On Tuesday, the Medical Group Management Association sent a letter to HHS Secretary Kathleen Sebelius urging CMS to conduct ICD-10 testing with outside organizations, FierceHealthIT reports (Bowman, FierceHealthIT, 7/23).
U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures. The switch from ICD-9 to ICD-10 code sets means that health care providers and insurers will have to change out about 14,000 codes for about 69,000 codes.
In August 2012, HHS released a final rule that officially delayed the ICD-10 compliance date from Oct. 1, 2013, to Oct. 1, 2014, partially to look at the incremental changes needed in reforming health care.
There were rumors that CMS had decided not to conduct “external, end-to-end” testing with outside organizations for ICD-10 claims flows.
During an HHS National Committee on Vital and Health Statistics Subcommittee on Standards hearing in June, Cathy Carter — director of the business applications management group in CMS’ office of information services — said, “I don’t believe there was ever a plan [for Medicaid administrative contractors] to test with providers all the way through.” Carter said, “The announcement everyone is talking about wasn’t really an announcement.”
She said that CMS officials have informally agreed to discuss the issue in response to negative comments but expressed little optimism that CMS would change its plans, citing a lack of funding and time (iHealthBeat, 6/20).
In the letter, MGMA President and CEO Susan Turney said she is “extremely concerned” about CMS’ decision, adding that outside testing could help to avoid a potential “catastrophic back-log of Medicare claims” after the Oct. 1, 2014 compliance date (FierceHealthIT, 7/23).
Turney wrote, “ICD-10 will be one of the most significant changes the physician practice community has ever undertaken — impacting both the clinical and administrative sides of every care delivery organization,” adding, “End-to-end testing between trading partners is absolutely critical to measure operational predictability and readiness, and also to identify any roadblocks well in advance of the compliance date.”
She added, “Failure to do so could result in significant cash flow disruption for physicians and their practices, and serious access to care issues for Medicare patients.”
The letter concluded, “We believe it is imperative that you address this concern without delay and direct Medicare to conduct ICD-10 end-to-end testing with all external trading partners” (Goedert, Health Data Management, 7/23).
Source: iHealthBeat
Many physician practices seeking to replace their current electronic health record system plan to do so within the next year, according to a Black Book Rankings report, Healthcare IT News reports.
The report is a follow-up assessment to a study released earlier this year (McCann, Healthcare IT News, 7/23).
A study by Black Book Rankings released in February found that 17% of physician practices are considering switching electronic health record vendors by the end of 2013.
It also found that of the physician practices interested in switching EHR vendors:
The new report found that:
The report found that the most popular vendors for replacement EHR systems were:
According to the report, other vendors that received top rankings in client satisfaction were:
Source: iHealthBeat
During a Senate Finance Committee hearing on Wednesday, health care providers and health IT vendors recommended that Stage 2 of the meaningful use program be delayed by one year until Oct. 1, 2015, Government Health IT reports (Sullivan, Government Health IT, 7/24).
Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicaid and Medicare incentive payments.
More than 50% of eligible health care professionals and 80% of eligible hospitals have begun using EHR systems since the meaningful use program launched in 2011, according to CMS.
So far, the Obama administration has paid almost 310,000 health care providers a total of $15.5 billion for implementing EHR systems, according to CMS.
During a Senate Finance Committee hearing earlier this month, National Coordinator for Health IT Farzad Mostashari and Patrick Conway — director of CMS’ Center for Clinical Standards and Quality –pushed back against lawmakers’ requests to delay the program (iHealthBeat, 7/18).
During the hearing, providers and vendor representatives said Stage 2 of the meaningful use program is too rigid and could increase the digital divide between urban and rural caregivers.
John Glaser — CEO of Siemens Health Services — said other federal government mandates — such as the ICD-10 transition, payment reforms and new care models — combined with Stage 2 of the meaningful use program could create a “perfect storm” to cripple hospitals (Government Health IT, 7/24).
He warned that “many providers may opt out of further participation” in the meaningful use program if deadlines are not changed.
