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Advanced APM Timeline – MACRA Monday

Posted on December 5, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

Last week we posted about the APM Expansion in MACRA and the new PTAC Committee. Today we’ll dive into the timelines for APMs. They can get pretty confusing, so hopefully after you read this post you’ll have a better idea on how the APM timelines work.

Before we dive into the timelines, I also wanted to make a quick note of the benefits related to participating in an APM. The APM benefits really didn’t change in the MACRA final rule so our previous post on Advanced APM incentives is still accurate as well.

As we noted before, participating as an advanced APM provides incentives on top of whatever rewards are part of your original APM agreement. Under MACRA, you just get an extra 5% bonus on top of your pre-MACRA rewards for being in an APM. Here are the 3 main benefits of participating as an advanced APM under MACRA:
advanced-apm-benefits

As far as reporting as an Advanced APM, CMS will take three “snapshots” on March 31, June 30, and August 31 in order to determine which eligible providers are eligible as an Advanced APM and meet the thresholds to become a Qualified APM participant.

Here’s the official timeline details from CMS:

cms-apm-determination-timeline

At point B, the snapshots are taken to determine eligibility and at point D in the graph above, eligible providers will be notified of their APM eligibility. Yes, this is a very compressed timeline, so it behooves you to get started early. Remember that if you don’t qualify as an Advanced APM, then you still have to participate in MIPS.

The timeline for paying the 5% reward for being part of a qualified Advanced APM is still 2019 for reporting year 2017. 2018 reporting year will determine payouts for 2020 and so forth. That’s no change from the proposed MACRA rule.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

APM Expansion and New PTAC Committee – MACRA Monday

Posted on November 28, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

Most of the general details about APMs was changed in the final rule (See our previous post about APMs and whether you should take part in an APM or MIPS within MACRA). However, if you want to dive into the details of APMs, then check out this CMS webinar and slides that dive into the APM program. One thing that didn’t change much yet is the types of programs that counted as possible advanced APMs:

  • Shared Savings Program (Tracks 2 and 3)
  • Next Generation ACO Model
  • Comprehensive End Stage Renal Disease Care Model (Two-Sided Risk Arrangements)
  • Comprehensive Primary Care Plus (CPC+)
  • Oncology Care Model (OCM) (two-sided risk track)

However, as CMS mentioned previously, their goal is to get more and more people involved in the APM program. As part of that effort, a number of other programs are likely to be eligible as an advanced APM in 2018:

  • Comprehensive Care for Joint Replacement (CJR) Payment Model (CEHRT)
  • Advancing Care Coordination through Episode Payment Models Track 1 (CEHRT)
  • ACO Track 1+
  • New Voluntary Bundled Payment Model
  • Vermont Medicare ACO Initiative (as part of the Vermont All-Payer ACO Model)

In fact, some of these might even be available in 2017. The MACRA final rule also created a new committee called the PTAC (Physician-Focused Payment Model Technical Advisory Committee). This committee will accept suggestions on other programs that should be considered an advanced APM. Then, they make recommendations to the HHS secretary on which programs should be added as Advanced APMs.

All updates on programs that qualify as an Advanced APM will be available on the CMS Quality Payment Program (MACRA) website.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

What Will Be Trump’s Impact on MACRA? – MACRA Monday

Posted on November 21, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

Next week we’ll be kicking off our weekly series of details from the MACRA Final Rule. However, before we start going through the changes and what you need to know about MACRA, I wanted to cover an important topic of concern for many practices. I’ve heard a lot of practices that are afraid of what they consider the uncertain future in the coming Trump presidency.

While I believe that healthcare could see significant impact from a Trump presidency, I don’t believe that MACRA will be impacted by the change in presidency. First, MACRA was as bipartisan as you could find in Washington DC. Even if Trump wanted to replace, modify, repeal MACRA, I can’t imagine it getting enough support in the senate and house. If this is true, Trump won’t even try to do anything with MACRA. Second, Trump has plenty of bigger fish to fry. When you look at the various priorities that Trump has said he has for his presidency, nothing indicates that MACRA will be anywhere near those priorities. Third, it’s hard for me to imagine that Trump would see a problem with the move to technology in healthcare.

What also is worth noting is that MACRA is separate from ACA (aka Obamacare) and even ARRA (the HITECH Act). I’ll leave the predictions for what will happen with ACA for other people. I have no doubt that ACA will be impacted by the change in presidency, but even if they did a full repeal of Obamacare (which looks like it’s impossible), MACRA will still remain and be in force. If MACRA was part of Obamacare, I’d have a different view, but since it’s not then I think MACRA will continue forward as planned.

