

In 2012, as an extension of the Affordable Care Act, the Obama Administration launched the Pioneer Accountable Care Organization (ACO), a 'global payments' model that rewards hospitals that deliver quality care at costs lower than a pre-defined benchmark and punishes hospitals that overspend. If hospitals in the program spend below expected costs, they keep 70% of the savings; the other 30% goes to the federal government. If they spend more than expected, they pay the federal government the difference.

Some policymakers and physicians worry that the Affordable Care Act's global, or bundled, payments model is simply disguised capitation. Although bundled payments have a cost control structure similar to global capitation, they have been flexibly designed to avoid its pitfalls by rewarding value-based patient care. Physicians are paid for each patient based on how much treatment would cost for a given clinically defined episode of care. This risk adjustment allows for variability in global payments based on the illness burden of a provider's patient population. Additionally, unlike capitation, providers are directly rewarded for improving patient outcomes, incentivizing consistently-measured, high-quality care. Some global payment models do not involve any punishments for overspending, as opposed to the Pioneer ACO, but continue to reward strong physician performance.

Over the last two years, the Pioneer ACO program has saved $384 million in healthcare costs. In combination with the Medicare Shared Savings Program (MSSP), another global payments initiative, it has contracted with 154 organizations in forty states. All hospitals involved showed improved performance quality measures, readmission rates, and cholesterol level monitoring. Furthermore, patients gave similar rates of satisfaction compared to previous models of care and even reported better access to physicians. The end result is higher quality care at a lower cost for patients.

While Pioneer is illustrative of a step towards progress in managing healthcare costs, it hasn't been perfect. Most 2012 Pioneer participants were large, sophisticated hospital networks with the capability to rapidly change their method of delivering care, very different from the public hospitals that serve the populations that need health reform the most. Of the 32 hospitals that registered for Pioneer in 2012, 13 dropped out and 14 failed to produce any substantial savings. However, most dropout hospital networks still plan to pursue less-aggressive value-based payment models, such as MSSP, and found their experience with Pioneer to be an effective transition for both patients and providers to the global payments model. Additionally, the practice of measuring and collecting data on physician performance and patient outcomes will give both the federal government and providers a more transparent understanding of what treatments work, providing evidence-based information to set prices based on the value of individual treatments. If there's any one change that will reduce U.S. healthcare costs in the long term, it's lowering prices.

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Advocacy Groups Question Logic of Stage 3 Proposals to CMS

Advocacy Groups Question Logic of Stage 3 Proposals to CMS | Healthcare and Technology news |

Healthcare advocacy groups and other stakeholders are turning a critical eye towards the proposed rule for Stage 3 of meaningful use.

Comments for the Stage 3 proposed rule, released in March, are due at the end of the week. Major groups, such as the American Hospital Association (AHA) and the College for Healthcare Information Management Executives (CHIME), have begun to release their overall thoughts. The early consensus is a negative outlook on the Stage 3 proposals.

CHIME called the sum of all Stage 3 proposals by the Centers for Medicare and Medicaid Services (CMS) “unworkable.” Specifically, CHIME mentioned the requirement that would establish a single set of objectives and measure, tailored to eligible providers (EPs), eligible hospitals (EHs), and critical access hospitals (CAHs), by 2018. They said that most providers wouldn’t be able to participate by 2018.

“And with so few providers having demonstrated Stage 2 capabilities, we question the underlying feasibility of many requirements and question the logic of building on deficient measures,” CHIME wrote in its letter to Andy Slavitt, Acting Administrator for CMS.

CHIME offered specific suggestions including a 90-day reporting period for the first year of Stage 3, the elimination of patient action thresholds for the care coordination objectives, reduce the view, download or transmit requirement from 25 percent to five percent, reduce the number of measures in multi-measure objectives, and allowing paper-based means to achieve measure thresholds. They specifically targeted the patient action requirements to care coordination, saying it was “unrealistic.”

"We question the value of setting thresholds for technology and process not yet invented, let alone widely deployed in healthcare," CHIME Board Chair Charles E. Christian, Vice President of Technology and Engagement with the Indiana Health Information Exchange, said in a statement. "From the heavy reliance on APIs to an assumption that patient-generated health data will flow in standardized ways, our industry has a long way to go if it is going to catch-up with this rule by 2018."

The AHA had an even more critical tone with the patient-generated data element. They called it “premature” in their comments. They said the readiness of standards to support the validation of the data and the ability to match the data to the correct patient are record are “unknown at this time.” They also say that the concept of using APIs to share data also lacks maturity and the security risks are too significant to be a requirement. Like CHIME, they said the lack of a patient matching solution is a huge issue to accelerating health information exchange.

Both the AHA and CHIME were not certain over the health information exchange objectives outlined in the proposed rule. CHIME said the thresholds for the three HIE measures were unrealistic while AHA said that the standards and exchange infrastructure were not mature.