Glaser recommended that lawmakers delay the implementation of Stage 2 for one year and reconfigure the program to have each stage take three years.
Marty Fattig — CEO of Nemaha County Hospital, a 20-bed facility in Nebraska — noted that “most rural hospitals have yet to meet the exceedingly complex requirements for Stage 1” of the meaningful use program and that executives of such facilities worry that vendors will not be able to accommodate them in the program’s tight time frame.
He added that health IT systems can “introduce risk when things go wrong,” especially if they are “upgraded under severe time constraints” (Reichard, CQ HealthBeat, 7/24).
Janet Marchibroda — the health innovation initiative director at the Bipartisan Policy Center — urged lawmakers not to delay the start of Stage 2.
The next phase of the meaningful use program “advances considerably the engagement of patients and you don’t see that much of it in Stage 1,” she said, adding, “The information sharing is the primary driver in reductions in costs that we’ll see through health IT.”
However, Marchibroda suggested that lawmakers could let health care providers — such as accountable care organizations — that have made a lot of health IT progress reap the benefits of Stage 2 of the program, while providing more time for rural and critical access hospitals that are lagging behind (Government Health IT, 7/24).
Meanwhile, the National Partnership for Women and Families in a statement urged lawmakers not to delay the program and criticized the committee for not including patients and family caregivers at the hearing, according to CQ HealthBeat.
Following the hearing, committee Chair Max Baucus (D-Mont.) said he was “[n]ot yet” convinced to delay Stage 2 implementation (CQ HealthBeat, 7/24).
Source: iHealthBeat
Approximately 80% of physicians do not currently use an electronic health record system. Unfortunately, this statistic isn’t surprising, given the number of barriers to adoption, including the high cost of EHR systems and the often complex process of selecting and implementing new technology. It costs about $54,000 to purchase an EHR system, with annual maintenance costs of about $10,000. The HITECH Act aims to address the high cost of adoption by providing physicians with federal incentives of up to $44,000 for Medicare physicians and up to $63,750 for Medicaid physicians, if they can meet the “meaningful use” requirements outlined in the final rule recently released by CMS.
Throughout the meaningful use rulemaking process, the American Medical Association worked to ensure flexibility for physicians in meeting the requirements to help make the process of adopting and using EHRs as smooth as possible. With this final rule, physicians have a clear outline of what they need to do to take advantage of federal incentives that can help offset the cost of an EHR system. The final rule offers many improvements over previous drafts, but challenges do remain that may make it difficult for physicians to meet the requirements, especially those in solo and small practices.
Let’s start with the good. The final rule reduces the overall number of measures physicians have to meet during the initial stage of the incentive program and lowers the high reporting volumes associated with several measures to a more manageable amount. For example, the requirement for the use of computerized physician order entry has dropped from 80% to 30% and is now limited to just medication orders.
The rule also offers greater flexibility in meeting quality measures by limiting the number of clinical quality measures physicians need to report to only those with electronic specifications. Physicians are also able to select quality measures that are most relevant to their practice. Nearly half of the quality measures approved in the meaningful use rule come from the AMA-convened Physician Consortium for Performance Improvement, so participating physicians can be assured that many of these measures were developed through a rigorous, evidence-based and physician-led process.
The objectives and measures related to administrative simplification have been removed during the initial stage of the incentive program, allowing physicians to focus on only meeting requirements that are directly related to an EHR. Lastly, CMS has adopted an approach that calls for greater uniformity and less variation between the two incentive programs in Medicare and Medicaid.
Now for the challenges. Currently there is no EHR in the market that does all the things required for physicians to successfully meet the meaningful use criteria. To qualify for incentives, physicians must demonstrate they meaningfully use EHRs for a minimum of 90 consecutive days in 2011. CMS expects EHR systems that support meaningful use to become available this fall, giving physicians less than a year to purchase, implement and begin using EHR technology in accordance with the requirements. This is no small feat, considering it can take a year or more for some physician practices to purchase and implement an EHR system.
