On Tuesday, the Medical Group Management Association-American College of Medical Practice Executives sent a letter asking acting CMS Administrator Marilyn Tavenner to delay the deadline for submitting hardship exemptions for the federal electronic prescribing program, Modern Physician reports (Daly, Modern Physician, 5/16).
Background
Physicians must report submitting at least 10 electronic prescriptions by June 30 to avoid the 2013 reimbursement penalties through the Medicare e-prescribing program.
Physicians who do not report at least 10 e-prescribing encounters on claims for eligible services or file for an exemption in time face a 1.5% payment reduction for all Medicare claims in 2013 (iHealthBeat, 5/4).
Details of the Letter
In the letter, Susan Turney — president and CEO of MGMA-ACMPE — recommended that CMS extend the deadline for submitting hardship exemptions for the e-prescribing program from June 30, 2012, to Dec. 31, 2012.
The letter states that such an extension would allow physician practices to evaluate the effectiveness of their e-prescribing reporting in 2012 and avoid the penalties that would be imposed in 2013.
The physician group also called for CMS to “harmonize and simplify the various data reporting processes” for the e-prescribing program and other quality reporting-related initiatives, such as the meaningful use program.
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 (Modern Physician, 5/16).
Source: iHealthBeat
Physician use of tablet computers has nearly doubled since 2011, according to a new report by Manhattan Research, Becker’s Hospital Review reports (Roney, Becker’s Hospital Review, 5/14).
For its annual “Taking the Pulse” report, Manhattan Research interviewed 3,015 physicians across more than 25 specialties during the first quarter of 2012 (Dolan, MobiHealthNews, 5/14).
Use of Tablets, Mobile Devices
The report found that about 62% of surveyed physicians were using tablets in 2012, compared with 35% in Manhattan Research’s 2011 report.
Of the surveyed physicians who use tablets, the report found that 81% said they use Apple’s iPad (Horowitz, eWeek, 5/11). About 50% of the surveyed physicians who use tablets said they have used their device at the point of care.
The report also found that physicians who use smartphones, tablets and computers tend to spend more time on the Internet than those who have fewer devices (Becker’s Hospital Review, 5/14).
According to the report, physicians often use mobile devices to read medical news, research symptoms, prescribe medication and access medication reference databases.
Monique Levy, vice president of research at Manhattan Research, said doctors are less likely to use mobile devices to access electronic health records and laboratory results.
Other Survey Findings
The report also found that:
Source: iHealthBeat
An accountability tool embedded in an electronic health record system could help reduce unnecessary CT scans among emergency department patients with abdominal pain, according to a study presented last week at the annual meeting of the Society for Academic Emergency Medicine, United Press International reports.
Angela Mills — medical director of the Hospital of the University of Pennsylvania’s ED and co-author of the study — said abdominal pain often is difficult to diagnose, so ED physicians typically rely on CT scans to determine the source of the problem. Such practices can expose patients to unnecessary radiation and increase health care costs, Mills said (United Press International, 5/12).
About the Tool
In October 2011, the Hospital of the University of Pennsylvania installed an accountability tool in its EHR system that asks physicians a series of questions when they order an abdominal CT scan. The tool asks physicians about:
Although the tool does not prevent physicians from ordering abdominal CT scans, it does require an attending physician to sign off on CT scans ordered by a medical resident.
Study Details
For the study, researchers compared the number of CT scans ordered at two Penn EDs between July 2011 and Oct. 16, 2011 — before the accountability tool was installed — with the number of CT scans ordered between Oct. 17, 2011 and March 2012.
The study population included 11,176 patients older than 18. Eighty-one percent of those patients presented with a primary complaint of abdominal pain.
Study Findings
After the implementation of the accountability tool, the percentage of patients studied who underwent a CT scan decreased from 32.3% to 28%, according to the study.
After adjusting for certain factors, the researchers calculated a 10% overall reduction in the number of abdominal CT scans ordered after the tool was deployed (Fratt, CMIO, 5/14).
