Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

When Did A Doctor Last Worry About Social Determinants of Health (SDOH)?

Posted on June 16, 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.

I’ve heard over and over the importance of social determinants of health (SDOH) and their impact on healthcare costs. The concept is fascinating and challenging. There are thousands of examples. A simple one to illustrate the challenge is the patient who arrives at the emergency room with a fever. The doctor treats the fever and then sends them back to their home where they have no heat and are likely to get sick again.

I ask all the doctors that read this blog, when was the last time you worried about these various social determinants of health (SDOH) in the care you provided a patient?

I’ll be interested to hear people’s responses to this question. I’m sure it would create some incredible stories from doctors who really care about their patients and go above and beyond their job duties. In fact, it would be amazing to hear and share some of these stories. We could learn a lot from them. However, I’m also quite sure that almost all of those stories would end with the doctor saying “I wasn’t paid to help the patient this way but it was the right thing to do.”

Let me be clear. I’m not blaming doctors for not doing more for their patients. If I were a doctor, I’m sure I’d have made similar decisions to most of the doctors out there. They do what they’re paid to do.

As I’ve been sitting through the AHIP Institute conference, I’m pondering on if this will change. Will value based reimbursement force doctors to understand SDOH or will they just leave that to their health system or their various software systems to figure it out for them?

I’m torn on the answer to that question. A part of me thinks that most doctors won’t want to dive into that area of health. Their training wasn’t designed for that type of thinking and it would be a tough transition of mindset for many. On the other hand, I think there’s a really important human component that’s going to be required in SDOH. Doctors have an inherent level of trust that is extremely valuable with patients.

What do you think of SDOH? Will doctors need to learn about it? Will the systems just take care of it for them?

Government Involvement in Healthcare IT – How Meaningful Use Went Wrong

Posted on June 15, 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.

I have about 150 draft blog posts on EMR and EHR. Most of them are ideas for future posts. Unfortunately, I get so many new ideas, a lot of the drafts remain draft blog posts for long periods of time. I probably should create a better process for tracking my blog post ideas, but this was worked so far. Plus, it’s fun to go back and see what past ideas I had for posts and then think about how things have changed or whether that insight has stood the test of time.

This post is an example of that and the draft blog post contained a tweet that Greg Meyer shared during a #HITsm Twitter chat back in December 2014. Here’s the tweet:

No doubt Greg’s tweet resonated with me back in 2014 and still resonates with me today. In meaningful use, the government got way too deep into the how and caused all sorts of unintended consequences. We’d be in a much better position if the government would have just defined the measures and functions and not how you actually got there.

What’s interesting is that this is more or less what I’ve been hearing from Andy Slavitt in regards to MACRA. I’m not sure CMS has executed this vision well, but it’s at least hopeful that their leader is espousing a similar approach to what Greg describes above.

I’d also point out an insight I believe I first heard from Dr. Michael Koriwchak. He espoused the principle that CMS shouldn’t require the collection of any data which it wasn’t going to actually use. Think about how meaningful use would have been totally different if they’d employed this rule. What value is there to healthcare if we collect a whole bunch of data that’s never actually used to improve care?

Do you think CMS will get this right with MACRA? Share your thoughts in the comments.

Telemedicine Coverage and Payment Parity

Posted on June 14, 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.

I recently heard Nathaniel Lacktman from Foley & Lardner LLP give the best presentation on telehealth I’d ever seen. I’d never heard someone so familiar with the challenges and laws associated with telehealth. In fact, with that in mind, I’m hoping to get him on a Healthcare Scene interview in the future.

One of the key things he said about telehealth is the need for: Coverage and Payment Parity.

I thought it was the perfect synopsis of what’s holding telehealth back. If we had telehealth insurance coverage and payment parity, then telehealth services would go through the roof! Although, it’s worth pointing out that you need both of these things.

One problem I’ve seen with many telehealth initiatives is that a telehealth visit is treated like a second class citizen. Why would a doctor want to do a telehealth visit if they aren’t getting paid the same? This is why payment parity is so important and hasn’t been addressed nearly enough in the telehealth laws that have been passed.

The real question is why shouldn’t a telehealth visit be paid the same? If you’re able to document and code the telehealth visit to the same level as you would an in-person visit, why would we pay a doctor less for doing the same type of visit, just virtually?

