Tag: Health Information Exchange (HIE)
The Centers for Medicare and Medicaid Services wants home health agencies to accelerate their use of health information technology. The agency is issuing no mandates yet, but certainly is leaving the door open.
CMS’s encouragement of electronic health records and health information exchange is in a proposed rule for the calendar year 2016 Medicare home health prospective payment system. Among the proposed financial provisions in the rule are reductions of 1.72 percent in CY 2016 and 2017 to the national and standardized 60-day episode payment rate, and a home health value-based purchasing model (value-based reimbursement) that would be imposed on all Medicare-certified home health agencies in nine states to be selected under a proposed methodology.
CMS, as it has done in other Medicare payment rules targeting ancillary provider organizations, explains the various initiatives, reports and guidance that can aid home health agencies in starting their journeys toward adopting more health IT.
CMS also makes clear its belief that advanced IT equates to greater success for home health organizations. “While home health providers are not eligible for the Medicare and Medicaid EHR Incentive Programs, effective adoption and use of health information exchange and health IT tools will be essential as these settings seek to improve quality and lower costs through initiatives such as value-based purchasing.”
Consequently, CMS strongly encourages use of HIT to improve care delivery processes and lower costs, engage patients, support care management across the continuum, and enable quality measures. And the regulator adds this note: “As adoption of certified health IT increases and interoperability standards continue to mature, HHS will seek to reinforce standards through relevant policies and programs.”
The fiscal year 2015 Omnibus Appropriations bill passed by Congress includes legislative language directing the Office of the National Coordinator for Health IT to decertify electronic health record products that are effectively blocking the sharing of health information.
“ONC should use its authority to certify only those products that clearly meet current meaningful use program standards and that do not block health information exchange,” states the bill. “ONC should take steps to decertify products that proactively block the sharing of information because those practices frustrate congressional intent, devalue taxpayer investments in [Certified EHR Technology], and make CEHRT less valuable and more burdensome for eligible hospitals and eligible providers to use.”
The legislation instructs ONC to submit a detailed report, not later than 90 days after enactment by Congress, regarding the extent of the information blocking problem. The report would include an estimate of the number of vendors or eligible hospitals or providers who block information, and a strategy on addressing the information blocking issue.
Congressional appropriators also instruct ONC’s Health IT Policy Committee to submit a report to the House and Senate Committees on Appropriations and the appropriate authorizing committees not later than 12 months after enactment regarding the challenges and barriers to interoperability. “The report should cover the technical, operational and financial barriers to interoperability, the role of certification in advancing or hindering interoperability across various providers, as well as any other barriers identified by the Policy Committee,” states the legislative language.
In March, industry stakeholders at a Federal Trade Commission workshop in Washington on healthcare competition warned that the proliferation of closed data networks are trapping providers and patients into proprietary networks that are barriers to interoperability and competition. Specifically, they charged that some health systems block patient information sharing in ways that have antitrust implications.
Business practices that inhibit or block the electronic sharing or transfer of health information are a serious concern, particularly developers or providers who restrict information exchange with users of other EHR products or HIE services, according to ONC. The agency has publicly pledged to work more closely with FTC to formulate policies that “improve transparency, promote interoperability, create incentives for quality, and reduce barriers to competition and innovation.”
Healthcare information-sharing is largely stuck in neutral, according to the Office of the National Coordinator for Health Information Technology’s annual report on electronic health-record adoption, released Thursday.
While standards and services have been established to support information-sharing, “practice patterns have not changed to the point that healthcare providers share health information electronically across organization, vendor and geographic boundaries,” the report argued.
Information-sharing is seen as a key component in the move from a fee-for-service approach in U.S. healthcare to a quality of care approach, so signs that the sharing isn’t happening could spell trouble for progress toward that shift.
As of June 2014, 75% of eligible professionals and 92% of eligible hospitals had received subsidies from the federal government to kick-start their adoption of electronic records, the report noted. So, EHR adoption is booming, the report noted. But moving beyond that to data-sharing appears problematic.