While the final rule does reduce the overall number of measures physicians must meet, requiring physicians to meet 20 measures in the first year is still a very high bar, especially for smaller practices that are new to the technology. Those physicians who have already invested substantially in EHR technology will now have to upgrade their systems to meet the certification criteria in order to be eligible for incentives.
Despite the challenges, a properly implemented EHR system can help streamline the clinical and business functions of a physician practice and support physicians with providing coordinated, patient-centered, quality health care. AMA is committed to helping physicians overcome barriers to implementation so they can successfully adopt EHR technology in their practices and qualify for federal incentives.
Source: iHealthBeat
Most hospitals and health systems have made progress related to the ICD-10 transition, but there undoubtedly is still more work to be done. Many have completed their readiness assessment, identified ICD-10 leadership, assembled their ICD-10 workgroups, planned coder, documentation specialist and other staff education, identified necessary IT infrastructure requirements and recognized the need to renegotiate payer contracts that reference ICD-9 codes. Still, even if all the above elements are in place, on time and functioning well, ICD-10 holds the potential to devastate a hospital’s revenue cycle integrity leading to short-term, if not long-term, losses in revenue.
Another critical piece missing from the list above is: Assuring that your medical staff is ready for the ICD-10 transition. Although many argue ICD-10 is a coding issue requiring coding solutions, we see time and time again surveys that identify physician education as the most difficult challenge in preparing for ICD-10. Why the inconsistency? It actually makes sense from an operational perspective. We can mandate that coders attend necessary education, purchase computer-assisted coding (CAC) solutions and negotiate with vendors to assure that all IT platforms are ICD-10 compliant. But how do you mandate appropriate documentation for ICD-10 from your independent physicians? Short answer… you don’t. It won’t work. That is the most likely reason many health systems have turned a blind eye to the issue of physician documentation for ICD-10. There is a better answer — don’t mandate; collaborate and educate.
Peer-to-Peer Education Is Best
I have been very impressed by the collegial response by physicians of all specialties when ICD-10 education is focused on their practice. Physicians are life-long learners and are interested in better documenting patients’ clinical conditions, particularly when framed in regards to the effect on outcomes and their workflow and practice.
However, many are still trying to find a “workaround” to avoid direct physician education. First and foremost, many health systems are looking at CAC as a bridge from inadequate physician documentation to efficient coding. It is not. We know that inadequate physician documentation has been a challenge under ICD-9. If documentation does not improve, CAC will provide so many erroneous codes to coders that the level of rework will be highly frustrating, requiring many iterative queries to physicians. In turn physicians will be angry, resentful and non-collaborative with a system that appears from a clinical perspective to be duplicative, time-consuming and adversarial. We must provide peer-to-peer, specialty-specific education regarding the specific documentation requirements for diagnoses and procedures as an integral part of overall ICD-10 planning.
Extending a Helping Hand to the Independent Physician
According to a 2010 MGMA survey, the U.S. health care system experienced a steady transition from independent physician-owned medical groups to hospital/health system employment models. Let us assume, for the moment, that hospital-owned practices, due to their affiliation with organizations developing ICD-10 expertise and infrastructure, will be at least relatively prepared for the ICD-10 transition. What will the impact be on health systems when independent physicians and physician groups aren’t prepared?
At a recent presentation to a large group of physicians, I had the opportunity to poll attendees on their current state of preparation for ICD-10. Only 15% of attendees acknowledged that they had, as of yet, done anything to prepare for ICD-10. The potential effect on hospitals and health systems is profound. Yet, a much broader risk has not been fully appreciated, and it will negatively affect health systems, particularly their physician executives. Many independent or small group practice physicians haven’t yet grasped the reality that their professional income will cease if they are not prepared to submit ICD-10 compliant bills as of Oct. 1, 2014. So what will happen as we approach the deadline?