Those of you hoping for MACRA to disappear due to the new president and those of you waiting for MACRA to change after the comment period is over are grasping at straws. Love it. Hate it. Feel however you may about MACRA, I really don’t see any scenario where MACRA is not part of the future of healthcare.

What do you think? If you disagree, I’d love to hear why in the comments. If you agree, I’d love to hear from you as well. With that view, we’ll be continuing MACRA Monday blog posts for the foreseeable future so that our readers are ready.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

What the Final Rule Means for Small Practices – MACRA Monday

Posted on November 14, 2016 I Written By

This guest blog post by John Squire, President and COO of Amazing Charts, is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

With the long-awaited issuance of the MACRA Final Rule earlier this month, the Centers for Medicare and Medicaid Services (CMS) tried to soften the blow for small practices in the first year of the program. Depending on the 2017 data you submit by March 31, 2018, your 2019 Medicare payments will be adjusted up, down, or not at all. This flexible timeline casts a wide net and should get everyone to participate.

Here’s a breakdown of all the options for 2017, from opt-out to maximum bonus, open to a small practice using a 2014 Certified EHR Technology (CEHRT). As you’ll see the sections get longer as we progress since each stage becomes more complex.

Be excluded from Medicare’s Quality Payment Program
In the Final Rule, CMS increased the exclusion threshold from $10,000 or less in Medicare Part B allowed charges, to $30,000 or less in billings, or seeing fewer than 100 Medicare Part B patients during the 2017 calendar year.

CMS estimates that this change will exempt approximately 30 percent of eligible clinicians from the Quality Payment Program. If you fall below the threshold, CMS will automatically exclude you. If you don’t meet the exclusion criteria, keep reading.

Do nothing… and take a penalty
Unlike previous programs such as Meaningful Use, there is no opt out for MACRA. If you don’t meet the exclusion requirement above, you are subject to downward adjustments. The Merit-based Incentive Payment System (MIPS) is the most likely option for small practices.

MIPS has a scale of 100 points. If you don’t report on any 2017 data by March 31, 2018, you’ll earn zero points and receive a four percent downward adjustment on your Medicare payments in 2019. This penalty rises over time, becoming five percent in 2020, seven percent in 2021, and nine percent in 2022!

A small minority of providers might be willing to make this financial sacrifice, but the vast majority of small practices using CEHRT are more likely to take a few simple steps to avoid the penalty.

Test out for a neutral outcome
You can avoid a downward adjustment by reporting just one quality measure, attesting to one improvement activity, or attesting to the four required Advancing Care Information (ACI) measures (formerly Meaningful Use) – for any length of time period in the calendar year of 2017. You’ll earn three points and there will be no downward adjustment to your 2019 payments.

This is a no-brainer for most small practices. If you use a 2014 Certified EHR, you’re already doing many of these activities, such as e-Prescribing, today. Belong to a Health Information Exchange? You’ve just earned your three points.

Participate for a bonus
You can earn four to 100 points for the chance of a small, moderate, or high positive adjustment to your payments in 2019. Submit at least 90 days of data on more than the minimum (i.e. on two or more quality measures, two or more improvement activities or more than the required four advancing care information measures) to earn more than three points.

Basically, the more information you submit over the longer length of time translates to more points and the more points you earn, the larger a positive adjustment on your payments will be, up to the maximum of four percent.

To earn the most possible points, (1) report for a full year on at least six quality measures (or a measure set); (2) attest to improvement activities worth 20 or 40 points (depending on the geography, size and make up of your practice); and (3) attest to all four of the required ACI measures as well as the five optional ACI measures, plus the one bonus ACI measure. Every 2014 Certified EHR technology has the functionality to support all ten ACI measures.

It could be easier than you think
CMS allows you to get a bonus for ACI when you use 2014 CEHRT to complete one of 94 eligible activities from the eight improvement activities categories. These include telehealth services, care coordination, or any kind of population health management. It could be something as simple as setting a flag for regular check-ups for your Medicare/Medicaid dual-eligible patients. A complete list can be found at this excellent CMS resource: https://qpp.cms.gov/measures/ia.