“Electronic health information is not yet sufficiently standardized to allow seamless interoperability, as it is still inconsistently expressed through technical and medical vocabulary, structure, and format, thereby limiting the potential uses of the information to improve health and care,” the report (PDF) said.
In 2013, 14% of office-based physicians shared patient information with providers outside their institutional walls; 39% shared information with any physician, even those inside the same institution. And 42% of hospitals electronically shared clinical-care summaries outside their systems, up 68% since 2008. In addition, 55% of hospitals shared radiology reports outside of their systems, and 57% laboratory reports.
Information-sharing is particularly problematic when attempting to share with post-acute-care and behavioral health providers, and long-term-care institutions. Those providers were not included in the federal EHR subsidy program and therefore have lower rates of adoption, the report noted.
The report stresses increased use of standards and “rules of the road” to aid interoperability. The report states the second stage of the meaningful-use program will help spur greater information-sharing, and believes HHS, CMS and ONC programs to aid innovation and health information exchanges will bear fruit. The report also argues that the earlier release of the ONC’s 10-year roadmap to interoperability will attract helpful comments on how to boost interoperability.
Interoperability and health information exchange (HIE) are getting a big boost thanks to several additions to the nation’s largest health information network (HIN).
On Tuesday, Surescripts made two announcements with the first revealing the extended scope of its public reporting service for immunizations. Four pharmacies (CVS/pharmacy, Rite Aid, Safeway, and Walgreens) and three vendors (including Aprima) signed on to gain access to 44 state and regional immunization registries across the country.
Around the same time, Surescripts announced the addition over the past year of approximately 100 major health systems to its network, whose services are used by a couple thousand provider organizations and scores of health information exchanges (HIEs) and health information service providers (HISPs).
As the Surescripts Executive Vice President and General Manager of Clinical Network Services Jeff Miller explains, the growth of the network and its services is pivotal in building a health IT infrastructure capable of address future and ongoing obstacles in the way of interoperability.
“Interoperability is a journey not a destination,” Miller tells EHRIntelligence.com. “There is not a point in time when operability is ‘done’ — just as there is not a point in time when internet connectivity is ‘done” or e-commerce is ‘done.’ Once we solve the interoperability challenges that we face today, we will face new challenges brought about by innovative delivery models and changes in the technologies themselves.”
Those comments are not meant to understate the importance of connections Surescripts continues to make in the short-term. If anything, it is an admission that the evolution of health IT systems and services necessarily leads to new and perhaps unforeseen consequences.
“It’s important to note that interoperability is happening today — e-prescribing was the first example, and that took the better part of a decade,” Miller continues. “Immunization reporting is another example, and we saw seven million transactions from Walgreens last year. And now, we’re seeing real progress in clinical messaging, with more than 2,000 provider organizations exchanging nearly one million messages last month alone.”
So what’s next for the growing network of healthcare providers, vendors, and other organizations?
“There is certainly still work to be done, primarily around provider adoption and utilization, development and support of more advanced workflows, and refinement of current standards to support the changes in the manner that this information is being utilized,” Miller maintains. “But demand is growing, the regulatory environment is encouraging, and the market dynamics are favorable.”
As noted in a story published earlier today concerning the partnership between Walgreens and Greenway Health, industry stakeholders are becoming acutely aware of the need to support patients in their journey along the care continuum by ensuring that relevant quality health information is available at the point of care, wherever that may be.
Recently, Cisco chairman and CEO John Chambers told me that U.S. health care is at a tipping point. A positive one, he hopes, but the truth is no one knows for sure which direction the system will tip.
At the close of our interview, I asked Chambers what health care topic he’d like me to cover in the future. He asked me to answer two questions. And they happen to be the two questions weighing most heavily on the minds of just about every U.S. health policy expert:
Question 1: “How will the health care world move from operating in silos to working together seamlessly?” And question 2: “How will (doing that) help patients achieve the health outcomes that are possible and most important to them?”
Predicting the future is impossible. But these five health care megatrends offer reason for hope – and for concern, as well.