Researchers said that requiring physicians to walk through a series of steps before ordering a CT scan appeared to encourage the care team to rethink their decision to order the test (United Press International, 5/12).
Source: iHealthBeat
Last week, the American Medical Association sent a letter to acting CMS Administrator Marilyn Tavenner asking the federal government to further delay the compliance date for the transition to ICD-10 code sets to Oct. 1, 2015, Modern Healthcare reports (Conn, Modern Healthcare, 5/11).
Background
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 April, HHS announced that it would delay the deadline for complying with ICD-10 standards by one year, to Oct. 1, 2014.
HHS said it decided to push back the compliance date partly in response to health care providers’ concerns that they would not be able to meet the initial deadline (iHealthBeat, 5/10).
The comment period on the new ICD-10 compliance date ends May 17.
AMA’S Comments
In the letter, AMA Executive Vice President James Madara urged the federal government to allow a two-year extension of the ICD-10 compliance deadline because physicians are “overwhelmed with the simultaneous implementation of multiple health IT programs.”
In addition, Madara said that “if stakeholders cannot reach consensus on this matter during this two-year period, then the move to ICD-10 should be postponed indefinitely” (Modern Healthcare, 5/11).
Source: iHealthBeat
The HIT Policy Committee met on May 2 in Washington and contemplated a measure in the proposed meaningful use Stage 2 rule that would allow licensed professionals or scribes to enter data into a patient’s electronic health record on behalf of a doctor.
The difficulty is this: If a doctor doesn’t enter the order, he or she will not be able to see the decision support built into the EHR system that appears at that time. Decision support is supposed to help with the prevention of medical errors and is, according to federal officials, one of the reasons for the EHR incentive program in the first place.
Most EHR systems only show decision support once, as an order is typed into the CPOE system, according to Paul Tang, MD, chief innovation and technology officer at the Palo Alto Medical Foundation and vice chair of the HIT Policy Committee. The problem is, most doctors do not type in their own orders. Nurses often enter medication orders or clerical persons type in handwritten physicians’ orders, later to be “signed off” – or approved on the computer – by the physician, often in groups of multiple orders at the end of the day.
As the proposal stands now, the physician is required to use his or her personal log-on to open the record, and he or she is the person responsible for the electronic record. The physician is also responsible for approving any information entered by someone representing him or her in a clerical sense. If doctors want to see decision support, which includes warnings about dangerous drug interactions and other health preventative and safety warnings, then the doctor must be the one to type in the information.
Some members of the committee felt the rule was never intended to make doctors into typists. And even if they are good typists, they shouldn’t be required to spend their time doing it. It prescribes too much for a doctors’ workflow, and is not what the proposal framers intended.
A serious discussion arose over the CPOE subject, scribes and decision support – labeled by Tang as “the single most important objective of the entire EHR incentive program.”
Last month, the committee discussed if there were other ways a clinician could have something recorded, then take responsibility for it. A physician might want to have a licensed professional enter the computerized order and then have someone else do the clerical task of entering the progress notes. Tang urged the committee to be more specific about who can enter non-CPOE entries.
Some members of the committee were in favor of scribes entering non-clinical orders, some were against, with the major consensus among the group that the physician is ultimately responsible for what is recorded.
Tang was in favor of scribes for some things. “This does not interfere with how people want to enter progress notes,” Tang said, “since we don’t have that same need for a feedback mechanism” in that case.
“My opinion was to let it fall where it falls, and let them decide whether their physicians were less efficient or more efficient” at typing notes, said committee member Judith Faulkner, founder and CEO of Epic. “In some cases they might be, and in other cases they might not be.”
Gayle Harrell, a Republican state representative from Florida, said the requirement needs to fall where the liability falls. “Liability is the issue,” she said. “It’s going to be difficult to determine who’s the typist.”
“There are two separate issues,” Tang offered. “The accountability for the entire EHR and the accessibility of the information.“
Neil Calman, MD, president and CEO of the Institute for Family Health felt decision support should not be compromised. If a physician doesn’t see the decision support, what good is it? “As long as the decision support appears at the time of authorization, the person who enters the order isn’t really that important,” he said. He added that it is common practice now for physicians to sign off on orders that were typed in by other people.