Even better news: providers participating in a patient-centered certified medical home (PCMH) will automatically receive full credit for the practice improvement category of MIPS. Similarly, providers participating in an Advanced Alternative Payment Model (APM) like an accountable care organization (ACO) will receive 50 percent of the full score for the practice improvement category.

Don’t get complacent – start today
While the agency’s idea of implementing a transition period was necessary, providers in small practices can’t get complacent. The formula for success is going to change very quickly. January 1, 2018 brings the full-year reporting requirement on the expanded measures.  The quality measures will still be required and the cost measures (previously called “resource use”) are going to dial up.  The year 2022 is only six years away, so unless the provider prepares next year, they could start facing some rather significant penalties.

About John Squire
John Squire, President and COO of Amazing Charts, has more than 27 years of high tech industry experience, 15 of them in Health IT. Before joining Amazing Charts, John was Senior Director of Alliances and Cloud Strategy for Microsoft’s U.S. Health and Life Sciences Business Unit.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

Should More Doctors Think About MACRA Like Med School? – MACRA Monday

Posted on November 7, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

While at the recent MGMA Annual conference I ran into Dr. Robert Wah at the CSC Health booth. Dr. Wah has a fascinating background as the former President of the AMA and was also the first Deputy National Coordinator for Health IT back in the Brailer days before now becoming Global Chief Medical Officer at CSC. No doubt he’s seen the full evolution of healthcare IT.

During our chat, Dr. Wah expressed some concern about doctors decision to not properly prepare for MACRA. Between the Pick Your Pace options which basically mean doctors don’t have to fully participate in 2017 and the MACRA final rule being published with a comment period, many doctors have decided to just sit back and not worry about MACRA for now. Those doctors argue that they should wait until the comment period is over to see if the final rule will be changed or they just figure they’ll worry about MACRA in 2018 when they have to fully participate.

Dr. Wah explained to me that this is a dangerous strategy for doctors to employ. He then compared this strategy to medical school. Dr. Wah said that medical students realize pretty early on that they can’t just cram for a class the day before the test in medical school. If students get behind in their studies, then it’s really hard for them to catch up before the test.

Dr. Wah argues that this is what many doctors are doing with MACRA and it could lead to problems. Much like in medical school, it won’t be possible to “cram” for MACRA right before a doctor must fully participate in 2018. Instead, doctors need to use 2017 to appropriately “study” for the MACRA test that’s coming in 2018.

Thanks to Pick Your Pace, CMS have given doctors a pretty big window to make sure that they’re ready for everything that’s required with the full MACRA requirements in 2018. Those that sit on their hands in 2017 will be complaining about how hard MACRA is in 2018. Those that fully participate in 2017 will likely not worry much about the MACRA requirements in 2018.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

ONC Offers Guide To EHR Contracting

Posted on October 5, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Last year, the PinnacleHealth health system saw a series of dangerous technical failures take place which put patients at risk. Some patients weren’t accurately tracked, one patient’s blood pressure dropped dangerously after allegedly getting the wrong medications at discharge, and in another case, a physician couldn’t place the pharmacy order for newborn to receive an anti-bleeding dose of vitamin K.

Pinnacle has since sued Cerner, claiming that the Siemens EHR it uses was the source of the problem. (Cerner bought Siemens’ health IT assets in early 2015.) And since the lawsuit was filed, the details of the alleged problems are now public knowledge.

But if the contract between Siemens and the health system is a typical one, it’s possible Pinnacle was legally barred from discussing the problems until it filed the suit. And if the problems Pinnacle has outlined are due to technical problems on Siemens’ end, other patients might have been at risk until the suit was filed.

Hoping to help providers avoid being put in such a difficult position, the ONC has released a new guide designed to help them negotiate EHR contracts effectively. The guide, “EHR Contracts Untangled: Selecting Wisely, Negotiating Terms, And Understanding The Fine Print” offers a truckload of detailed legal recommendations designed to help providers get into the right contract with their EHR vendor.

The dense 56-page guide offers providers advice on every step of the contracting process, including what to do before they sit down with their vendor of choice. It kicks off with a discussion of how to plan for your EHR purchase or upgrade, noting that the provider should be well prepared before they consider making an IT investment.

Providers need to take several steps before they proceed, it notes, including researching the EHR market, assessing their organization’s readiness to implement EHR changes, developing a vision and plan for how the system will support their needs and creating a checklist of high-priority features they want to have in place.

It also offers sample contracts for providers to review and an overview of standard contracts vendors use, identifies language vendors might use that could cause harm and supplies substitute language they should seek to include.

