Jobs, Funding Related to Health Care Law at Risk

 

There’s little precedent for axing funding after a law is struck down.
 

Should Obama Care be rescinded by the constitutional conundrum and the decision of Supreme Court to throw out, it will take some time to unravel what has already taken place.

Sometime is better to cut your losses, and untold millions of dollars have already been spent forming new agencies and staffing them.

If the Supreme Court pulls the plug on health reform, winding it down could be almost as contentious as building it up in the first place.

And the hundreds of federal employees in the agencies created or expanded by the health law could find themselves at the center of a new round of fighting. Those positions rely on Affordable Care Act dollars that the court could take away by holding the whole law unconstitutional.

A lot could still be left up to the White House and Congress to work out — and the decisions would affect the new offices and agencies, the livelihood of the men and women who work in them and status of the multiyear contracts and projects they have embarked on.

It’s likely that some in the health reform workforce would get reabsorbed into other Health and Human Services offices, where a number worked prior to the health law’s passage two years ago. But some could end up without a job — and without their health benefits.

The offices created to implement the health reform law include the Center for Consumer Information and Insurance Oversight and the Center for Medicare & Medicaid Innovation. The consumer office is writing the health law’s new insurance rules and the Innovation Center is experimenting with different payment models for entitlement programs.

Neither Center for Medicare & Medicaid Services nor the White House would I have a comment for this story, but HHS records show about 500 people work for these two offices. A recent Senate Republican analysis of federal jobs data concluded that thousands more new HHS workers are busy implementing the health law, with about 3,000 new positions in the Office of the Secretary alone.

It’s complicated, and I find little satisfaction in the morass created by an irresponsible congress who did not take the time to read the law. It’s more than ‘I told you so.”  How much will it cost to take apart ‘Rubik's  cube ? 

Removing the freshly poured foundation, and filling a deep hole still seems far less complicated than figuring out procedure codes and how to link them with ICD diagnostic codes to submit a bill to patients, insurers and Medicare.  And the number of codes are about explode exponentially.

 

Technorati Tags: CPT icd,Obama Care,supreme court,unconstitutional,HHS

Combining all of these changes and near misses, Obama care, HITECH, ARRA, HIX, ACO, Pay for Performance, Outcome studies, Medical Meetings and implementing a new Electronic Medical Record system I may have to relinquish blogging and social media.

Big Data Part II Social Media

 

This article is a compilation of several sources, referenced at the end.

750 million users of Facebook, 100 million users of Google plus and an additional   users of Twitter, Myspace and Pinterest produces and enormous amount of data. How much of it is useful?  That depends upon who wants to know.

The same can be said for Health Information Systems. A conundrum is developing and will become an overriding issue as the Health Information Exchanges, regionally and nationally become operational.  There are substantial barriers financially and some reticence on the part of hospitals to invest. The initial construction will be heavily subsidezed by HITECH and ARRA.  When these grants expire the exchanges must be self supporting.  When and if completed HIX will gather enormous amounts of information. Will it gather dust unused? That will depend upon a second and even third generation of software.

It comes in “torrents” and “floods” and threatens to “engulf” everything that stands in its path. The sheer size of the pile (measured in petabytes, one million gigabytes, or even exabytes, one billion gigabytes) combined with its complexity has threatened to overwhelm just about everybody, including the scientists who specialize in wrangling it.

“It’s easier to collect data,” said Michael Franklin, a professor of computer science at the University of California, Berkeley, “and harder to make sense of it.”

Making sense of Big Data is, in fact, a holy grail of computer science these days — and technology companies, academic institutions and the federal government are investing heavily in the endeavor.

And with Google, Facebook, Twitter and many other leading data-heavy technology companies based in the Bay Area, many locals are on the cutting edge of Big Data research.

Last month, the National Science Foundation awarded $10 million to Berkeley’s A.M.P. Expedition, which stands for “algorithms machines people,” a team of Cal professors and graduate students who take an interdisciplinary approach in their drive to advance Big Data analysis.

The Berkeley group was founded in early 2011 and includes Google, SAP and Oracle as sponsors.

The grant is part of the Obama administration’s “Big Data Research and Development Initiative,” which will distribute $200 million. One of the more innovative aspects of the Berkeley group is its emphasis on the people part of dealing with Big Data.

Meanwhile, for every minute that it took you to read this article, 48 hours of video were uploaded to YouTube. According to the site, an overwhelming amount of material — about eight years of content — are added every day by users.

Big Data will play a role in ACOs, and Medicare’s budding plan to incentivize or penalize outcomes. Individual providers will be judged in the context of their “beneficiary community” and local providers.

 

Technorati Tags: big data,acos,medicare,incentive payments,outcomes,beneficiary community,hix,hie,google +,twitter,health information exchange

PAIN FOR PERFORMANCE

Attributed to Jonathon  Low  (from the blog “Lowdown”)

A Partner and Co-Founder of Predictiv and PredictivAsia, Jon specializes in management performance and organizational effectiveness for both domestic and international clients. He is an editor and author whose works include Invisible Advantage: How Intangilbles are Driving Business Performance.