Moreover, the AHA said that CMS should avoid doing anything at all with Stage 3 until Stage 2 is all settled.  “While the Stage 3 proposals offer promising ideas that could further health information exchange and support greater patient engagement, we do not yet have sufficient experience at Stage 2 to be confident that the proposals for Stage 3 are feasible and appropriate,” AHA Executive Vice President Rick Pollack wrote.

Healthcare Informatics will add more to this story as published comments from stakeholders roll in. Once the commenting period ends, CMS will use that feedback to create the Stage 3 final rule. Potentially adding to the confusion is a requirement in newly minted legislation repealing the Sustainable Growth Rate that sunsets penalties for meaningul use by 2019.

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Is Synchrony on the Horizon When It Comes to Harmonizing MD Quality Reporting Efforts?

Is Synchrony on the Horizon When It Comes to Harmonizing MD Quality Reporting Efforts? | Healthcare and Technology news |

As if federal healthcare officials hadn’t laid out enough clarity around where things are going in terms of incentives to providers in U.S. healthcare during HIMSS15, on Thursday, Apr. 23, the federal Centers for Medicare and Medicaid Services (CMS) clarified things even further. As HCI reported  last week, the agency announced, via a blog post by Patrick Conway, M.D., principal deputy administrator and chief medical officer at CMS, the release of its strategic vision for physician quality reporting programs, describing a long-term vision for the agency’s M.D. quality reporting program, and a vision for physician quality reporting going forward.

As the blog noted, the agency believes that five principles will ensure that physician quality measurement and public reporting play a critical role in improving care, those five being:

  • Input from patients, caregivers, and healthcare professionals, which will guide those programs.
  • Feedback and data drives rapid-cycle quality improvement
  • Public reporting providers meaningful, transparent, and actionable information.
  • Quality reporting programs rely on an aligned measure portfolio.
  • Quality reporting and value-based purchasing programs are aligned.

In the CMS blog, Dr. Conway noted that “CMS relies heavily on quality measurement and public reporting to facilitate the delivery of high quality care. This strategic vision articulates how we will build up on our successful physician quality reporting programs to reach a future-state where quality measurement and public reporting are optimized to help achieve the CMS quality strategy’s goals and objectives.”

Conway further noted that “These quality measurements and public reporting goas and initiatives encourage stakeholder engagement; reduce participation burden for healthcare professionals; and support meaningful public reporting.”

Interestingly, also at the same time last week, the Oliver Wyman consulting firm reported that the number of accountable care organizations (ACOs) nationwide continued to rise in 2014, to the extent that nearly 70 percent of the U.S. population now lives in localities served by ACOs, and 44 percent lives in areas served by two or more ACOs. What’s more, the Oliver Wyman reported noted, ACOs of all kinds now collectively serve between 49 and 59 million U.S. residents, or between 15 and 17 of the nation’s people.

The synchrony in those two developments is worth noting. As HCI reported earlier this month, the U.S. Congress passed, and President Obama signed, legislation eliminating the much-criticized sustainable growth rate (SGR) formula for Medicare physician payment, and within that legislation was contained an overhaul of physician quality reporting programs under Medicare. Interestingly enough, as more and more accountable care programs emerge in U.S. healthcare, with many private-payer programs mimicking some of the core elements of the Medicare program’s ACO programs, over time, the vast majority of U.S. physicians are coming under contract with public and/or private payers that are measuring their outcomes. Now, one of the longstanding complaints about all the various measurement programs out in the industry has been how many there are and how complicated their differing requirements are making life and practice for practicing physicians.

What inevitably seems to be happening here is that some kind of harmonization of outcomes measurement is evolving forward organically. It is still quite nascent; yet it is also clear. As I reported during HIMSS15, the Blue Cross Blue Shield Association’s Blue Distinction Total Care Program is pulling many tens of thousands of practicing physicians into its nationwide umbrella population health program, creating a quality outcomes reporting program within its population health program that could become one of a few dominant such programs in the U.S. private insurer sector.

So the reality is that the long-anticipated harmonization of physician quality reporting emerging both on the public (Medicare) and private health insurer sides of the industry could be starting to come into focus now as we speak. The opportunities coming out of the gradual harmonization of outcomes reporting and measurement efforts across the industry will certainly be a welcomed development for practicing physicians nationwide—and a signal that healthcare quality measurement is reaching a new, more impactful stage.

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Meaningful Use Facts: Medicare vs. Medicaid

Meaningful Use Facts: Medicare vs. Medicaid | Healthcare and Technology news |
The Medicare and Medicaid EHR Incentive Programs ("meaningful use") have been, and continue to be, a hot topic. Early 2015 is an excellent time to revisit some of the details and the differences between the Medicaid and Medicare programs.