There are a few states where they’re making progress with coverage and payment parity. It’s too bad we don’t have a national effort to get this in place. Telehealth is not the end all be all. It won’t replace all in-person visits to your PCP, but it could replace a lot of them. Plus, it will encourage a lot of early interventions that would have been delayed because a patient didn’t want to go to the hassle of an in-person visit to the doctor’s office.

Fixing Small Stress Inducing Moments Creates Magic

Posted on June 13, 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.

I thought this was a really genius perspective that I heard at the WEDI Annual conference. Or at least it was the thought that was inspired at the conference. I think the speaker was referencing various apps like Uber or Lyft and how they took a whole set of small, individually stress inducing moments and solved them.

Using that example, it was stressful to wonder when the cab would come, it’s stressful to know if the cab will take credit cards, it’s stressful to know if the cab is taking a longer route to make you pay more, etc etc etc. None of these individually was all that stressful but combined they made for a pretty stressful experience. Uber and Lyft were able to look at all of those minor individual stresses and make a great customer experience by removing them.

It’s worth pointing out that these companies likely needed to solve more than one stress for their app to be successful. If they’d only solved one small stress, they likely wouldn’t be as popular today as they have been.

Now let’s apply this to healthcare IT. Ironically, I think many would argue that EHRs have taken a bunch of small stresses and turned them into large stresses. That’s the pessimistic viewpoint. Although, it’s pretty hard to argue that most EHR software has taken the stress out of the medical documentation experience. Is it any wonder that so many doctors hate EHR?

I guess I’m pretty pessimistic that EHR vendors will change and start taking the little stresses out of the healthcare experience. A few EHR vendors have done better than others but most of them are making so much money doing what they’re doing, they’re unlikely to change course. Does that mean we give up hope?

Not me. I’m optimistic about technology’s ability to make healthcare better. I just don’t think it’s going to come from EHR vendors. Instead, it’s going to come from entrepreneurs who do create magical experiences that take the small stresses out of a doctor’s or patient’s day. They may tie into the EHR, but they’ll build it separately.

What do you think? Where have you seen solutions that solve the “small” stresses in healthcare? We could use more “magic”.

Is CMS Listening to Doctors’ Thoughts on MACRA?

Posted on June 10, 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.

I have to admit that I have a lot of respect for Andy Slavitt. He’s doing a really hard job as Acting Administrator of CMS and he’s been very vocal and open about his view of what they’re doing and their efforts to listen to those of us in healthcare. I’ve really appreciated his willingness to engage the community on challenging topics. Did you ever see this from previous CMS administrators?

This tweet illustrates Andy’s efforts to really listen to doctors when it comes to MACRA:

This illustrates why I previously wrote that Andy Slavitt was very much in touch with the pulse of what doctors are feeling and experiencing. Although, with that comment I also said that I hoped that the policies and programs they implemented would match that understanding.

I realize that this concept is much easier said than done. Andy Slavitt and his team at CMS are sometimes not able to make changes to things like MACRA even if they know it’s the right thing to do. They aren’t the ones responsible for making the legislation. Their jobs are to implement the legislation. It’s a tough balance which always leaves people wanting.

The only thing awkward about Andy Slavitt’s tweet above is that he says CMS has “trained nearly 60,000.” It’s quite interesting that he views these MACRA sessions as trainings. I thought they were more listening sessions than training sessions, but I guess I was wrong. Certainly you have to train a doctor on the MACRA legislation if you want to get the right feedback from them. So, I guess training and listening aren’t mutually exclusive, but it’s not surprising that many doctors don’t want to be “trained” on MACRA. For some doctors, anything less than a full repeal of MACRA will be less than satisfying and that’s not going to happen.

While you can complain about the way Andy might phrase things in a tweet, I don’t think that’s very productive. Although, I don’t think listening to (or should I say training) 60,000 physicians’ thoughts about MACRA is very useful either if we don’t see that feedback incorporated into the final MACRA rule. This tweet gives me some hope that the feedback has been heard and we’ll see some important changes to MACRA:

When the MACRA final rule comes out, I hope that along with the changes that were made we also get a look into the changes that people requested that CMS was unable to make because of the way the legislation was written. I’m not sure if CMS is allowed to be that transparent, but if we’re going to help push for better legislation it would be great to know which feedback was thwarted by legislation so that doctors can push for better legislation.