As is typical in human nature, there comes a point where individuals recognize the inevitability of change and begin to adapt. As physicians recognize the necessity of ICD-10 compliance and their inability to assess their preparedness, train their staff and acquire and implement necessary technologies (the cost of which they may not be able to absorb), they will need to turn to some entity for help — and survival.
The inevitable partner will be a larger entity which has prepared for the ICD-10 transition — that is the hospital or health system. Here’s the challenge. At the very time when a hospital/health system CFO is facing the potential of up to a 50% decrease in coder productivity, increases in Discharged Not Final Billed charts (awaiting ICD-10 clarifications) and at least transitional revenue impact, physicians will be requesting (or more accurately demanding) acquisition to allow their survival.
The message is clear. Even for health systems with a high percentage of employed physicians, it is critical to partner now with your independent physicians, as well to assist them in maintaining self-sufficiency during the expensive and potentially difficult transition to ICD-10.
Physicians must have specialty-specific education regarding necessary documentation for ICD-10 in order to not negatively impact coder productivity and the entire revenue cycle. Proactive hospitals are planning to provide this education to their medical staff through a phased approach utilizing learning management systems and expert content delivered via a peer-to-peer, physician-to-physician format. That will greatly mitigate the risks of the ICD-10 transition and will clearly decrease the level of rework, improve coder productivity and positively affect physician satisfaction and an organization’s bottom-line.
Source: iHealthBeat
Well-developed electronic health records hold the promise of helping health care professionals improve patient care and deliver it more efficiently, and the American Medical Association recognizes that enhancing EHR usability and interoperability will further ensure our nation’s goal of a high-performing health care system. Physicians are generally prolific users of technology: new patient monitoring devices, diagnostic imaging, equipment and advanced surgical tools, to name a few. In each case, physicians have adopted these tools quickly and became proficient users — and they have done so without the need for a national incentive program. Why is it, then, that so many physicians are still trying to incorporate EHRs into their practices?
While the Medicare/Medicaid EHR incentive program can be credited with sparking a rapid adoption of health IT, it has also created negative consequences. Swift implementation of certified EHRs, needed to obtain incentives under the meaningful use program, has compelled physicians to purchase tools not yet optimized to the individual user’s needs. These tools often impede, rather than enable, efficient clinical care. EHRs can also pose challenges as a physician attempts to meet documentation, coding and billing requirements. AMA has been an outspoken advocate for health IT improvements and continues to work with the federal government and other stakeholders to advance usability and interoperability.
EHR Usability
According to the Healthcare Information and Management Systems Society, “usability is one of the major factors — possibly the most important factor — hindering widespread adoption of [EHRs].” Surprisingly, the Office of the National Coordinator for Health IT does not provide physicians any information about the usability of EHRs that it certifies. Usability standards should be included in ONC’s certification criteria to ensure that physicians are able to invest in the EHR system that fits the needs of their practice.
Many physicians report they are unhappy with the EHR products available to them, likely due to the fact that EHRs are still in an immature stage of development. They find them clunky, confusing and complex, and they are struggling to successfully incorporate EHRs into their workflow. According to a recent survey of physicians by American EHR Partners, approximately one-third of all surveyed physicians said that they were very dissatisfied with their EHR and that it is becoming more difficult to return to pre-EHR productivity levels.
Given this decrease in productivity, it is no surprise that since the start of the meaningful use program, we’ve seen continued escalation in physician dissatisfaction with their EHRs. According to the same American EHR Partners survey, the percentage of physicians who would not recommend their EHRs to a colleague increased from 24% to 39% between 2010 and 2012.
AMA also is concerned about the viability of the thousands of certified EHR products. We’ve heard from many physicians who have invested in EHRs that have gone out of business. These physicians, who were doing their best to adopt EHRs, are now faced with the financial hardship of purchasing an entirely new system. The uncertain future of an EHR extends beyond the product’s business model to the security of the product’s certification status. In fact, ONC recently revoked the certification of two EHR systems so providers cannot use those EHRs to satisfy meaningful use requirements. Physicians who have already invested in these now-uncertified systems will need to spend even more money on a new, certified EHR to replace their non-certified EHR or face a penalty.
