Tag: Affordable Care Act (ACA)
Responding to physician dissatisfaction with electronic health records, the Senate Health, Education, Labor, and Pensions Committee has created a bipartisan working group to identify ways that Congress and the Obama administration can collaborate to improve EHRs.
“After $28 billion in taxpayer dollars spent subsidizing electronic health records, doctors don’t like these electronic medical record systems and say they disrupt workflow, interrupt the doctor-patient relationship and haven’t been worth the effort,” said Sen. Lamar Alexander (R-Tenn.), chairman of the Senate committee, who has been joined in the effort by Ranking Member Sen. Patty Murray (D-Wash.). “The goal of this working group is to identify the five or six things we can do to help make the failed promise of electronic health records something that physicians and providers look forward to instead of something they endure.”
Alexander and Murray have extended an open invitation to all members of the Senate health committee to participate in the EHR working group, whose objectives include:
*Helping doctors and hospitals improve quality of care and patient safety;
*Facilitating information exchange between different EHR vendors and different health professionals;
*Empowering patients to engage in their own healthcare through convenient, user-friendly access to their personal health information;
*Leveraging health information technology capabilities to improve patient safety; and
*Protecting patient privacy and security of health information.
At an April 23 Senate Appropriations subcommittee hearing, Alexander informed Health and Human Services Secretary Sylvia Burwell that the working group would seek to address EHR problems “administratively” through HHS actions or “legislatively” with the passage of laws in Congress. Burwell told Alexander in response that HHS has put together a similar working group that is “ready to go and we are committed,” adding “we are looking forward to putting the list [of EHR issues] together and looking forward to getting it done.”
Toward that end, the Senate health committee announced that the bipartisan staff meetings will involve participation from health professionals, health IT developers, relevant government agencies, and other experts specializing in HIT.
When the 2015 legislative session begins next week, many of the state’s decisions on health care for the poor are on hold as state and federal Medicaid officials negotiate over funding, behind closed doors. Billions of dollars are at stake.
When it comes to health-care funding, Florida’s in a funny position. The state has twice turned down billions of dollars from federal Medicaid that would have covered care for about a million poor Floridians.
This year may be no different.
“I don’t believe for one moment that this is a good plan for Florida and I would certainly not change my opinion on that,,” said State Representative Matt Hudson, who chairs the powerful committee in charge of health spending.
At the same time, state legislators and Governor Rick Scott want federal officials to keep a special fund for hospitals that treat those same patients. It’s called the Low Income Pool.
It may seem inconsistent, but that’s health-care politics in Florida.
Justin Senior, Florida’s Medicaid director, is watching the calendar as he negotiates with federal health officials over renewing the Low Income Pool. It expires June 30.
“In order for us to make any plans for expenditures on July 1 of this year we really do need agreement in principle from our federal partners sometime in late March or very early April,” he said.
The Medicaid budget that Governor Scott recently sent to the Legislature includes more than $1 billion for the Low Income Pool. But federal Medicaid chief Eliot Fishman told business leaders in Orlando recently that the Low Income Pool – which he calls LIP — will not be renewed in its present form.
“We extended the LIP for a year with the explicit purpose of moving to a significantly reformed payment system,” Fishman said at the Associated Industries of Florida’s Health Care Affordability Summit.
To get that money last year, Florida had to agree on an independent evaluation of its Medicaid payment program. Fishman says that report by the consulting company Navigant shows lots of flaws.
“Florida’s payment system is complicated and far more so than the payment system in either Medicare or payment systems in other states,” he said. “That complexity leads to huge variation within the state in terms of the ratio of Medicaid payment to the cost of care.”
In other words, the program pays way more to some health-care providers than to others for the same service.
Florida can straighten out its payment problems if it expands coverage to the uninsured, Fishman said. Two years ago, the state House turned down billions of dollars from the Affordable Care Act intended for that purpose.
Fishman said states that did expand are seeing immediate results. In just one year, they’ve seen steep drops in unnecessary ER visits and hospital admissions.