The American Recovery and Reinvestment Act of 2009 (ARRA), not Obamacare, provided funding for incentives to promote the adoption and meaningful use of certified EHR technology, as well as penalties for Medicare providers who fail to do so.

1. The Medicaid incentives are more generous than those for Medicare.

• Medicaid maximum incentive per eligible provider (EP): $63,750

• Medicare maximum incentive per EP: $43,720

• The initial Medicare maximum incentive was $44,000.

Beginning in 2013, the incentive payments became subject to the 2 percent reduction for sequestration.

2. The years for incentive participation are different for Medicaid and Medicare EPs.


• Payments are available for a total of six years between 2011 and 2021, inclusive, meaning a Medicaid provider can earn the full incentive payment with participation beginning as late as 2016.

• Meaningful use attestation is only required in year one for EPs who were using an EHR before year one.


• Payments are available for a different number of consecutive years depending upon the first year of participation:

Year 1 – 2011, 2012, or 2013: 5 years

Year 1 – 2013: 4 years

Year 1 – 2014: 3 years

Year 1 – 2015 or later: No incentives

• No Medicare meaningful use incentives are available for any reporting period after 2016.

• The deadline to attest to meaningful use for a reporting period beginning October 1, 2014 is February 28, 2015. Although time is short, an EP could still qualify for Medicare incentive payments for 2014, 2015, and 2016.

3. The calculation for incentive payments is different for Medicaid EPs and Medicare EPs.

• The annual Medicaid incentive is 85 percent of the EP's net average allowable EHR costs for the reporting period.

• The annual Medicare incentive is 75 percent of the EP's Medicare allowable charges for covered services during the reporting period.

• Each incentive payment is subject to an annual maximum, depending upon the program (Medicaid or Medicare) and the EP's year of participation.

4. Penalties for non-participation in meaningful use begin for Medicare services rendered in 2015.

• Medicaid payments for services rendered are not subject to penalties related to meaningful use.

• Medicare payments, for services rendered in 2015 and later, are subject to reductions from the physician fee schedule (PFS.) The penalty begins at 1 percent. It can increase annually by 1 percent, up to a maximum of 3 percent, or 5 percent if less than 75 percent of EPs are meaningful users of a certified EHR system.

Even though the incentives for adoption are winding down, meaningful use is here to stay. It is still not a mandate, so each EP must evaluate the costs and benefits of implementing and meaningfully using an EHR for himself.

Here are some examples that may be helpful:

Example 1

An EP successfully attested to meaningful use for the first time by October 1, 2014.

The EP's 2015 Medicare payments will not be subject to the 1 percent reduction.

The EP must attest to or demonstrate meaningful use again by February 28, 2016 to avoid a reduction in 2016 Medicare payments.

Example 2

An EP successfully attested to meaningful use for a 2013 reporting period, making the attestation in either 2013 or 2014.

The EP's Medicare payments will not be subject to the 1 percent reduction in 2015, provided the EP successfully demonstrates meaningful use for 2014 no later than February 28, 2015.

Example 3

As of October 1, 2014, an EP has never demonstrated meaningful use.

Before February 28, 2015, the EP successfully attests to meaningful use in 2014.

The EP's 2015 Medicare payments will be subject to a 1 percent reduction from the PFS.

Example 4

An EP has successfully demonstrated meaningful use for 2013 and 2014. He does not demonstrate meaningful use for 2015.

There will be no reduction in the EP's Medicare payments in 2015, at least for meaningful use.

The will be a 1 percent reduction in the EP's Medicare payments for covered services rendered in 2016.
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Robust Technology Platforms and Medicare Home Health Providers

Robust Technology Platforms and Medicare Home Health Providers | Healthcare and Technology news |

The home care industry, in its various forms, represents an $82 billion market with a population of potential customers that is growing by the minute. In fact, within the next five years, 20 percent of Americans will be eligible for Medicare services and many of them will avail themselves of home health services that will be funded by Medicare. Last month, the Centers for Medicare and Medicaid Services (CMS) released the 2015 Home Health Final Rule (Final Rule), which sets forth the details of the second year of payment rebasing under the Patient Protection and Affordable Care Act (ACA) together with other new rules, clarifications of previous rules and discussions of things to come. CMS makes it clear that its goal is to more closely align payment for services with the cost of providing them.

Interestingly, while physicians and hospitals were included in CMS’ meaningful use EHR Incentive Programs that began in 2011, home care providers were excluded from incentive opportunities. However, even in the absence of financial incentives for technology adoption, implementation of robust technology platforms capable of gathering, organizing, processing and protecting patient health and financial information is still crucial. Consider the following top five reasons for why technology adoption is not optional for Medicare certified home health providers.