For example, the guide warns providers that some vendors might block access to patient data if there’s a contract dispute or if their bill isn’t paid. This approach is known as a “kill switch.” As a result, they note, providers should introduce contract language that bars the use of such “disabling technology” in their system. The guide also offers terms providers can adopt for handling contract disputes effectively without impacting patient care.

The guide also addresses another widespread problem vendor contract issue faced by providers, the so-called “gag clauses” found in standard-form contracts. These gag clauses can come in many forms, but common clauses might prevent physicians from discussing EMR usability and safety issues with third parties or making negative comments about the technology.

In its recommendations, the ONC strongly advises that providers rewrite standard contract language to permit them to share information on problems with the EHR. That includes sharing information when it is for the purposes of patient safety, quality improvement, and public health. In particular, this language should allow sharing of the EHR-related hazards, adverse technology events or other unsafe conditions, it points out.

Obviously, physicians should not rely on a general guide exclusively when signing a contract with their EHR vendor. But while it’s a bit late to the game, the ONC guide seems likely to prove helpful to many practices which might otherwise come to the contracting table poorly prepared.

ONC’s Budget: A Closer Look

Posted on August 3, 2016 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

When HHS released ONC’s proposed FY2017 budget last winter, almost all attention focused on one part, a $22 million increase for interoperability. While the increase is notable, I think ONC’s full $82 Million budget deserves some attention.

ONC’s FY2017 Spending Plan.

Table I, summarizes ONC’s plan for Fiscal Year 2017, which runs from October 1, 2016 through September 30, 2017. The first thing to note is that ONC’s funding would change from general budget funds, known as Budget Authority or BA, to Public Health Service Evaluation funds. HHS’ Secretary may allocate up to 2.1 percent of HHS’ funds to these PHS funds. This change would not alter Congress’ funding role, but apparently signals HHS’s desire to put ONC fully in the public health sector.

Table I
ONC FY2017 Budget

fy2017-budget-justification-onc

What the ONC Budget Shows and What it Doesn’t

ONC’s budget follows the standard, federal government budget presentation format. That is, it lists, by program, how many people and how much money is allocated. In this table, each fiscal year, beginning with FY2015, shows the staffing level and then spending.

Staffing is shown in FTEs, that is, full time equivalent positions. For example, if two persons work 20 hours each, then they are equivalent to one full time person or FTE.

Spending definitions for each fiscal year is a little different. Here’s how that works:

  • FY2015 – What actually was spent or how many actually were hired
  • FY2016 – The spending and hiring Congress set for ONC for the current year.
  • FY2017 – The spending and hiring in the President’s request to Congress for next year.

If you’re looking to see how well or how poorly ONC does its planning, you won’t see it here. As with other federal and most other government budgets, you never see a comparison of plans v how they really did. For example, FY2015 was the last complete fiscal year. ONC’s budget doesn’t have a column showing its FY2015 budget and next to it, what it actually did. If it did, you could see how well or how poorly it did following its plan.

You can’t see the amount budgeted for FY2015 in ONC’s budget, except for its total budget. However, if you look at the FY2016 ONC budget, you can see what was budgeted for each of its four programs. While the budget total and the corresponding actual are identical -$60,367,000, the story at the division level is quite different.

                                   Table II
                    ONC FY2015 Budget v Actual
                                    000s

Division

FY2015 Budget $ FY2015 Actuals $ Diff
Policy Development and Coordination 12,474 13,112 638
Standards, Interoperability, and Certification 15,230 15,425 195
Adoption and Meaningful Use 11,139 10,524 (615)
Agency-wide Support 21,524 21,306 (218)
Total 60,367 60,367

 

Table II, shows this by comparing the FY2015 Enacted Budget from ONC’s FY2015 Actuals for its four major activities. While the total remained the same, it shows that there was a major shift of $638,000 from Meaningful Use to Policy. There was a lesser shift of $195,000 from Agency Support to Standards. These shifts could have been actual transfers or they could have been from under and over spending by the divisions.

Interestingly, Table III for staffing shows a different pattern. During FY2015, ONC dropped 25 FTEs, a dozen from Policy Development and the rest from Standards and Meaningful Use. That means, for example, that Policy Development had less people and more money during FY2015.