“You’re talking about really dramatic historic reductions in that kind of utilization that certainly in my field, in health care policy, it’s really revolutionary,” he said.
Also, this issue is not just about the money. Fishman said poor people who can see doctors get illnesses diagnosed sooner. He says it can make a life-and-death difference.
“None of us should forget the sacred obligations that that really puts on us when we are talking about what the future is for the uninsured,” he said.
A big difference in the Medicaid expansion debate this year is that big business has added its heft to the push for the state to accept the Medicaid expansion money. That’s at least $3 billion a year.
The Senate may be open to considering taking that money, but the House isn’t.
“It’s dead on arrival.” State Representative Cary Pigman, a Republican from Sebring. He’s also an ER doctor who chairs a panel on health quality.
Unless, Pigman says, the proposal looks a lot different from last time. It would need to give the state more control, use private insurance, reduce some benefits, and require more from Medicaid enrollees — healthy behavior, co-pays and willingness to work.
He said the House Republican caucus won’t accept a demand to expand Medicaid in order to avoid a sudden cutoff of the Low Income Pool. It’s unclear if that will happen.
“We believe the jury is still out with that. I believe there are some bureaucrats in Washington who don’t want to cut Florida off abruptly, I think there are other bureaucrats in Washington would like to punish us for not expanding Medicaid the way they want us to expand it,” he said.
Mark Delegal is an attorney with Holland and Knight. He represents the hospitals that will be hurt most if the Low Income Pool disappears. He feels certain an agreement will be reached, at least on that.
“It’s absolutely essential, Florida deserves it, Florida’s relied on it for 25 years in some fashion,” Delagal said. “To pull it out and eliminate it would not be sustainable for many, many hospitals.”
Federal dollars flowing to hospitals, physicians and other eligible healthcare professionals under the federal electronic health-record incentive payment program have topped $28.1 billion, the latest CMS data show.
Through December 4,740 hospitals, or 95% of the 4,993 hospitals deemed eligible for participation in the program, have been paid, sharing $17.4 billion.
Also, 426,597 physicians and other “EPs”, or more than 79% of the 537,600 who are eligible, have received $10.7 billion.
Total payments surged by about $2 billion over November numbers, in part because physicians and other professionals needed to meet their meaningful-use targets by the end of the calendar year.
The program was created under the American Recovery and Reinvestment Act of 2009 to encourage adoption and meaningful use of health information technology.
Payments began in 2011.
Hackers infiltrated Anthem’s information technology system and gained access to the personal information of about 80 million current and former members. It appears to be by far the largest cyberattack ever disclosed by a healthcare company.
In what the Indianapolis-based company described as a “very sophisticated” attack, hackers gained access to the names, birthdays, medical IDs, Social Security numbers, addresses, e-mail addresses, employment information and income data of current and former members, including Anthem employees, according to a letter to customers by CEO Joseph Swedish. The company has no evidence that credit card or medical information, such as claims, test results or diagnostic codes were “targeted or compromised,” Swedish wrote.
The source of the attack is unclear. All product lines were impacted, including Anthem Blue Cross, Anthem Blue Cross and Blue Shield, and Blue Cross and Blue Shield of Georgia, among other brands. Anthem (formerly WellPoint) has 37.5 million members enrolled in its affiliated health plans and serves 68.5 million people through all of its subsidiary businesses, which include Medicaid managed care and claims administration for self-funded plans.
Anthem is cooperating with an FBI investigation into the attack, and has contacted Mandiant, a major cybersecurity firm, to determine the vulnerabilities in its systems. Swedish notes in the letter that, along with his employees, his own personal information was accessed in the breach.
“I want to personally apologize to each of you for what has happened, as I know you expect us to protect your information,” Swedish wrote. “We will continue to do everything in our power to make our systems and security processes better and more secure, and hope that we can earn back your trust and confidence in Anthem.”
The Health Information Trust Alliance, a healthcare data security collaborative, said in a statement that Anthem has been collaborating with the HITRUST Cyber Threat Intelligence and Incident Coordination Center, or C3, by sharing some evidence related to the attack.