Patients’ Rights Videos

Posted on June 9, 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.

ONC and OCR recently released a number of videos that outline patients’ rights. Here’s one called “Individual’s Rights under HIPAA to Access their Health Information”:

What do you think of these videos? Will they effectively educate patients?

Makes me wonder what ZDoggMD would do with the content.

Remarks of CMS Acting Administrator Andy Slavitt at the Marketplace Innovation Conference

Posted on 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.

Welcome. And thank you for coming to a session that allows us to look at a deeper level at what is happening inside the Health Insurance Marketplace. And I’m not talking about what’s in the headlines, but below the surface– what’s happening with millions of Americans as they get coverage– many for the first time– and also how the system is adapting. At the same time, the consumer is beginning through the Marketplace to shape many of the changes in health care as they make decisions about the coverage and care they want. My focus today isn’t really just on the success stories, of which I see many, but on the lessons we have learned and are still learning from what’s going on inside and across the Marketplace.

I stood up here a year ago and reflected on another program which served millions of people as it reached not its third year of operation, but its 50th– the Medicare program.

Before it became the beloved program that millions of Americans rely on for their health and financial security, Medicare had, for those of you that know the history, fairly controversial beginnings and has gone through a number of evolutions. In large part, Medicare has been successful because it has adapted to the progress of medicine and the needs of the consumer, moving from a medical benefit to prevention to the pharmacy and now to coordinated care models. Medicare today is not only a leading force in value-based care, but it also offers widely popular consumer choice and competition for services and benefits from private plans across Medicare Advantage. The Health Insurance Marketplace, in many ways, picks up right there, bringing private sector competition and services to make health care available in an even more open market fashion– and creating greater opportunities for us to learn to serve consumers successfully.

As I reflect on the progress of the Marketplace, I will cover three important topics:

-First, that the Marketplace is succeeding by almost any benchmark, but it is still in its early trial and error stage. Progress won’t be even and for the first five years, we will continue to be in a learning and experimentation period– where a lot will be tested before best practices are more widely developed.

-Second, that the Marketplace, stepping back from the daily headlines, is a highly strategic opportunity for those who see health care evolving into a more B2C market to create new competitive advantages.

-And, third, is that even though we are in the learning and experimentation stage, we are confident we have the tools to make sure the market is stable and succeeds for the long term

Success but Early

Secretary Burwell talked this morning about how far we’ve come thanks to the ACA and thanks to so many communities across the country– the many physicians and clinicians, consumer advocates, assisters, health plans and hospitals who have worked together to have a remarkable impact. We’ve brought the uninsured rate to a record low and for the first time, our country is providing access to care for people regardless of their medical condition or how much money they make. Competition has worked to create more affordable choices. Last year, as 4 million new consumers signed up for coverage, over 90 percent of them had an average of 3 insurance companies to choose from, translating into 50 plan options. Two-thirds of HealthCare.gov customers had the option of selecting a plan with a monthly premium of $75 or less after tax credits. And thanks to tax credits, consumer’s rate increases averaged only 4 percent.

But more important is what consumers are getting for their money. Commonwealth reports that consumers say they can afford primary care and prescription drugs they just couldn’t afford before. And a good-sized majority are satisfied with their coverage. So we are beginning the process, in community after community across America, of re-connecting consumers to the health care system. Employer-sponsored coverage has not been disrupted and yet employees now have options to move jobs without fear of their families being unable to afford and obtain coverage. And contrary to what some headlines may suggest, the Marketplace has launched at and maintained costs well below CBO estimates. This is true for both consumers and the government– even as we provide care more comprehensively and to many who had conditions that had gone untreated.

While this represents a good start, we are in the very early stages– particularly, in the context of how programs like Medicare developed. And the Marketplace is right in the middle of what i will call a 5 year “learning and experimentation stage.” During these early years, consumers are getting educated about their options, while market participants– payers and care providers– learn their needs and experiment with the best ways to meet those needs. We are hearing promising approaches every day. But it’s not every day, or even every decade, that a new market totaling in the $10s of billions of dollars is created and launched across the country– and in places as diverse as rural North Dakota and Center City Philadelphia– where consumers have a diverse set of health needs, languages, cultures and incomes. So today, I hope we recognize that while we have learned many things, we are still only in this first stage of learning how best to bring affordable high quality care and service to this new market.