“Medicare Starts to Tie Doctors' Pay to Quality and Cost

For all the data collected about medical care and health, the relationship between expenditures and results in the US remains stubbornly disconnected.”

Reimbursement from Medicare is going to become tricky with the imminent calculations regarding outcomes for your patients in your geographic location.

It appears that not only will your outcomes  affect your income, but the outcomes of your referring and referral providers will affect your practice income.

Jordan Rau (Washington Post) writes, “Making providers routinely pay attention to cost and quality is widely viewed as crucial if the country is going to rein in its health-care spending, which amounts to more than $2.5 trillion a year. It’s also key to keeping Medicare solvent. Efforts have begun to change the way Medicare pays hospitals, doctors and other providers who agree to work together in new alliances known as “accountable care organizations.” This fall, the federal health program for 47 million seniors and disabled people also is adjusting hospital payments based on quality of care, and it plans to take cost into account as early as next year.”

“Twenty-thousand physicians in four Midwest states received a glimpse into their financial future last month. Landing in their e-mail inboxes were links to reports from Medicare showing the amount their patients cost on average as well as the quality of the care they provided. The reports also showed how Medicare spending on each doctor’s patients compared with their peers in Kansas, Iowa, Missouri and Nebraska.”

“Efforts have begun to change the way Medicare pays hospitals, doctors and other providers who agree to work together in new alliances known as “accountable care organizations.” This fall, the federal health program for 47 million seniors and disabled people also is adjusting hospital payments based on quality of care, and it plans to take cost into account as early as next year.

Applying these same precepts to doctors is much more difficult, experts agree. Doctors see far fewer patients than do hospitals, so making statistically accurate assessments of doctors’ care is much harder. Comparing specialists is tricky, since some focus on particular kinds of patients that tend to be more costly”

Dr. Michael Kitchell, a neurologist and chairman of the board at the McFarland Clinic in Ames, Iowa, one of the state’s biggest multi-specialist practices, predicted the Medicare reports “will be a huge surprise to almost every physician.” That’s because the calculations of how much those doctors’ patients cost Medicare include not just the services of the individual doctor but of all the doctors that provided any treatment to the patient. Kitchell said his patients saw on average 13 physicians besides himself.

“You’re a victim or a beneficiary of your medical neighborhood,” Kitchell said. “If the primary-care doctors are doing the preventative screening tests, you’ll get credit for that, but if you’re in a community where the community doctors are doing a poor job, you’re going to look bad.”

Providers organized into a multispecialty medical group and/or accountable care organizations will have an easier time than those in solo, practice, or single specialty groups. These practices may require a redesign  They are at a distinct disadvantage caused by their local community provider network formal or informal.  It ups the stakes as to who you receive referrals from or to whom you refer.  The quality, efficiency and their outcomes will alter your reimbursement through incentives and/or penalties.  (Note that the metrics are determined by CMS, not your neighboring providers or you.)

Dana Gelb Safran, who oversees quality measurement for Blue Cross Blue Shield of Massachusetts, says she doubts it will be possible for the government to judge individual doctors. She predicts CMS will ultimately have to find ways to evaluate doctors as parts of groups — either formal affiliations as part of group practices or informal affiliations among doctors who refer to each other.

If you were an auto mechanic your brake repairs might be compared to a body shop, or engine mechanic that also worked on the same vehicle.  The brakes may be perfect, however your payment may be decreased by the condition or repairs on the rest of the vehicle

This may be an unprecedented change in payments for any services not only in health care but most industries.

Although the program is still being devised, it will become reality for many doctors starting in January, because CMS plans to base the 2015 bonuses or penalties on what happens to a doctor’s patients during 2013.

Medicare’s adoption of this approach would be “a game changer” in terms of making physicians directly accountable for costs, said Anders Gilberg, senior vice president at the Medical Group Management Association, which represents doctors groups. Medicare is “going to be shifting money from . . . physicians who are deemed to be high-cost relative to their peers to low-cost physicians. That’s going to create all kinds of new incentives in fee-for-service.”

Private insurers may follow Medicare’s lead, said Paul Ginsburg, president of the Center for Studying Health System Change, a Washington think tank. The formula Medicare ultimately designs to judge and pay doctors, Ginsburg said, could become “a valuable asset for private insurers, with a tool that will be somewhat bulletproof, that physicians won’t attack because they’ve been part of the process of developing them.”

“Patients are not behind this agenda. The public is very scared about managing costs.”

 

Technorati Tags: accountable care,medical home,cms benefits,medicare,pay for performance,quality,outcomes

Social Media in Healthcare—Where is it Leading Us?

 

The following selection is from the blog “Occupy Healthcare”

Do you remember when people had a family doctor that made house calls. I am one of the few physicians who can remember those days. Todays graduates in most locales would not think of this as a way to practice medicine. Perhaps in some rural areas (if there are any primary care physicians in those areas.)

When was the last time you heard of a medical home visit? Have you ever been seen in your home? What has changed in healthcare that we must go to a building in order to receive services? Why are services not coming to us? When did healthcare become removed from the community?

“20% of Americans or approximately 60 million people live in rural America. Those who live in rural communities are older, poorer and have more chronic diseases than the typical city dweller. The problem: few doctors choose to practice in rural America. And the doctors who are out there are getting older themselves and are close to retirement.”