By anonymously sharing the information with C3 participants, HITRUST was able to determine that Anthem was the sole target of the attack. The IT security organization said Anthem took the steps necessary to prepare itself for a significant attack.
“We believe that Anthem’s adoption of strong information security controls, comprehensive assessment process, participation in cyber preparedness exercises and cyberthreat information sharing were crucial in their ability to detect, analyze, remediate and collaborate swiftly and effectively,” HITRUST said.
Anthem has pledged to continue to share information with HITRUST, the organization said.
The attack on Anthem dwarfs what was previously the biggest known healthcare breach attribute to hackers. That was last year when Community Health Systems, the Franklin, Tenn.-based hospital chain, was targeted by an attack originating in China. CHS said at the time it believed the hackers were hunting for intellectual property on medical devices but instead stole patient information belonging to 4.5 million patients of its physician practices.
Anthem intends to individually notify affected individuals and provide credit monitoring and identity protection services free of charge. It also created a website and a hotline for questions related to the incident.
Florida continues to lead every other state using the federal marketplace health insurance marketplace, with just over 1.3 million who were enrolled or were automatically re-enrolled in a health plan as of Jan. 23.
The high numbers are due to high demand, federal health officials say.
“Florida continues to lead the way, and I think that has a lot to do with the demand and has a lot to do with the people on the ground, the assisters, the navigators, the outreach,” said Andy Slavitt, principal deputy administrator for the Centers for Medicare & Medicaid Services. “I’ve had the opportunity to listen to some calls in the call center, and people in Florida seem to be really enthusiastic about getting coverage.”
More people enrolled in Miami-Dade County’s Hialeah (ZIP code 33012) than anywhere else in the nation, with 12,330 plan selections.
The highest enrollment in the Tampa Bay area is in a northwest Hillsborough County ZIP code (33614), where more than 3,600 people have signed up for a health plan.
Data for ZIP Codes with 50 or fewer plan selections are not included, but the place listed with the lowest number of enrollments is Intercession City (ZIP code 33848), which is about five miles west of Kissimmee in Osceola County.
“I think the work we’ve done on CuidadodeSalud.gov and all of our language services, I think makes it easier for people who are bilingual or who are Spanish-speakers,” Slavitt said.
Open enrollment ends Feb. 15.
The majority of patients would like to have digital services from their physicians such as online appointment scheduling, bill paying, and access to lab results, yet only about one primary care physician in three offers such customer service.
That is the finding of a new survey from TechnologyAdvice, a Nashville-based company that provides independent review and analysis of enterprise technology products.
“Primary care physicians are reporting some of the highest rates of EHR adoption to comply with government regulations and to receive incentives from Meaningful Use, but a significantly lower number of patients claim to have access to these patient portal services,” said TechnologyAdvice Managing Editor Cameron Graham, who authored the survey. “The issue here may not be implementation of digital services, but instead a lack of patient awareness. If physicians are offering these in-demand digital services, a more proactive approach to promoting them is needed and could create an advantage in attracting and retaining patients.”
Sixty percent of patients surveyed said digital services like online appointment scheduling and online bill pay are either “important” or “somewhat important” when choosing a physician. However, when asked what services their current physician provides, less than one-third of patients indicated they have access to either online bill pay, online appointment scheduling, or the ability to view test results and diagnoses online, which are the top three services that patients report wanting the most.
In addition, 68.6 percent of respondents said it was either “somewhat important” or “very important” that a physician follow up with them, yet only 30 percent of respondents reported receiving a follow-up that wasn’t related to bill pay.
Patient age also appears to influence what services are expected from physicians. Notably, every digital service listed on the survey was in greater demand among younger respondents. For example, 41.2 percent of patients between the ages of 25-34 said they would like their physician to offer online appointment scheduling, while just 13.5 percent of respondents over 65 said the same. The results also showed that 48.4 percent of the youngest respondents (18-24 year olds) would like to use a smartphone app to schedule online appointments.