Table III
ONC FY2015
Budget v Actual Staffing FTEs
Division FY2015 Budget FTEs FY2015 Actuals FTEs Diff
Policy Development and Coordination 49 37 (12)
Standards, Interoperability, and Certification 32 26 (6)
Adoption and Meaningful Use 49 42 (7)
Agency-wide Support 55 55
Total 185 160 25

 

To try to make sense of this, I looked at the current and past year’s budgets, but to no avail. As best I can tell is ONC made great use of contracts and other non personnel services. For example, ONC spent $30 Million on purchase/contracts, which is $8 million more than it did on its payroll.

ONC’s budget, understandably, concentrates on its programs and plans. It puts little emphasis on measuring its hiring and spending abilities. It’s not alone, budgets government and otherwise, are forecast and request documents. However, if we could know how plans went – without having to dig in last year’s weeds  – it would let us know how well a program executed its plans as well as make them. That would be something worth knowing.

New ONC Scorecard Tool Grades C-CDA Documents

Posted on August 2, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

The ONC has released a new scorecard tool which helps providers and developers find and resolve interoperability problems with C-CDA documents. According to HealthDataManagement, C-CDA docs that score well are coded with appropriate structure and semantics under HL7, and so have a better chance of being parseable by different systems.

The scorecard tool, which can be found here, actually offers two different types of scores for C-CDA documents, which must be uploaded to the site to be analyzed. One score diagnoses whether the document meets the requirements of the 2015 Edition Health IT Certification for Transitions of Care, granting a pass/fail grade. The other score, which is awarded as a letter grade ranging from A+ to D, is based on a set of enhanced interoperability rules developed by HL7.

The C-CDA scorecard takes advantage of the work done to develop SMART (Substitutable Medical Apps Resusable Technologies). SMART leverages FHIR, which is intended to make it simpler for app developers to access data and for EMR vendors to develop an API for this purpose. The scorecard, which leverages open-source technology, focuses on C-CDA 2.1 documents.

The SMART C-CDA scorecard was designed to promote best practices in C-CDA implementation by helping creators figure out how well and how often they follow best practices. The idea is also to highlight improvements that can be made right away (a welcome approach in a world where improvement can be elusive and even hard to define).

As SMART backers note, existing C-CDA validation tools like the Transport Testing Tool provided by NIST and Mode-Driven Health Tools, offer a comprehensive analysis of syntactic conformance to C-CDA specs, but don’t promote higher-level best practices. The new scorecard is intended to close this gap.

In case developers and providers have HIPAA concerns, the ONC makes a point of letting users know that the scorecard tool doesn’t retain submitted C-CDA files, and actually deletes them from the server after the files have been processed. That being said, ONC leaders still suggest that submitters not include any PHI or personally-identifiable information in the scorecards they have analyzed.

Checking up on C-CDA validity is becoming increasingly important, as this format is being used far more often than one might expect. For example, according to a story appearing last year in Modern Healthcare:

  • Epic customers shared 10.2 million C-CDA documents in March 2015, including 1.3 million outside the Epic ecosystem (non-Epic EMRs, HIEs and the health systems for the Defense and Veterans Affairs Departments)
  • Cerner customers sent 7.3 million C-CDA docs that month, more than half of which were consumed by non-Cerner systems.
  • Athenahealth customers sent about 117,000 C-CDA documents directly to other doctors during the first quarter of 2015.

Critics note that it’s still not clear how useful C-CDA information is to care, nor how often these documents are shared relative to the absolute number of patient visits. Still, even if the jury is still out on their benefits, it certainly makes sense to get C-CDA docs right if they’re going to be transmitted this often.

We Still Need More Female Leaders In Health Tech

Posted on July 12, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Despite the looming presence of Epic’s Judy Faulkner, women are still underrepresented in the boardrooms of health tech companies. This point was underscored a recent article in Healthegy News, which offered a bracing reminder of the need for better gender balance in the industry, especially at the top.

As the article points out, women are grossly underrepresented within digital health, arguably the least traditional niche within the business, running only 6% of these ventures. I don’t know what the stats are for health IT at large but I can’t imagine the ratio is any better (and it may be worse).

And as writer Kirti Patel notes, it’s probably not a coincidence that only 6% of venture capitalists are female. Patel cites stats suggesting that VC teams with women on them are twice as likely to invest in management teams that include women, and three times more likely to invest in companies with female CEOs.