Strategic opportunity with consumerism

A fair question is why is it worth investing in all of this learning in all of this experimentation to serve the individual consumer market.

What makes the Marketplace an important strategic opportunity is very simply how squarely it puts power into the hands of the consumer. I mentioned this when I talked about the development of Medicare into Medicare Advantage and Medicare Part D, but the Marketplace is consumerism in the purest form. Over the years, the consumer has been much talked about but had very little power to shape what they wanted and paid for. There have been a lot of forces over the years that have shaped health care. Until now, everyone but the consumer has had a say in it.

The Marketplace gives the consumer a voice they have never had before. And every day, the Exchange gives us unprecedented insight into how consumers behave and what they want from the health care system. There’s a short list of learnings and a far longer list of things to be learned.

Let me start with some of things that we have learned.

-First, Marketplace consumers are much more engaged and increasingly educated about what they purchase particularly compared to other health care consumers. 70percent of renewing consumers on the Federal exchange– seven-zero– came back to the exchange to proactively choose a plan instead of opting automatic enrollment. That creates millions of opportunities for consumers to find the right offering at every open enrollment. As they say in my home state of Minnesota, the hockey capital of Minnesota, many more shots on goal means more opportunities to score– useful as plans experiment with different offerings.

-The second learning is that many consumers actually want to shop for their health care, in addition to their health coverage. Last year, the Marketplace began to offer consumers the option of selecting plans not by looking at the plan first– but by first finding a hospital or physician or prescription . . . then looking at which health plan offers them. Even in a pilot year, consumers chose this path 3.6 million times in just the 38 Federal marketplace states.

-Third, consumers want access to routine services without a deductible, with 8 in 10 consumers selecting plans which provide direct services outside of their deductibles like primary care and generic drugs. Health plans are responding in what I think is a promising early example of the consumer shaping a need and the market fulfilling it.

-Finally, consumers are saying loudly and most clearly that affordability matters more to them than it does when they select a plan through an employer– and is the most important concern. 90 percent of people have selected bronze or silver plans. And those large number of consumers who came back to shop? Those who switched plans saved over $500. So if consumers want savings, what are they willing to compromise on? According to a recent Kaiser Family Foundation report, consumers would much prefer a narrower network to a higher deductible or higher premium. This needs to be explored more as it opens the door, not just to narrow networks, but to innovative contracting and network strategies. While we have long wrestled with affordability as a country, the Marketplace allows us to see it in a new way– through the eyes of a consumer as they seek out high-quality care they can afford. And that reminds us– the millions of us who work in health care– that affordability and affordable care must be a part of everyone’s job.

So, while we’ve learned a lot about consumer preferences, there is still a longer set of questions that can be explored and experimented with over the next two years. And here are seven of mine but I know there are many others.

-How do we reach out to and connect with communities that are still left behind?

-What role will quality ratings and consumer reviews play in shaping the market and in improving quality as they are piloted and promoted?

-What role will exposing the actual cost of services play in consumer decision making and in increasing affordability?

-Will consumers choose the ease of a more standard set of “simple choice” benefits or will they opt for more customization?

-What about consumer loyalty? Working on health means building relationships with consumers and I expect this to be a big area of learning. There are examples of highly active markets where people can switch frequently, like cell phone service, music subscriptions or auto insurance. Competitors in those areas have found innovative ways to build long-term loyalty. Several companies are aggressively experimenting on the Marketplace. One, Centene, with its Ambetters product, offers a loyalty account to consumers and deposits money for consumers to use towards deductibles, coinsurance, and other health care spending.

-Next, what are innovative and consumer friendly ways to help consumers manage the costs of care — particularly in rural or other under-served locations? Companies are experimenting with enhanced primary care access, telemedicine, personalized health interventions, and other approaches you’ve heard today. These innovations will be ripe for scaling well beyond the Marketplace.

-Finally, what Marketplace specific contracting approaches will create aligned incentives and reduce the underlying unit costs that are a significant part of a consumer’s premium? Health plans must be successful in partnering with hospitals– who have seen a significant benefit from the ACA in reduced bad debt and increased patient flow– to lower the cost of care for consumers.