“I strongly disagree with that,” said David Bates, MD, chief of research for the division of general and internal medicine and primary care at Brigham and Women’s Hospital. If physicians are to see the decision support, they have to see it when they type in the order, he said. “I’ve looked at a lot of different systems, all of them deliver decision support at the time that you’re actually entering the order. I’m fine with having scribes with other things,” he added.
There was some disagreement among the committee over whether current certified EHR systems allowed for decision support to appear again after the order is entered. Most of the physicians in the group said it was not possible. At least one said it was. Tang said to make Calman’s idea possible, it would probably require most physicians to have their EHR systems reprogrammed. Not a feasible idea, he said.
The EHR incentive program will not move forward if a doctor has to enter everything into a system, Calman warned. This would be loading doctors with too much work.
Tang also argued, “We want people to do the work at the top of their license,” implying that for doctors, this would be practicing medicine, not typing.
The committee was pressed for time, with only the May 2 meeting left to smooth out an entire host of recommendations due to the Centers for Medicare & Medicaid Services by May 7. Tang called for a vote on the CPOE recommendation, with three agreeing with what is written, allowing physicians to sign off on scribes entering non-CPOE data and licensed professionals entering clinical orders, without regard to when decision support may appear in the system.
Five members were in favor of revising the recommendation to require the EHR system to show decision support to every person who enters the data, including again to the physician when signing off. And, four abstained from voting.
“Clearly, we have a split vote,” Tang said. “We will have to let CMS know about that.”
CMS is collecting public comments until May 7 on the proposed Stage 2 meaningful use rules. Agency officials say the final rule will be issued some time this summer. Physicians participating in the EHR incentive program would have to comply with Stage 2 rules as early as 2013, depending on when they complete Stage 1. Physicians who do not adopt EHRs by 2015 and use them according to the new rules, will face Medicare and Medicaid reimbursement penalties.
Source: PhysBizTech
On Thursday, HHS announced that CMS has issued two final rules that would update technical standards for the electronic prescribing program and streamline other regulations for hospitals and health care providers, Modern Healthcare reports (Zigmond, Modern Healthcare, 5/10).
Changes to E-Prescribing Technical Requirements
One of the proposed rules, called the Medicare Regulatory Reform rule, aims to eliminate duplicative, unnecessary and outdated regulations for health care providers. CMS estimates that the new rule would generate $200 million in savings in its first year (HHS release, 5/10).
The rule includes numerous provisions, including one related to the Medicare e-prescribing program. The rule states that CMS has “retired older versions of e-prescribing transactions for Medicare Part D and adopted the newer versions to be in compliance with the current e-prescribing standards” (CMS final rule, 5/10).
Revision to Medicare Conditions of Participation
The other final rule would update the Medicare Conditions of Participation for critical access hospitals and other hospitals (HHS release, 5/10). CMS estimates that the new rule would generate more than $900 million in savings annually (Modern Healthcare, 5/10).
Acting CMS Administrator Marilyn Tavenner said, “These changes cut burdensome red tape for hospitals and providers and give them the flexibility they need to improve patient care while lowering costs” (HHS release, 5/10).
Source: iHealthBeat
The Premier healthcare alliance has submitted comments urging the federal government to publish final rules on Stage 2 of the meaningful use program by August or extend Stage 1 of the program for an extra year, Healthcare IT News reports (Monegain, Healthcare IT News, 5/2).
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.
In February, CMS released a proposed rule outlining requirements for hospitals and health care providers seeking to attest to Stage 2 of the meaningful use program. The Office of the National Coordinator for Health IT also released a proposed rule outlining standards and criteria for the certification of EHRs under Stage 2 of the meaningful use program.
The deadline for submitting comments about the Stage 2 proposed rules is May 7 (iHealthBeat, 5/1).