1. The Formation Of Accountable Care Organizations (ACOs)
ACOs are groups of health care providers (primary care physicians, specialists, hospitals, etc.) who band together voluntarily to look after a patient’s total health. ACOs promise to eliminate silos, improve patient outcomes and lower overall health care costs.
At least, that’s the concept.
ACOs were built into the Affordable Care Act (ACA), also known as “Obamacare,” and carry both incentives for better clinical outcomes and the backing of many commercial insurance carriers.
If successful, ACOs could move American health care from its historically fragmented structure to one that provides substantially higher levels of integration and collaboration.
What that means for patients is that fewer will fall between the cracks at the point of care. When a primary care physician is sharing patient information and collaborating with a heart specialist, the probability of error decreases.
What’s the catch? Getting health care providers to work together is no easy feat.
Health care silos have been around for decades. Few doctors are quick to cede their independence or autonomy for the sake of greater collaboration. Meanwhile, hospital administrators don’t like having to share authority with clinicians. They’ve been trained to fill beds, not improve the effectiveness of care.
Most newly formed ACOs have demonstrated the ability to improve the quality of patient care. But few have been able to reverse the rising costs of health care delivery.
Overcoming the cultural issues is likely to prove harder than policy makers would hope.
2. Moving Away From Fee-For-Service Payment Models
Health care’s traditional fee-for-service payment model is flawed. Physicians and hospitals get paid based on volume and complexity of their services – not based on clinical outcomes.
Through these perverse incentives, physicians make more money by doing more tests, seeing patients more frequently and performing high-priced, complex procedures. Under fee-for-service, keeping patients healthy and avoiding major diseases would be relatively unprofitable for doctors and hospitals.
America spends nearly $3.8 trillion a year on health care. That’s 17.6 percent of the gross domestic product (GDP) and significantly more than any other country. Yet our measurable health outcomes – from infant mortality to life expectancy – rank nowhere near the top of developed nations.
Some health care delivery systems are adopting viable alternatives called prospective payments. These include bundled payments – a single payment for an entire episode of care (a start-to-finish treatment for any given patient). They’re also exploring capitation – a negotiated payment for a given period to cover the costs for a group of patients with clear expectations around quality and service.
Both approaches seek to shift financial incentives away from volume to providing total care for the patient. They’re about moving from sick care to health care.
And there have been some successes here. Take Pacific Business Group on Health (PBGH). Rather than generating a bill for hundreds of individual tests and procedures, PBGH is requiring hospitals and doctors to charge a single, all-inclusive price. In 2008, the purchasing group limited what it would pay for total joint hip replacements to $30,000. As a result, participating hospitals dropped the price of the procedure.
What’s the catch? Before we can generalize about the efficacy of this approach, we must recognize that total joint surgery is a procedure performed by only one group of medical specialists. And their outcomes are consistently good.
What happens when we introduce patients with more complex problems, like those with multiple chronic diseases? With bundled payments and capitation, physicians and hospitals will need to figure out how to distribute revenue among care providers from different specialties.
And this may prove more difficult in practice than theory.
3. Rewarding Better Health Outcomes and Quality
Medicare Advantage is an alternative to the fee-for-service (traditional) Medicare program.
Under Medicare Advantage, the Centers for Medicare & Medicaid Services (CMS) contract with private health plans to provide Medicare beneficiaries with medical coverage.
Patients enrolled in Medicare Advantage agree to obtain care from a specific group of physicians and hospitals. In return, subscribers enjoy lower out-of-pocket expenses.
Participating organizations must report quality and patient satisfaction data to CMS on an annual basis.
Based on this information, each Medicare Advantage program is awarded one to five stars. The Medicare stars program rewards the highest-rated organizations – the ones with superior quality, the greatest success in prevention and the highest levels of patient satisfaction – with additional payments.
What’s great about this program is that it aligns incentives and puts more power in the hands of patients. If the doctors and hospitals don’t perform, the health plans with which they contract receive a lower rating. And each year, patients get to assess which Medicare Advantage provider is right for them.
This program shows a lot of promise. It has demonstrated improved clinical outcomes and increased patient satisfaction. As a result, nearly half of all newly enrolled Medicare members select a Medicare Advantage plan.