The point is that consumerism brings a trial and error phase with new approaches to everything from network strategy, to care management models, to new product approaches, benefit designs and new customer retention. Many of the companies in this room and a number of others have found success and have passed that on to consumers in the form of lower and more predictable costs and innovative services. Others haven’t yet but are beginning to follow best practices or look for other competitive advantages. And some will end up as more pure B2B companies. In the age of Uber and the consumerization sweeping our economy, we need to allow everyone the opportunity to innovate in this space. Outside of health care, the B2C economy has upended businesses like stock trading, travel and even data storage that once had only a limited consumer presence but now give consumers the ability to do for themselves on their mobile phones what they couldn’t before.

For a number of health plan CEOs that I talk to, their view of the Marketplace represents the opportunity to accelerate their organizations into this B2C world and get in synch with consumer demands as many of them see health care continuing to shift across all areas from B2B to B2C. In our notice of rulemaking last year, we asked explicitly for ways we could make innovation and testing of new ideas and approaches easier and must look for more opportunities and flexibilities ahead.

Market Stability

Finally, as in all markets, strategies won’t succeed the first time, every time. Over the course of these five years, we need to allow for continued experimentation. But problems that have plagued certain health care markets for years, lack of access, higher prices, poor social determinants of health also won’t get solved overnight. Unlike the Medicare program, the Marketplace is a complete private-sector solution to covering the uninsured and competition and innovation take some time to work. Gaps, like low competition or higher costs in some rural communities that have existed for years, will remain and be even more visible while we all work on solutions to address them.

Part of our job in the Administration and overseeing the marketplace development is to create a predictable and level playing field for consumers, health plans and care providers and to create stability in these early years, even through these natural bumps and to allow for this experimentation.

Even as the market signs up millions of new consumers in record numbers, we are paying rigorous attention to adjustments that are needed as the Marketplace matures. We have an experienced team of career operators and actuaries, who have come from both the private sector and directly from our Medicare Advantage and Part D operations where we know how to set up and operate large successful marketplaces with a variety of risk structures. This team studies the data and meets regularly with all market participants and takes a strategic view to determine what adjustments are warranted.

This past January, I committed to complete a thorough review and making of adjustments on what we have learned to date. And over the past several months, we have taken a set of actions which strengthen the risk pool, limit upward pressure on rates, and provide a strong foundation for the Marketplace for the long term. This process is a continual ongoing commitment but we have made meaningful progress so far.

-First, we systematically review our policies towards Special Enrollment Period (SEP) sign ups. We eliminated many SEPs that were unnecessary or subject to abuse, clarified the process and added validation requirements and enforcement for those who have a need to enroll during a SEP.

-Second, we have proposed steps to align risk adjustment to account specifically for consumers who may need Marketplace coverage for only a partial year, reducing the unintended consequences. One of the aims of the Marketplace is to be there for people when people need the coverage and when people find work, insurance companies shouldn’t be penalized.

-Third, we have proposed further enhancements to risk adjustment so health plans can invest in serving sicker, hard to treat populations. This begins with incenting everyone to invest in the data and analytics to understand their members better.

-Fourth, we are providing health plans with earlier and better information for rate filings to reduce surprises and help them better predict the cost of medical care for enrollees and price their policies appropriately.

-Fifth, we have announced several actions that both help consumers get or keep the right coverage and improve the risk pool: by closing short term coverage loopholes; by significantly improving our Data Matching process to prevent consumers from unnecessarily losing coverage; and, by improving the transition for Medicare eligible consumers out of the exchange and on to Medicare.

-And, of course, in recognition of the still early stage we’re at with the end of the 3-year reinsurance program, the one-year tax holiday of $13.9 billion will also help stabilize premiums next year.

And later this year, we will talk about our innovative effort to focus on reaching young people in the fourth Open Enrollment period.

These changes will give health insurers, supported by state departments of insurance, the ability to become more confident in putting together affordable offerings for consumers as they finalize rates over the summer and fall. And more broadly, as new areas emerge, I am highly confident in the focus and expertise of the career staff at CMS, and at the tools at their disposal, to continue to make the Marketplace attractive, stable and successful.

Close

In closing I would just like to emphasize a few points. I originally came to CMS to help lead the turnaround of HealthCare.gov and participate in the implementation of the Affordable Care Act. Thanks to the passage of the ACA, we have finally moved past the place where many of us have spent our careers– in debates about how we might address the uninsured or improve care, to a time when can now get busy actually covering people. It has been and is uniquely rewarding to be a part of. But health care didn’t automatically become affordable and accessible the day the law passed. It has taken incredible effort to see a system that hasn’t changed in a long long time begin to build this new market, but much more will be learned before best practices are more harmonized.