EHR Interoperability
In addition to the usability challenges surrounding the use of EHRs, physicians also face a nascent and often uncertain health information exchange environment, including interoperability challenges associated with the ability of different EHR systems to share patient information with one another. Unless physicians and other health care providers are able to securely, accurately and effectively exchange health data about their patients, health IT’s promise for enabling high-quality and efficient care cannot be realized. A survey by the Bipartisan Policy Center revealed that more than 70% of clinicians surveyed identified lack of interoperability, lack of an information exchange infrastructure and cost of setting up and maintaining interfaces and exchanges as major barriers to health IT use.
Interoperability of EHRs will become more of an issue as physicians attempt to successfully participate in advanced stages of meaningful use. The meaningful use program has been structured such that each stage calls for physicians to meet an increasing number of requirements, including ones that call for more robust data exchange. This requires expensive, customized EHR interfaces so physicians can connect with other systems. Simply increasing the data exchange requirements physicians must meet in meaningful use will not solve the underlying challenges that persist around the operability of EHRs and HIE, things that are generally outside the average practicing physician’s control. Adding to this are the ongoing concerns that the requirements for meeting meaningful use are too one-size fits all and don’t accommodate all the different physician practice patterns and workflows. Layering these requirements on top of requirements that mandate physicians use certified systems that are clunky to use makes for a challenging adoption environment.
Physicians are doing their best to successfully adopt health IT, but more must be done to advance usability and interoperability. AMA is actively engaged with the administration to communicate the concerns of physicians and is pushing for criteria that would make certified EHR systems more user friendly for physicians and meaningful use Stage 2 requirements more flexible. While we believe that CMS and ONC’s decision to postpone rulemaking for Stage 3 is helpful, more must be done to address concerns with Stage 2, which begins Jan. 1, 2014. AMA will continue to highlight these issues and press CMS and ONC to address them before that date.
Source: iHealthBeat
The Office of the National Coordinator for Health IT has issued guidance on how health information exchange organizations and health IT service providers can help health care providers meet the transition of care measures under Stage 2 of the meaningful use program, Clinical Innovation & Technology reports (Pedulli, Clinical Innovation & Technology, 5/13).
Background
Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicaid and Medicare incentive payments.
The Stage 2 transition of care measures require eligible health care providers and hospitals to use certified EHR systems or information exchanges to:
Guidance Details
ONC’s guidance states that health information service providers and health information exchange organizations can support providers in meeting the transition of care measures in various way, such as by:
The guidance also includes information on:
Source: iHealthBeat
Many pharmaceutical companies use vast databases of patient and doctor information to market their products, raising concerns among some experts and privacy advocates, the New York Times reports.
About the Databases
The databases are maintained by organizations like research firm IMS Health, which began tracking patient data in the 1990s. Data tracked by IMS includes patients’:
In 2011, IMS expanded its collection of patient data by acquiring a company — SDI Health — that tracked patients’:
According to the Times, some drug companies leverage the databases to promote their products to major industry players, such as insurers, by showing that their drugs are more cost-effective or lead to better patient outcomes.
Pharmaceutical firms also say that the databases help them provide doctors with information tailored to meet their needs.
Andrew Kress, a senior vice president at IMS, said, “You can read a dark side to any of this, but the reality is that most manufacturers that IMS does research for are really trying to engage in a much more productive dialogue with the health care providers.”
Experts, Advocates Raise Concerns
Although HIPAA requires that personally identifiable data be removed from the databases, some experts say that the use of personal information to sell drugs still raises privacy concerns.
In addition, privacy advocates note that research has shown that individuals’ de-identified information sometimes can be re-identified.
Jerry Avorn, a professor of medicine at Harvard Medical School, said, “I think the doctors tend not to be aware of the depths to which they are being analyzed and studied by people trying to sell them drugs and other medical products.” He added, “Almost by definition, a lot of this stuff happens under the radar — there may be a sales pitch, but the doctor may not know that sales pitch is being informed by their own prescribing patterns” (Thomas, New York Times, 5/16).