What’s the catch? In spite of this success, most Medicare beneficiaries are still in the older fee-for-service payment model.
The Medicare Advantage model may be the future’s preferred approach. It combines many of the elements for success: choice, accountability and transparency. And it could well provide the force needed to tip the U.S. health care system in the right direction.
4. Health Information Technology (healthIT) Incentives
The year is 2014. Technology drives nearly every American industry. But look behind the reception desk at your doctor’s office and there’s a good chance you’ll find a maze of file-folders stuffed with patient information – just as it was 20 years ago.
As part of the recent HiTECH legislation, physicians were offered $44,000 to purchase, install and demonstrate “meaningful use” of modern information technology systems.
These computer systems can provide doctors with important clinical information and help them coordinate with other medical colleagues. As a result, physicians will be able to make better clinical decisions and avoid duplication of tests or procedures.
What’s the catch? Lack of connectivity.
You’d think that doctors and hospitals would share a single technology platform or would, at least, be able to achieve connectivity between their systems.
That’s not the case. Progress in linking disparate technology systems has been slower and more difficult than previously imagined.
Meaningful Use “Stage 2” will provide incentives for interoperability (the ability of making systems and organizations work together). But it remains to be seen whether these federal incentives will be enough to offset the cost required to connect these systems.
Having taken the original dollars, physicians must now deliver on the “meaningful use” requirements. But to net a positive ROI on the IT investment, physicians will need to modify their practices – something they have not been interested in doing in the past.
5. A New Generation Of Physicians
The new generation of physicians are tech-savvy. They can’t imagine their lives without mobile devices or constant connectivity.
And in school, they were trained to work in teams – unlike their elder colleagues. As a result, a majority of new docs prefer to be employed by an established organization (a hospital or an integrated health care system, for example) rather than launching their own private practice.
Their backgrounds and predilections align well with what willAmerican health care will need in the future.
What’s the catch? Many Gen X and Y physicians value and expect greater work-life balance than physicians who came before them. And their enthusiasm may wane once they realize how sluggish the profession has been in embracing new technology.
On the other hand, when patients begin choosing this next generation to care for them, the world of health care may tip rapidly.
Will Change Happen?
Physicians and hospitals are moving forward in each of these areas. They are forming ACOs, accepting new forms of payment, focusing on preventive services, reducing medical errors, and learning to benefit from computer systems.
Still, many providers are hedging their bets.
Some of their practice is bundled and prepaid, but much remains fee-for-service. Some patient information is available through their computers, but much remains on paper. Some are hoping that the prevailing megatrends in health care are just fads. Some will continue to resist change.
What many don’t recognize is what John Chambers emphasized heavily in our interview. The economics will drive change in health care, whether we like it or not.
Change will happen one way or another.
Jersey City Medical Center said a computer disk containing 2011 Medicaid patient information was lost in June when a package sent via United Parcel Service failed to arrive.
The medical center, part of the Barnabas Health system, said that on June 13, 2014, it sent the disk to a company engaged by New Jersey Medicaid to help the state review certain types of payments to hospitals in New Jersey.
The unencrypted CD was scheduled to be delivered June 16, but the medical center said it “learned on or about that date, that the package did not arrive as scheduled.”
The medical center did not reveal the number of patients whose information was on the disk. It said letters are being sent to the affected patients and that “While UPS has no evidence that personal information has been made available to any unauthorized parties, or misused in any way, patients are being advised to be aware of any suspicious activity and to monitor their credit reports and financial accounts.”
All those impacted are being offered 12 months of free professional identity monitoring services.
The CD did not include addresses, personal contact information or specific medical information.
The medical center said the CD did include the patients’ name, and for a majority of the patients, their Social Security numbers and birth dates.
The medical center said “We have followed up extensively with UPS regarding this incident, attempting to ensure that UPS has followed all of its internal procedures designed to locate missing packages.”
And Jersey City Medical Center said it has taken measures to avoid similar incidents in the future and that technological measures and retraining are being implemented to minimize the chance of such incidents.