For all our success to date, new coverage must only be the start of things. We have the opportunity to change health care in America like we did 50 years ago at the dawn of Medicare and Medicaid, back when 1/3 of seniors lived in poverty to a time, now, when less than 10 percent of seniors live in poverty. And if we learn and experiment in these early years, we are just getting started. And part of the next leg of the development is not just how people’s lives change in profound ways, but how the consumer can force changes on the health system that wouldn’t happen– or happen as quickly– otherwise. Progress won’t be a straight line, but we are committed to working side by side with all of you in what will have far reaching impact to improving health care across this country. Thank you for all of the incredible hard work and innovation.

ICD-10 Deja Vu – End of Grace Period

Posted on June 8, 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.

I recently came across this article by Aiden Spencer about the possibility that ICD-10 could still cause issues for healthcare organizations once the grace period ends. Here’s what he suggests:

The CMS grace period was a welcomed relief because it meant practices would still be reimbursed under Medicare Part B for claims that at least had a valid ICD-10 diagnosis code. This meant physicians and their staff could get up to speed without worrying about taking a huge hit to their revenue stream.

With only five months left until the grace period ends, industry experts are predicting that an ICD-10 crisis might still be coming for some providers. Will you be one of them? Are you currently implementing quality medical billing software, or will the system you’re using fail come October 1st?

This certainly feels like what we were talking about last October when ICD-10 went live. A bunch of fuss and very little impact on healthcare. Are we heading for another round of fear and anxiety over the end of the ICD-10 grace period?

My gut tells me that it won’t be a bit deal for most healthcare organizations. They’ve had a year to improve their ICD-10 coding and so it won’t likely be an issue for most. This is particularly true for organizations who have quality HIM staff that’s gone through and done audits of their ICD-10 coding practices to ensure that they were doing so accurately.

I saw one stat from KPMG that only 11 percent of healthcare organizations described the ICD-10 implementation as a “failure to operate in an ICD-10 environment” with 80% finding the move to ICD-10 to be smooth. I imagine we’ll have a similar breakout when the ICD-10 grace period ends. Just make sure you’re not part of the 11 percent.

New Effort Would Focus HIE Data Around Patients

Posted on June 7, 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.

In theory, doctors should be able to pull up all data available on a patient located within any networks to which they have access. In other words, not only should they be able to see any data on Patient A within the EMR where A’s care is documented, but also retrieve data on A from within any HIEs which connect with the EMR. But the reality is, that’s not always the case (in fact, it’s rarely the case).

To help weave together patient data strung across various HIEs, three exchanges have teamed up to pilot test the idea of a patient-centered data home (PCDH). While many health leaders have looked at the idea of putting patients in charge of their own data, largely by adding to or correcting existing records, getting patients involved in curating such data has been difficult at best.

In this model, Arizona Health-e Connection, western Colorado’s Quality Health Network and the Utah Health Information Network are testing a method of data sharing in which the other HIEs would be notified if the patient undergoes an episode of care within their network.

The alert confirms the availability and specific location of the patient’s clinical data, reports Healthcare Informatics. Providers will then be able to access real-time information on that patient across network lines by initiating a simple query. Unlike in other models of HIE data management, all clinical data in a PCDH will become part of a comprehensive longitudinal patient record, which will be located in the HIE where the patient resides.

The PCDH’s data sharing model works as follows:

  • A group of HIEs set up a PCDH exchange, sharing all the zip codes within the geographic boundaries that their exchanges serve.
  • Once the zip codes are shared, the HIEs set up an automated notification process which detects when there is information on the patient’s home HIE that is available for sharing.
  • If a patient is seen outside of their home territory, say in a hospital emergency department, the event triggers an automated alert which is sent to the hospital’s HIE.
  • The hospital’s HIE queries the patient’s home HIE, which responds that there is information available on that patient.
  • At that point providers from both HIEs and query and pull information back and forth. The patient’s home HIE pulls information on the patient’s out-of-area encounter into their longitudinal record.