 

Healthcare reform paid a significant amount of attention to expanding coverage for individuals who previously had no health coverage. In some rural areas, being able to have access to insurance means that you are now more likely to be seen than before. But what happens when there is no one there to see you? What happens where there is no workforce to address your healthcare needs? While the same can be said for urban areas too, the need is more apparent in our rural communities.”

 

Commentary:

Gary Levin M.D.

Are social media and telemedicine the first retro step in a journey to house calls? I believe we are just at the beginnings of the applications of remote monitoring and telehealth.  The perfect storm and convergence of smartphones, tablet computers, internet, cell phone technology and an exploding interest in Health 2.0 and 2012 has earned the year of mobile applications in healthcare.

Today computer technology allows for EKGs, Ultrasound examinations, Blood testing,  and video transmission of images. ‘Scopes” can be attached to video to be transmitted via inexpensive tele conferencing applications. The technology is now here, and only political and regulatory reform are necessary for the technology to become widespread. All of the above can be performed in a home environment, removing the inadequacies of home examinations and treatments.

While the concept today seems archaic to most current trainees there still remain physicians who remember the day when the diagnosis was made during the history taking, confirmed by physical examination, and laboratory data as the last resort.

Today young physicians seem to rush through the history and physical and resort to imaging as the first resort of an evaluation, be it abdominal pain, headache, or trauma.  I am not implying these relatively advanced technologies should be abandoned, rather selectively applied.  The medic-legal environment also sways our judgment in ordering these tests as they have become a ‘standard of care’ in most communities.

Government Poised To Provide A Huge Boost To Healthtech Startups

 

Attribution:  All of this article is attributed to

 

Dave Chase is the CEO and Co-founder of Avado, a Patient Relationship Management platform that automates interactions between an individual and their healthcare providers greatly reducing the administrative burden for healthcare providers and improving the patient experience. 

Currently, the federal government is poised to level the playing field for healthtech startups. An unprecedented wave of innovative healthtech startups has been developing over the last few years. You can see them at conferences such as Health 2.0, TechCrunch Disrupt, TEDMED and demo day events that Blueprint Health, Healthbox, Rock Health and Startup Health host. Nonetheless, the health sector may be the single most challenging arena for startups.

Fortunately, there are scores of innovative startups who are start up health,well positioned to address the patient engagement requirement. Look no further than the companies in startup incubators/accelerators or the scores of companies demonstrating at Health 2.0 conferences. These software developers from Silicon Valley, Seattle, Boston, New York and elsewhere have the skillset to address this critical requirement. They can assist healthcare providers directly or via their vendor partners.

Unfortunately, with little awareness of innovative healthtech startups, providers and legacy vendors are pushing back against the requirements proposed by the ONC. There is a major risk that the proposed requirements will be watered down based upon this feedback. What could be the biggest ever jumpstart to the healthtech startup community could become a missed opportunity. More importantly, the opportunity to make a huge difference in the health of our population would also be missed.

 

Note: The image accompanying this article is from Regina Holliday. As described on her Wikipedia page, Regina paints images that encapsulate her view and others in the e-patient community

Having high expectations for Patient Engagement will cause healthcare providers to rise to the occasion to solve this huge issue. Consider that three-quarters of healthcare spend is on chronic disease and decisions that drive outcomes are made by individuals (aka “patients”). It’s long been said the most important member of the care team is the patient. It’s time to transform that from a catchphrase to reality.

 

2012 TEDMED. During the event, they had a “Great Challenges“ contest. Not surprisingly, “The Role of the Patient” was a leading vote getter. This despite the fact that it didn’t begin to hint at the role patients can play if they’re equipped with information.  And that’s a major point of why patient and family engagement are proposed in Stage 2 Meaningful Use.  As support built for the challenge, it’s critical that your voice is heard on the proposed Stage 2 Meaningful Use requirements.

Voting for the petition is great to raise visibility, but the most impactful thing you can do is to comment on the government site

Technorati Tags: meaningful use,stage II,healthtech,startups,david chase,Avoda,patient care and affordability act,tedmed 2012,health 2.0,healthbox,blueprint health,rock health

I am taking a break today.....it's my birthday. 

Something In It for Everyone (to Oppose)

 

Health Train Express was derailed by a ‘near miss’ and had an unscheduled trip to my “Center for Excellence” in Heart Affairs.  I will report on that in my next blog post, but already have this one ready to go.

The Affordable Care Act is a rich target for almost everyone, employers, hospitals, physicians, patients. The only ones not opposed to it are the uninsured and disadvantaged, but they are suspicious as well.

If the Act itself is not sufficient there are annual budget proposals that will modify and tweak it further.

Let’s begins with

Chicoholley’s World

Military Tiering: Govt. wants retirees to pay for their health care according to retirement salary. These were earned benefits for all and shouldn’t be treated like a welfare program. It was a promise and part of the package for serving a minimum of 20 years.