Of course, Faulkner isn’t the only woman to hold a powerful position in the health IT world. Female influencers and leaders in U.S. healthcare industry range from Nancy Ham, CEO of Medicity to Carla Kriwet, CEO of Patient Care and Monitoring Solutions at Phillips to AHIMA CEO Lynne Thomas Gordon. Other standouts include Deborah DiSanzo, General Manager of IBM Watson Health and of course Karen DeSalvo, Acting Assistant Secretary for Health at ONC. But numbers-wise, women with top roles in health IT are still in the minority.

To be fair, the lack of women in the health IT boardroom reflects the larger technology industry. Research suggests that only 25% of professional computing physicians in the 2015 U.S. workforce were held by women, and that just 17% of Fortune 500 CIO positions were held by women that year. This dovetails with other trends, such as the fact that only 15% of 2014 computer science bachelor’s degree recipients at major research universities were women.

Still, even given these statistics, I’d argue that we all know incredible women in health IT who might be capable of far more, including top leadership roles, if they had the opportunity. And while I’m not suggesting that conscious discrimination is going on, gender bias pops up in ways that people don’t always recognize.

The problem is so pervasive, in part, because it extends beyond technical positions to healthcare as a whole. According to statistics from a couple of years ago, women made up 80% of the healthcare workforce, but just 40% of the leadership roles in the industry.

Health IT faces too many challenges to pass over anyone who might have good solutions to offer. Health IT organizations should do everything they can to be sure that unseen gender bias in preventing them from moving the industry forward.

No, The Market Can’t Solve Health Data Interoperability Problems

Posted on July 6, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

I seldom disagree with John Halamka, whose commentary on HIT generally strikes me as measured, sensible and well-grounded. But this time, Dr. Halamka, I’m afraid we’ll have to agree to disagree.

Dr. Halamka, chief information officer of Beth Israel Deaconess Medical Center and co-chair of the ONC’s Health IT Standards Committee, recently told Healthcare IT News that it’s time for ONC and other federal regulators to stop trying to regulate health data interoperability into existence.

“It’s time to return the agenda to the private sector in the clinician’s guide vendors reduce the products and services they want,” Halamka said. “We’re on the cusp of real breakthroughs in EHR usability and interoperability based on the new incentives for outcomes suggested by MACRA and MIPS. {T}he worst thing we could do it this time is to co-opt the private sector agenda more prescriptive regulations but EHR functionality, usability and quality measurement.”

Government regs could backfire

Don’t get me wrong — I certainly appreciate the sentiment. Government regulation of a dynamic goal like interoperability could certainly backfire spectacularly, if for no other reason than that technology evolves far more quickly than policy. Regulations could easily set approaches to interoperability in stone that become outmoded far too quickly.

Not only that, I sympathize with Halamka’s desire to let independent clinical organizations come together to figure out what their priorities are for health data sharing. Even if regulators hire the best, most insightful clinicians on the planet, they still won’t have quite the same perspective as those still working on the front lines every day. Hospitals and medical professionals are in a much better position to identify what data should be shared, how it should be shared and most importantly what they can accomplish with this data.

Nonetheless, it’s worth asking what the “private sector agenda” that Halamka cites is, actually. Is he referring to the goals of health IT vendors? Hospitals? Medical practices? Health plans? The dozens of standards and interoperability organization that exist, ranging from HL7 and FHIR to the CommonWell Health Alliance? CHIME? HIMSS? HIEs? To me, it looks like the private sector agenda is to avoid having one. At best, we might achieve the United Nations version of unity as an industry, but like that body it would be interesting but toothless.

Patients ready to snap

After many years of thought, I have come to believe that healthcare interoperability is far too important to leave to the undisciplined forces of the market. As things stand, patients like me are deeply affected by the inefficiencies and mistakes bred by the healthcare industry’ lack of interoperability — and we’re getting pretty tired of it. And readers, I guarantee that anyone who taps the healthcare system as frequently as I do feels the same way. We are on the verge of rebellion. Every time someone tells me they can’t get my records from a sister facility, we’re ready to snap.

So do I believe that government regulation is a wonderful thing? Certainly not. But after watching the HIT industry for about 20 years on health data sharing, I think it’s time for some central body to impose order on this chaos. And in such a fractured market as ours, no voluntary organization is going to have the clout to do so.

Sure, I’d love to think that providers could pressure vendors into coming up with solutions to this problem, but if they haven’t been able to do so yet, after spending a small nation’s GNP on EMRs, I doubt it’s going to happen. Rather than fighting it, let’s work together with the government and regulatory agencies to create a minimal data interoperability set everyone can live with. Any other way leads to madness.