The notion of a PCDH is being developed by the Strategic Health Information Exchange Collaborative, a 37-member HIE trade group to which the Utah, Arizona and Colorado exchanges belong.

Developing a PCDH model is part of a 10-year roadmap for interoperability and a “learning health system” which will offer centralized consent management and health records for patients, as well as providing national enterprises with data access. The trade group expects to see several more of its members test out PCDHs, including participants in Arkansas, Oklahoma, Indiana, Kentucky and Tennessee.

According to the Collaborative, other attempts at building patient records across networks have failed because they are built around individual organizations, geographies such as state boundaries, single EHR vendors or single payers. The PCDH model, for its part, can bring information on individual patients together seamlessly without disrupting local data governance or business models, demanding new technical infrastructure or violating the rights of local stakeholders, the group says.

Like other relatively lightweight data sharing models (such as the Direct Project) the PCDH offers an initial take on what is likely to be a far more complex problem. But it seems like a good idea nonetheless.

Specialty-Focused EHRs Re-Entering The Picture

Posted on June 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.

Over time, I’ve read a great deal on whether specialist clinicians should invest in EHRs designed for their area of practice or not. One school of thought seems to be that specialists can do just fine by buying broadly-based systems and implementing practice-specific templates, a move which also offers them a longer list of EHRs from which they can choose. Another, meanwhile, is that EHRs designed for use by all clinicians can undercut practice efficiency by forcing specialist workflow into a one-size-fits-all straightjacket.

But the arguments in favor of specialized EHRs seem to be taking hold of late. According to the latest data from Black Book, specialist surgical and medical practices have been switching over to specialty-driven EHRs in overwhelming numbers during the first half of this year. Its researchers found that during the first and second quarter of 2016, 86% of the 11,300 specialty practices it surveyed were in favor of switching from generalist to specialist EHRs.

According to the research firm, 93% of specialists surveyed felt that templates available in specialty EHRs offered a substantial benefit to patients who needed individualized documentation, especially in practices that see a high volume of predictable diagnoses.

If that’s the case, why did so many specialists start out with generalized EHRs?  Eighty-nine percent of respondents said that they bought the non-specialist EHR they had because they were focused on meeting Meaningful Use deadlines, which left them too little time to vet their original EHR vendor sufficiently.

Lately, however, specialist practices have decided that generic EHRs just aren’t workable, Black Book found. Nearly all respondents (92%) said that given their workflow needs, they could not afford to spend time need to shape all-purpose systems to their needs. When they switched over to purchasing a specialty-driven EHR, on the other hand, specialists found it much easier to support ultra-specific practice needs and generate revenue, Black Book reported.

That being said, specialists also switched from generalized EHRs to practice-specific systems for reasons other than clinical efficiency. Black Book found that 29% of specialists make the change because they felt their current, generic EHR was not achieving market success, raising the possibility that the vendor would not be able to support their growth and might not even be stable enough to trust.

Specialists may also be switching over because the systems serving their clinical niche have improved. Black Book researchers note that back in 2010, 80% of specialist physicians felt that specialized EHRs were not configurable or flexible enough to meet their needs. So it’s no surprise that they chose to go to with more robust multi-use and primary care systems, argues Black Book’s Doug Brown.

Now, however, specialized EHRs perform much better, it seems. In particular, improvements in implementations, updates, usability and customization have boosted satisfaction of specialist EHRs from 13% meeting or exceeding expectations in 2012 to 84% in the second quarter of 2016.

Still, practices that buy specialty EHRs do make some significant trade-offs, researchers said. Specifically, 88% of specialists said they were concerned about a lack of interoperability with other providers, particularly inpatient facilities. Respondents reported that specialty-specific EHRs aren’t fitting well within hospital network and regional health information exchanges, imposing a considerable disadvantage over large multispecialty EHRs.

And not surprisingly, investing in a replacement specialty EHR has proven to be a financial burden for specialist practices, Black Book concluded. Forty-eight percent of all specialty practices switching EHRs between June 2014 and April 2016 said that making such investment has put the practice in an unstable financial position, the research firm found.

My general sense from reading this research is that specialist practices have good reasons to replace their generalized EHR with a specialist EHR these days, as such products appear to have matured greatly in recent years. However, these practices had better be ready to deploy their new systems quickly and effectively, or the financial problems they’ll inherit will outweigh the benefits of the switchover.