The Presidents budget for FY 13 proposes “tiering” which is means testing based on retired pay.  This testing is for the health care we have earned through a full career.  These were promises made by the government.  The health care and  pay was earned through many years of service to protect our country. This certainly is discriminatory.  Means testing health care fees is rare in the civilian community.  The types of programs that are means tested for example are welfare programs.  Military retirees have earned their health care for a full career in the military.  Now, the government wants to break promises to all those who have served for 20 to 30 plus years.  Their word means nothing.  This is unfair to all those who have served and protected our country.  I am sure many of you out there have friends and family members who have spent years their lives being career military.  We need your help to tell congress and the president that this is unfair and discriminatory toward those who have served.  Thank you.  M. Moll  USAF Retired.

Employers are faced with providing insurance to all employees or face penalties. Many may opt out and pay a penalty which will be less costly to them than purchasing insurance coverage.

Employees

Providers will be affected by meaningful use requirements, HIT directives, reorganization of payment models using accountable care organization and elimination of procedure driven billing codes. and the burden of installing electronic medical records or suffer penalties in payments. Providers will have to chose carefully regarding Health Insurance Benefit Exchange Offerings, and completely review state Medi-caid plans.

Hospitals are faced with the expensive challenge of forming accountable care organizations to monitor and control cost, and outcomes. Nice new income source for attorneys

Insurance

Major changes in regulations regarding limits on profit, broad expansion of eligibles, changes to coding, payment models with formation of accountable care organizations.

Retired   Means testing and tiering are also being proposed for social security benefits, as well as increasing eligibility age for benefits.

State Health Departments will have to reassess their eligibility standards for state sponsored plans using Medi-caid as an administrative plan. Current standards are highly restrictive and make no sense as they are not based on any type of meaningful coverage nor consistency and are based upon month to month eligibility.  Medi-caid eligibility standards are retro based on poverty standards and meaningless maintenance requirements and size of household.  Standards are set for disqualifications such as household size and other factors.

.

All of these complaints lead me to repost something I had posted in the past on Facebook. 

“The Donkey in The Well”

One day a farmer's donkey fell down into a well. The animal cried piteously for hours as the farmer tried to figure out what to do. Finally, he decided the animal was old, and the well needed to be covered up anyway; it just wasn't worth it to retrieve the donkey.
He invited all his neighbors to come over and help him. They all grabbed a shovel and began to shovel dirt into the well. At first, the donkey realized what was happening and cried horribly. Then, to everyone's amazement he quieted down.
A few shovel loads later, the farmer finally looked down the well. He was astonished at what he saw. With each shovel of dirt that hit his back, the donkey was doing something amazing. He would shake it off and take a step up.
As the farmer's neighbors continued to shovel dirt on top of the animal, he would shake it off and take a step up. Pretty soon, everyone was amazed as the donkey stepped up over the edge of the well and happily trotted off!
MORAL :
Life is going to shovel dirt on you, all kinds of dirt. The trick to getting out of the well is to shake it off and take a step up. Each of our troubles is a steppingstone. We can get out of the deepest wells just by not stopping, never giving up! Shake it off and take a step up.

 

Technorati Tags: military tiered health benefits,cms tiered benefits,retired,aco,obamacare,means testing

Health care reform should start locally not nationally

 

Edward J. O'Boyle

Edward J. O'Boyle is senior research associate with Mayo Research Institute offices in New Orleans, Lake Charles and West Monroe.

“To replace a monolith like Obamacare, whicot affiliated with the Mayo nh brings down the whole house when it fails, Mayo Research Institute (Mayo Research Institute is not affiliated with the Mayo Clinic) recommends 10 bare essentials of a more flexible and freedom-protecting reform that puts control of health care largely in the hands  of the states.

If the Supreme Court rules that Obamacare is unconstitutional, Congress will have to decide whether to attempt another federal overall or put in place entirely different reform legislation

Based on the 10th amendment that reserves all un-enumerated powers in the Constitution to the states, each state is instructed to reconstruct its own health care system according to the specific health care needs, resources, values and principles of its citizens.

Guided by the principle of subsidiarity, the federal government would provide financial support for any state that is unable to meet the basic health care needs of its citizens with its own resources. To assure that any such state continues to function as the principal party in its health care system, federal assistance would contain no mandates and would be limited to no more than 49 percent of that state's public

While the system Mr. Boyle discusses has some shortfalls, it retains the Constitutional framework of leaving to the states the responsibility of running and  financing it’s own mechanisms.  Given the large range of financial resources of each state, the federal government would only subsidize programs that the states could not.

Founded on the principle that health care is a universal human need, each state would decide the minimum health care it requires of insurance companies offering coverage to its citizens. The minimums would be recommended by an advisory group constituted of representatives from throughout the state's health care system. Whenever that advisory group reaches agreement its recommendations would be passed without revision by the legislature and signed into law by the governor. Whenever that advisory group is unable to reach agreement the legislature would define those minimums. The advisory group would revisit those minimums as circumstances change. .

Ideally this system starts from the bottom up rather than the reverse. The  state sets up it’s own devices, without Federal interventions, nor  mandates. Each state establishes it’s own priorities.