  • First, there are 1,836 potential Health Insurance Prospective Payment System (HIPPS) Codes that form the basis for Medicare home health reimbursement. There are 3,273 counties represented for which an applicable wage index has been established for purposes of calculating reimbursement. That yields a potential universe of payment values in excess of $6 million.
  • Second, even the most straightforward of the episode payment calculations has at least three steps and the most cumbersome, outlier calculations, has over a dozen. Imagine trying to manually arrive at accurate calculations for each episode.
  • Third, newly proposed Medicare Conditions of Participation place increasing emphasis on the quality and coordination of patient care supported by detailed clinical records. Significant survey emphasis for home health providers is now being placed on reconciliation of medications as well as the adequacy of other clinical documentation. Technology greatly assists in creating efficient ways of achieving the desired end result of coordinated, cohesive and locatable clinical documentation.
  • Fourth, in order to justify payment, home health agencies must be able to schedule visits based on physician ordered care plans, record when visits are made or missed, and aggregate visit notes that are responsive, in the main, to ordered interventions. And, not incidentally, visit times must be translated into unit-based increments for claim submission purposes.
  • Finally, as the 2015 Final Rule demonstrates, the calculation rules and values change every year.

The operational needs and payment changes put into place for home health agencies are significant and have far reaching implications not only for agencies, but also for the whole industry. As the importance of post-acute care modalities grows in a countrywide effort to regulate costs and improve health outcomes, strong home health providers will play a key role in our general success in this area whether or not they are incentivized to adopt technology through meaningful use programs.

In order for home health agencies to continue building business momentum while ensuring top-quality care and health outcomes, they will need to be able to fully and quickly implement new regulations that change each year and adapt operational procedures correspondingly. Calculations, functions, decision support tools, up-to-the minute informational dashboards and reports will be a must for any home health provider that expects to thrive in what will be a very challenging and intricate operating environment. Fortunately, just as intricacy in processes will increase, there is also an increasing amount of cost-efficient and cloud-based technology alternatives available to providers to enable them to manage effectively the required details of providing home health services.

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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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257K Meaningful Use EPs to Get Medicare Payment Adjustments |

257K Meaningful Use EPs to Get Medicare Payment Adjustments | | Healthcare and Technology news |
Close to 260K meaningful use eligible professionals will receive notice of upcoming Medicare payment adjustments for failing to meet the requirements of the Medicare EHR Incentive Program.

Over the next few weeks, more than 257,000 provider eligible for the Medicare EHR Incentive Program will receive notice that they will be subject to Medicare payment adjustments beginning in 2015.

Earlier today, the Centers for Medicare & Medicaid Services (CMS) revealed the number of eligible professionals who would reductions in their Medicare payments in 2015 for failing to demonstrate meaningful use in previous years.

“As part of the American Recovery and Reinvestment Act of 2009, Congress mandated that payment adjustments be applied to Medicare-eligible professionals who are not meaningful users of certified EHR technology under the Medicare Electronic Health Record Incentive Program,” the federal agency told reporters.

“We are getting ready to start mailing the letters to the eligible professionals who will be getting this payment adjustment and it is a number that is over 257,000,” CMS officials continued, “and these people will be paid one percent less of the Medicare Physician Fee Schedule amount that would otherwise apply for all their Medicare-covered professional services that they provide.”

More than 28,000 EPs will see a two-percent reduction in their 2015 Medicare payments for failure to comply with both the Electronic Prescribing (eRx) Incentive Program as well as the Medicare EHR Incentive Program.

The Medicare payment adjustments for EPs will begin next month, going into effect on January 5 after CMS completes system changes. As part of the notification, these providers will receive instructions for challenging CMS’s decision. “When they receive the letter, they will receive instructions for how they can apply for reconsideration and we will be taking those applications through the end of February,” the federal agency explained.

The application for reconsideration should appear on the CMS website later today. “They just answer the questions on the form and fill in the information. It’s possible that we could’ve made a mistake and we want to make sure that people have the opportunity to point that out to us,” added CMS officials.

The number of Medicare EPs receiving notices pales in comparison to the number of hospitals subject to payment adjustments, which according to CMS is slightly for than 200 eligible hospitals. CMS is not yet able to say what percentage of the total number of EPs is subject to Medicare payment adjustments. “We don’t have that information available at this time. We’re working on developing that,” CMS revealed.

What is known is the effectiveness of the two meaningful use hardship exception application periods. The first period ending July 1, 2014, saw 43,000 applications submitted and little than 1,000 denials. The second period ending Nov. 30, 2014, saw another 13,000 applications and less than 1,000 denials.

The final 2014 meaningful use reporting period is coming to end this month after which time EPs must complete their meaningful use attestation to avoid 2016 Medicare payment adjustments. Currently, EHs are coming closer to the deadline for meaningful use attestation extended to Dec. 31, 2014, to avoid similar penalties.

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