Details of Premier’s Comments
Premier said that a failure to publish the Stage 2 final rules by August would significantly compromise health care providers’ ability to meet Stage 2 requirements beginning in 2014. Premier said that if the Stage 2 rules are not released by August, CMS should continue Stage 1 for another year and start Stage 2 in 2015.
Premier also recommended that the federal government:
Source: iHealthBeat
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Sending text messages and other electronic reminders might improve medication adherence in the short term, but the long-term effectiveness of the strategy remains unclear, according to a review published in the Journal of the American Medical Informatics Association, CMIO reports.
About the Review
For the review, researchers from the Netherlands analyzed 13 studies that evaluated the effectiveness of medication reminders delivered through:
Review Findings
The researchers found that in all but two of the studies, the electronic reminders contributed to a “significant improvement” in medication adherence over a short time span of six months or less. They noted that the long-term effectiveness of electronic medication reminders was unclear (Durben Hirsch, FierceHealthIT, 4/30).
The researchers wrote that text messages and other electronic reminders “appear to be easily integrated into patients’ lives. As such, this seems to be a simple intervention for both patient and professional for enhancing medication adherence” (CMIO, 5/1).
The study authors also called for further research to examine how often electronic medication reminders should be sent (FierceHealthIT, 4/30).
Source: iHealthBeat
On Tuesday, Facebook launched an initiative that will leverage its network of 161 million U.S. residents to more quickly match patients who are waiting for organ transplants with possible donors, the New York Times reports.
Background on Organ Donation
Nearly 7,000 patients in the U.S. die annually while waiting for an organ, and the federal government’s Organ Procurement and Transplantation Network currently has about 114,000 patients on its waiting list, according to the Times.
Data from Donate Life America show that 43% of residents age 18 and older in 2011 officially designated themselves as organ donors. Donation rates in 2010 varied from 7% in Texas to 76% in Alaska.
Details on the Initiative
Facebook officials and organ transplant advocates say the new Facebook initiative could spur more individuals to register as organ donors.
Through the initiative, members of the social networking website can declare themselves as organ donors under a new “Health and Wellness” section, which includes biographical information and updates on their health. The section also includes links to state donor registries.
In addition to the U.S., Facebook is rolling out the new initiative in the U.K., where it has about 30 million members. The social networking website plans to expand the initiative to members in several other countries over the coming months (Richtel/Sack, New York Times, 5/1).
Source: iHealthBeat
On Monday, the American Hospital Association sent a letter to CMS stating that the meaningful use program might be too ambitious and that it might not achieve its goals, Bloomberg reports.
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.
AHA Letter Details
In the letter, Rick Pollack — executive vice president of AHA — wrote that more than 80% of hospitals have not been able to meet the Stage 1 requirements for the meaningful use program, partly because of “the high bar set and market factors, such as accelerating costs and limited vendor capacity” (Wayne, Bloomberg, 4/30).
Pollack added that the Stage 2 meaningful use requirements “raise the bar too high and are not feasible for the majority of hospitals to achieve” (Manos, Healthcare IT News, 5/1).
In addition, Pollack wrote that hospitals are “particularly concerned” about a requirement that they allow patients to electronically view and download their health records. Pollack said the requirement “is not feasible as proposed, raises significant security issues and goes well beyond current technical capacity” of hospitals (Bloomberg, 4/30).
To make it easier for health care providers to meet the requirements of the meaningful use program, AHA recommended that CMS:
Letter From Rep. Ellmers
In related news, Rep. Renee Ellmers (R-N.C.) — chair of the House Small Business Committee’s health care subcommittee — has sent a letter on behalf of small physician practices urging CMS to make certain changes to the meaningful use program (Bloomberg, 4/30).
Ellmers called for CMS to grant “hardship exemptions” to small physician practices and doctors nearing retirement so they would not face financial penalties for failing to demonstrate meaningful use of EHR systems.
She wrote, “Many of these physicians simply do not and will not have the resources to purchase and maintain health IT systems” (Millman, “Pulse,” Politico, 5/1).
Source: iHealthBeat
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