Grounded on the principle that individuals have a fundamental responsibility to provide for their own needs as far as possible, any individual without employer-backed insurance would be encouraged but not required to purchase coverage with the state reimbursing up to 50 percent of the cost of the state minimum coverage. Co-pays would be a necessary part of any insurance policy. Anyone who wants coverage above the minimum would have to pay in full the additional cost for that protection.

Taking account of the special health care needs of certain persons, catastrophic coverage policies would be required of any insurance company doing business in the state. Anyone electing that added protection but not able to afford it would get a state tax credit to cover up to 50 percent of the cost.

Relying on the principle that no one of means has a right to impose the cost of their health care on others, anyone of means who decides not to have insurance coverage and subsequently requires health care services would be restricted to the minimum coverage as defined by the state. That person would be eligible for health care beyond the minimum only if he/she is willing to pay in full the additional expense of providing that care.

Based on the fundamental dignity of all humankind, persons too poor to afford their own health care would have access to the minimum coverage as defined by the state at the state's expense. To help eliminate abuse, a nominal co-pay would be required of anyone in financial distress.”

This idea eliminates the onus of “universal payer” which most Americans want but are averse to any idea that it is ‘socialized medicine’ or a national health care plan.

The full article in the NewStar.com (Gannett)

Reference:  Subsidiarity

 

Technorati Tags: subsidiarity,obamacare,constitution

Knowledge (Data) is POWER In the Health System Part I

 

The title of today’s article is a cliché for most professionals, be it in medicine, law, accounting, education, entrepreneurship and everyone else.

“How much?” or “How many” is a key theme appearing in all of the above, whether it involves how successful you are, business planning, and budgeting.

Some prefer to keep their heads down and carry on as events swirl around them, preferring to continue on their thus far successful business and medical enterprise, rightly concerned that the chaos and confusion ‘out there’ will absorb emotional and intellectual energy which could be better put to work within their medical practice.

Some changes are gradual, like the tides,scarcely noticed on a minute to minute basis .  Other changes are waves, paradigm shifts, and even tsunamis,  inundating events as they come on shore, and causing even more damage leaving, sweeping out the remnants of the old structures.

Medical practices, hospitals, insurance companies, are all data gatherers as well as becoming the agent for exportation of their data for studies. At one time most of this data was highly private and guarded. However, today it is different. Some patients are clamoring for data, openness and transparency….access to their medical records,  and our government clamors for data to study  for information, so intently that it is willing to fund EMR and HIX at taxpayer expense. 

Your taxpayer dollars investing in information that may benefit you.  The dividends still very much in doubt.

The flow of knowledge (data) ever increases as the internet becomes the central technology in most commerce.  

It is necessary to have broadband access to avail use of Health Information Exchanges to share patient information. If not available dial up access is a poor substitute unless graphics poor, text only data is used.

Rural medical practices are in this empty space with poor access to the fiber and backbone of the global flow of information.  In fact unless you are in a metropolitan area, and even in some suburban locations you are at a disadvantage.

The next generation expects and depends upon the worldwide internet to function.

Some examples

New graduates select areas with broadband access for medical practice

Real estate values are much higher in areas with broadband. Housing sales suffer without it. Potential entrepreneurs seek regions with broadband access.

Part II of this topic  will address the enormous amounts of data now being accumulated and the developing inadequacy of our  present analytics to gather and process it.  I will discuss new techniques and processing algorithms that address this challenge to extract not just the data, but to interpret it.

Technorati Tags: incentive payments,big data,analytics,broadband,internet,emr,hix

MedPAC Raises Concern About Meaningful Use Attestation

Many are skeptical about accepting Federal Incentive payments for the adoption of meaningful use to become qualified for the payments authorized by HITECH and stimulus funding.  It may also be true that many are willing to face penalties for not adopting EMRs after the deadline for implementation passes.

The usual approach of the federal government to offer the carrot before the stick has become a hackneyed way of doing business with the Feds and the States.

Now that Medicare and some private insurers have squeezed most practices to the breaking point and the number of uninsured has soared in the past two years no one can blame beleaguered physicians for accepting the Machiavellian tactics of HHS planners.  None of this was encouraged, nor promoted by the grass roots of medical practice in the United States.

Hopefully it is not too late and freedom loving physicians and patients will take the risk of saying ‘hell no’. The end of the road is clearly in site, unless this occurs, and accepting this fiat from the Feds will only be the beginning of endless demands to add more MU criteria every few years.  The handwriting on the wall is clear, as we are marched off to get our bar of soap for the ‘showers’.   I know the comparison is grim and probably offends many..But it is the truth as I see it.

We are not in a unique situation, as this is occurring in the U.S. in general with an executive branch and congressional branch that ignore the US Constitution. This is no accident as our President is a constitutional scholar. 

Early studies, save for a very few, show a dismal ROI and a lack of meaningful  improvement in health care delivery, not withstanding the meaningless use criteria invented by social planners and ‘visionary’ leaders.

This report from MEDPAC clearly tells the story of disappointment.

During a meeting in Washington, D.C., on Thursday, several Medicare Payment Advisory Commission members raised concerns about the small number of eligible professionals and hospitals that have successfully attested to the Medicare portion of the meaningful use program, AHA News reports (AHA News, 4/5).

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

MedPAC Data

Commission members noted that health care provider participation in the meaningful use program is lower than the federal government projected.