Source: IHealthBeat
A coalition of consumer organizations has sent a letter to six Republican senators calling for the meaningful use program to be bolstered, taking issue with a letter and white paper from the senators saying the program should be rebooted, FierceEMR reports (Durben Hirsch, FierceEMR, 5/16).
Background
Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicaid and Medicare incentive payments.
On April 16, the GOP senators released a 28-page white paper — titled, “REBOOT: Re-examining the Strategies Needed to Successfully Adopt Health IT” — outlining their concerns about current federal health IT policy.
The white paper accompanied a letter that the six lawmakers sent to HHS Secretary Kathleen Sebelius. The letter requested information about the agency’s progress in promoting EHR adoption through the meaningful use program.
The six Republican senators who released the white paper and signed the letter are:
In the white paper, the lawmakers acknowledged that the meaningful use program aims to improve health care quality and reduce costs. However, they wrote, “nearly four years after the enactment … we see evidence that the program is at risk of not achieving its goals and that $35 billion in taxpayer money is being spent ineffectively in the process” (iHealthBeat, 4/17).
Details of Coalition’s Letter
The coalition — led by the Consumer Partnership for eHealth and the Campaign for Better Care — defended the EHR incentive program and lauded Congress for developing a quick, phased-in approach to health IT adoption (FierceEMR, 5/16).
The letter stated that it is “imperative” to keep meaningful use rulemaking on its “intended trajectory and implement the lessons learned in order to ensure that the outlay of public funds through this program results in a healthier population, better care and more affordable health care costs.”
According to the letter, any delay or retooling of the meaningful use program would:
Source: iHealthBeat
A mobile health application might be more effective than traditional interventions to help patients lose weight, according to a study published in the Journal of Medical Internet Research, Time‘s “Healthland” reports.
Study Details
For the study, researchers from the University of Leeds in in the United Kingdom divided 128 overweight volunteers into three groups, with each group using a different weight loss tool.
The three tools — which participants used over a six-month period — were:
At the end of the six-month period, researchers evaluated the participants’ adherence to their weight loss tool and measured changes in their weight (Sifferlin, “Healthland,” Time, 4/15).
How the App Works
The My Meal Mate app allows users to set a weight loss goal and record various health metrics. For example, users can record their:
The app provides graphs to track users’ progress and also offers additional support through weekly text messages tailored to the user (Slabodkin, FierceMobileHealthcare, 4/15).
Study Findings
Researchers found that study participants who used paper or online food diaries made entries about one per week. However, those using the My Meal Mate app used the tool every other day.
By the end of the six-month study period, the average amount of weight lost was:
Janet Cade — a professor at the University of Leeds’ School of Food Science and Nutrition — said, “Smartphone technology could be harnessed to promote health; generally people don’t know how many calories they are eating daily.” Cade added that the mobile app “really helped people monitor their food intake and resulted in an important amount of weight loss” (University of Leeds release, 4/15).
Source: iHealthBeat
MGMA Supports ICD-10 Testing With Outside Organizations
July 30, 2013
Report: Many EHR Users Set To Replace Systems Within the Next Year
July 30, 2013
Providers, Vendors Urge Congress To Delay Meaningful Use Stage 2
July 30, 2013
Many Doctors May Find Meeting ‘Meaningful Use’ Requirements a Challenge
June 28, 2013
When it Comes to ICD-10 Physician Documentation: Collaborate and Educate
June 28, 2013
The Slow Crawl Toward Improved EHR Usability and Interoperability
June 28, 2013
Efficient Patient Communication and Engagement
June 13, 2013
ONC Issues Guidance on Stage 2 Transition of Care Requirements
May 31, 2013
Drugmakers Leverage Doctor, Patient Data To Market Their Products
May 31, 2013
Consumer Organizations Defend Meaningful Use Program
May 31, 2013