According to CMS data released at the MedPAC meeting, total incentive payments awarded to eligible professionals for the meaningful use of EHRs reached $636 million in February, a 57% increase over the previous month, while cumulative payments to hospitals reached $1.4 billion, a 10% increase from the previous month.

The 10% increase in hospital payments in February is down from December 2011 when there was a 50% increase in cumulative incentive payments to hospitals.

According to the data, 3,280 hospitals -- or 58% of eligible facilities -- and 126,321 physicians -- or 25% of eligible professionals -- have registered for the meaningful use program.

Of those, 796 hospitals -- or 16% -- and 31,650 physicians -- or 6% -- have received payments.

Comments

Some hospital and physician advocates cited high EHR adoption costs and overly burdensome program requirements as reasons for the low adoption rates (Daly, Modern Healthcare, 4/6).

MedPAC members indicated an interest in monitoring the meaningful use program to determine if EHR adoption reduces costs and boosts efficiency (AHA News, 4/5).

Read more: http://www.ihealthbeat.org/articles/2012/4/6/medpac-raises-concern-about-meaningful-use-attestation.aspx#ixzz1rKRXQsf9

 

Technorati Tags: ehr adoption,incentive payments,medicare,penalties,cms,medpac

Sustaining the Unsustainable by Creating New Institutions Costing more to spend less.

 

In the world of health information exchange development process and implementation are very slow.

I previous posted here about the Inland Empire Health Information Exchange becoming operational on April  1, 2012.

                             

 

In an article by Lauren McSherry, California Healthline Regional Correspondent she ably outlines the processes, delays and pitfalls of developing an entirely new entity.

“After two years of planning and negotiation, an information-sharing network linking health care providers throughout Riverside and San Bernardino counties is almost ready to go live.

Health officials say the Inland Empire Health Information Exchange will be one of the largest in the nation, covering a geographic region nearly the size of Maine with a population of 4.2 million. About 15 hospitals and 2,000 doctors are expected to participate in the health information exchange. California has a strategic plan for the mobilization of health care information electronically across organizations within regions, communities and ultimately the state.

"Our challenge in the Inland Empire is that our counties have some of the lowest health outcomes when it comes to some of the more chronic diseases," said Christina Bivona-Tellez, regional vice president of Riverside and San Bernardino counties for the Hospital Association of Southern California. "This is a tool we can use to more expeditiously intervene and make a difference," she said.

In June, supervisors in Riverside and San Bernardino counties passed resolutions recognizing the exchange as the designated HIE network for the region. Each county's department of health will participate in the exchange.

In the future, regional HIEs will share information through state HIEs, with the ultimate goal being national connectivity. So far, $22 billion has been allocated through the 2009 Health Information Technology for Economic and Clinical Health Act, or HITECH Act, as part of a national push to link health care providers.

California has 17 HIEs and is working to build its own state HIE, called Cal eConnect.

Costs and Other Challenges

With an estimated cost of $2.2 million to $2.5 million annually, building and maintaining the exchange is an expensive proposition.

"One of the most critical things is being able to make it work financially," Bradley Gilbert -- CEO of the not-for-profit Inland Empire Health Plan, a participant in the new HIE -- said, adding, "The difference [from other exchanges] is you've got health care entities that will be providing the dollars for the program to work. You've got different fee structures for the different kinds of entities."

The high cost of maintaining and operating HIEs is not unusual, and sustainability is one of the biggest challenges facing HIEs across the nation, said Jennifer Covich Bordenick, CEO of the eHealth Initiative, an independent not-for-profit organization in Washington, D.C.

An eHealth Initiative survey released July 14 found that at least 10 HIE initiatives have closed or consolidated since 2010. HIEs totaled 255 in 2011, but only 24 initiatives reported having sustainable business models.

"You're talking about infrastructure that can be created so that doctors can talk to pharmacies, and pharmacies can talk to labs, and patients can look up their information in their homes," Covich Bordenick said. "There are issues of who pays for this because there are so many different users of the system."

The HITECH Act spurred growth in HIEs across the nation. But as the number of HIEs grows, so does the competition to attract health care providers to participate.

"Some groups are collaborating or absorbing other HIEs," Covich Bordenick said.

Meanwhile, experts are paying particular attention to ensure that the Inland Empire HIE will be sustainable and not be reliant on grant funding, so it can survive and grow.

"HIEs that have been started predominantly with grant funding have had difficulty sustaining themselves," Gilbert said. "You cannot be dependent on grants because grants eventually dry up and stop."

Covich Bordenick said an example of a successful HIE that has not relied on public funding is HealthBridge, an HIE serving the greater Cincinnati area, which covers parts of Indiana, Kentucky and Ohio.

The Inland Empire HIE will be a subscription-based model with annual fees to support the initiative, Gilbert said. One model used in developing the Inland Empire network has been the Santa Cruz HIE, which dates back to 1995 and has brought together more than 400 health care providers.

Other HIEs are encountering challenges related to technical aspects and systems integration as they attempt to share information.

 

Looming Health Care Reform

The importance of ‘anchor participants’ for a health information cannot be overemphasized because it provides a bedrock of financial sustainability. Financial stability has been a major and impenetrable wall for most plans, save a few. Even those that became operational (Santa Cruz RHIO) failed when the initial grants expired.

Being a part of the Inland Empire HIE is particularly important for Inland Empire Health Plan because its membership is growing dramatically, Gilbert said. Compared with other health insurers in the region, the health plan has the largest proportion of low-income residents.

The importance of ‘anchor participants’ for a health information exchange cannot be overemphasized because it provides a bedrock of financial sustainability

The unemployment rate in the region has been hovering around 14%, and many residents currently are unable to afford health insurance. The Inland Empire area has more than one million uninsured residents, according to a February study by the UCLA Center for Health Policy Research.

By June 2012, the Inland Empire Health Plan expects to have more than 600,000 members, fueled by the economic downturn and the state's mandate to transition Medi-Cal beneficiaries into managed care plans, Gilbert said. Medi-Cal is California's Medicaid program.

By 2014, when many insurance provisions under the federal health reform law take effect, IEHP's membership is expected to reach 900,000, Gilbert said. The HIE will help keep patient records easily accessible and organized during a time when the sources of health care for a large number of people will be in constant flux.

"As members come in and out of our program, the HIE is very critical," Gilbert said. "People have been losing their jobs, losing their commercial insurance and transitioning to IEHP. The more data we have about them for our doctors and hospitals, the better."

If a patient has been seen in the past by another physician or was admitted to an emergency department elsewhere in the region, those records can be retrieved by the new health care provider. The key point is that the information will be easily transmittable and can be accessed wherever the patient seeks care, Gilbert said.

Starting Small

The diversity in participants -- from large hospitals to physician groups and county clinics -- makes the Inland Empire HIE unique, Gilbert said. In addition to the two counties, stakeholders include the Riverside County Medical Association and the San Bernardino County Medical Society.

A pilot project to test the exchange will be launched in the next four months. Loma Linda University Medical Center, Beaver Medical Group, Riverside Community Hospital, Parkview Hospital, Riverside Physicians Network, Riverside Medical Group and Inland Empire Health Plan have agreed to participate in the initial pilot project, Bivona-Tellez said.

The idea is to start small and then expand the exchange.

"The pilot project will last until we demonstrate it is functioning properly," Bivona-Tellez said. "You make sure you've got everything covered. Then you go bigger."

Bivona-Tellez said that a crucial aspect of the new HIE will be the design of its interface, which could make or break the success of the new system.

"You don't want to slow down the work of a frontline provider in caring for a patient in a critical situation," she said, adding, "You want the ability to look up something to enhance the care needed at that time."

In recent years, HIEs that were not able to present complicated information clearly and in a timely manner have failed, she said.

"Ease of use is probably the biggest concern and the ability to look at disparate information displayed in one place," she added. "If you have a system that isn't user friendly, your physicians and others won't use it. Some large institutions have dropped multimillion-dollar projects because the end users didn't like it."

Ultimately, all of the participants who join the Inland Empire HIE will be doing so with the goal of improving patient care, one of the motivations behind the passage of the HITECH Act.

Hard evidence as to whether HIEs are effective in improving patient care is difficult to come by, but anecdotal evidence suggests they are making a difference.

"The issue with collecting evidence about improved patient care is that it's hard to draw a direct correlation because there are so many groups on the exchange," Covich Bordenick said. "What we hear from doctors and patients is that it is more convenient, that the information is there when they need it. That's really important."

MORE ON THE WEB

• "Tale of Two Exchanges Shifting Gears in California" (Lauer, California Healthline, 7/7).
• "Survey: Data Exchanges Expand, but Hurdles Must Be Addressed" (iHealthBeat, 7/14).  
• "Riverside and San Bernardino Counties Designate Inland Empire Health Information Exchange To Advance Resident Health" (Hospital Association of Southern California release, 7/1

 

Technorati Tags: iehp,hix,hie,inland empire hix,inland empire health plan,inlad empire health information exchange,riverside community,hospital,riverside county regional medical center,loma linda university medical center,beaver medical clinicmedoedical clinic,riverside medical clinic,parkview community hospital,riverside physician network

Unsustainable Health Care System

 

Posted by Christopher M. Shoffner

“If we are going to fix our ineffective and unsustainable healthcare "system" the only real cure is a vibrant, diverse and independent Primary Care provider base. The only way to get that is to change the way people pay for primary care (giving everyone equal means). Everyone needs primary care and preventive services, not necessarily insurance. I even found SCOTUS making the statement that the only way to buy healthcare was to buy insurance; a false and somewhat scary assumption. By giving everyone the same means to purchase primary care and introducing pricing transparency into primary care, costs will go down and quality will improve. Why? because the patient is now the payer (the only single payer system I agree with) and they can hold the Practitioner/Practice accountable for wait times and interpersonal skills (are they listening to me?) This also alters the economics for the Practitioner; for the better. Reducing the administrative burden thrust upon each practice by the antiquated CPT Code based billing system. We are working diligently in NC (other states are waiting for the template) with all major parties to create the next major "pilot project" for meaningful reform (Medicaid, State Health Plan, Private Payers). This is not a political effort, but an effort by one state to do what is in the best interest of its residents. This is why/how decisions should be made in the political realm.

Author’s Comments: (Health Train Express)

The terms left and right are counterproductive to the process and usually create a solution that is unpalatable to each side. One alternative would be to expand (our little known service, NHS, National Health Service (the former public health service) See my blog at http://healthtrain.blogspot.com .This would in the short run it would offset the PCP shortage. ACOs will be a disaster except in already formed organization that are large and comprehensive. They can form an independent ACO

Peter,as a retired specialist (Ophthalmologist) and ex-PCP (ER and general practice for five years) I am on a mission to support Primary Care (the name of which I disagree intensely). I believe all specialists should strive to eliminate the RUC since it is not truly representative of PCP and places all principals in an adversarial position. PCPs have a far greater challenge in dealing with bureaucracy that specialists avoid. In fact that is a primary reason why young physicians chose to specialize. I agree with all of your ideas and will continue to promote them in my writing, travels and speeches

 

Technorati Tags: aco,pcp,nhs,public health,cpt code,scotus,single payer

 

Posted by Christopher M. Shoffner

The U.S. Supreme Court is debating whether the Obama administration's Affordable Care Act is constitutional. How will that decision affect the development of health insurance exchanges?

This is a very appropriate and timely question. Here in California and in other states who want to control their own HBIE time and money are already being invested into establishing HBIEs.

Not well understood is that the federal government grants only run until 2014 when HBIEs are mandated to be self sustaining. At this point the stakeholders have little financial skin in the game. That means taxpayer dollars are being expended for something that may not develop. The Obama administration has spent $729 million laying the groundwork for health insurance exchanges, according to a White House report published this morning. That number will likely tip over $1 billion in the coming months,

The Health Insurance Exchange are designed to form a financial means to support the entry of non insured and underinsured into the health market. This forms the underpinnings of uniform and mandated coverage.

At issue is whether the Obama administration overstepped itself in passing the 2010 Patient Protection and Affordable Care Act (PPACA) and mandating that all citizens purchase health insurance by 2014 or face a penalty.

The Commerce Clause of the Constitution rules that Congress is the branch of government that regulates commerce, and the states are arguing that the administration's ACA violates this clause by mandating that states be forced to implement HIXes. All states must set up HIXes by 2014, according to the ACA. If states are no longer required to set up the HIXes, the exchanges may not take off.

According to a March 26 Harris Interactive poll, 51 percent of the public would like to see this mandate to purchase insurance repealed. In the survey, Americans were split on whether they support the ACA overall. Of those polled, 36 percent support it, 41 percent oppose it and 23 are unsure.

What the White House doesn’t highlight are states that haven’t bought in — those that have resolutely resisted setting up an exchange. Florida, Louisiana, Texas and others have committed to not moving forward on implementation until the Supreme Court rules on the health reform law’s constitutionality. Two years after the health reform law passed, many states are taking a wait-and-see approach: As the above map shows, 22 states are still studying their options on health insurance exchanges.

HIX Map

Health Information Technology Fallout

At the same time this judicial battle is occuring, the HIT industry is ramping up for web portals for consumer choices. Some of these companies are implementing Travelocity-like HIXes powered by technology from companies such as Adobe, Microsoft and Oracle. This sounds much like Expedia, Kayak and other platforms that can easily be modified into health exchange data bases.

The Adobe Digital Enterprise Platform (ADEP) incorporates Adobe's PDF reader to produce welcome kits and digital signatures for health insurers that offer plans in the Web-based exchanges.

Meanwhile, Oracle's HIX platform includes a built-in rules engine to allow states to meet federal eligibility requirements. The Oracle platform is built on the Fusion Middleware application infrastructure.

Microsoft's HIX platform allows states to determine enrollment and eligibility, and it provides tools for business intelligence and case coordination.

In addition, vendors have been introducing software that allows health care companies to get reimbursed for expenses based on quality of care, or outcomes, rather than getting paid per visit.

The ACA as a whole is unlikely to be ruled unconstitutional, but the mandate for buying insurance could be, said Shah. Business models for HIX platforms may need to be tweaked if individuals and small businesses aren't required to buy health insurance, he noted.

"If the insurance mandates are unconstitutional, then the demand side for HIXes goes away, and the government would need to figure out where to get the money for exchanges," said Shah. "I think HIXes could still survive, but they'd need to be reworked quite a bit."

He noted that the government may raise taxes on businesses to pay for Web-based HIXes without a mandate for citizens to join .

It makes sense that many states have delayed their HIXs until the smoke settles at the Federal level.  HIX planning may be premature, even though the deadline looms.

States are already heavily challenged managing what exists now…medi-caid, state disability programs and more. 

Introducing further chaos for the states is a mis-directed political move.  The court may rule sooner than June, and a two month wait is not very long.

States should cool their “heels” a bit longer.

Health Train Express provides the personal opinions of Gary M. Levin M.D., a lone wolf in the wilderness of healthcare.  Comments are always invited, either here or a tweet to @glevin1

 

Technorati Tags: health insurance exchange,ACA,insurance mandate,supreme court,web portal,microsoft hix platform,oracle hix platform