New rules for accountability care organizations out today from CMS may please providers amid reports of inefficient care delivery models and quality. When the feds released initial ACO rules earlier this year, the process was met with major rounds of criticism with physicians barking the loudest. As a group, its top concern was the financial risk involved (lowered reimbursements amid higher penalties) in agreeing to participate.
Quality benchmarks in EHR adoption and clinical outcomes in certain key chronic medical diagnoses as part of the ACA-mandated rules have all but been retooled with the release of new ACO parameters.
The regulations reduced the number of quality measures by about half and increased the financial incentives for providers. The changes won preliminary praise from major trade groups and professional associations, which moved quickly to digest hundreds of pages of rules from multiple federal agencies, including the CMS, the Federal Trade Commission and the Justice Department.
Enhanced opportunities in order to improve quality amid a decrease in the perceived risks of doing so. With this new credo in place, many initial hostilities toward the inclusion of ACOs within the scope of reform may be tempered just a bit. | LINK
Throughout one’s professional life as a physician, there are some things that are inevitable: changes to Medicare reimbursement schedules due to factors beyond our control, insurance denials, and the presence of the National Practitioner Data Bank — the omniscient arbiter of physician conformity and performance in the eyes of the public and watchdog groups. This latter factor is one many physicians manage to avoid, especially in this age of defensive medicine. But, sometimes lawsuits rear their ugly heads, and notifications of judgments (whether favorable, or not) follow the unfortunate clinician forever.
The NYT is reporting that groups of journalists are protesting the Obama administration’s apparent decision to remove the database access from the Internet, at the same time, imposing fines for confidentiality breaches as sources for articles.
“Reporters across the country have used the public use file to write stories that have exposed serious lapses in the oversight of doctors that have put patients at risk,” Charles Ornstein, president of the Association of Health Care Journalists and a reporter for ProPublica, an investigative newsroom, said in an interview. “Their stories have led to new legislation, additional levels of transparency in various states, and kept medical boards focused on issues of patient safety.”
Having used ProPublica as a source for many an article or post here on Doctor Pundit; I, too, am understandably concerned. The feds say that the issue was whether more private information — as opposed to the public database — was accessed and that the response to the original complaint letter was sent directly to a journalist upon database takedown. Further, a division spokesman from within DHS explains
“We are going to do everything we can to get the data back up in a public use file as quickly as we possibly can,” Mr. Kramer said. “We want to make sure the public, researchers and reporters have access to all the information that we can legally make available.”
Seems that it would be in the best interest of the public to get this resolved as quickly as possible, and without significant “changes” made to the public file by a government agency.
Clarence Thomas wrote for the 5-4 decision in which companies were shielded from lawsuits by consumers suffering from adverse effects of certain drugs. Anthony Kennedy, the SCOTUS justice often seen as the court’s swing vote, wrote for the majority opinion in another pharma case which strikes down a Vermont law that banned companies from using data mining techniques to obtain information about the prescription drugs individual doctors have a preference in prescribing.
Federal law requires the makers of brand-name drugs to label their products with FDA-approved warning information and to update the warnings when reports of new problems arise. But in a 5-4 decision, the high court said this same legal duty to warn patients of newly revealed dangers did not extend to the makers of copy-cat generic drugs.
I actually agree with Thomas on this decision. Fed law should trump state law in this case. Generic formulations are essentially chemical equivalents of their branded predecessors and, as such, really cannot be held accountable to novel warnings not appearing on the branded parent drug. A ruling in the reverse could open the door to flurries of suits for a range of untoward events for a multitude of generics — only adding to the cost of already fiscally overburdened healthcare delivery at the outset of reform (emphasis below, mine).
In the second decision, the court by a 6-3 vote struck down a Vermont law that barred pharmacies, drug makers and others from buying or selling prescription records from patients for marketing purposes. [...] Writing for the court, Justice Anthony M. Kennedy said that “information is speech,” and that under the 1st Amendment, the government usually cannot restrict speech because it does not approve of the message. “If pharmaceutical marketing affects treatment decisions,” he said, it does so because doctors find it persuasive”.
Exactly. This case highlights the effect Pharma representatives have always had on the prescribing patterns of physicians and protects the ultimate decision maker at the point of healthcare delivery — the provider. Is it any wonder why reps have been essentially banned from many healthcare systems in many markets nationwide? | LINK
Guess I’m feeling a little “inspired” by the cloudy day outside today on the cusp of a Memorial Day weekend. You may have heard about the emergence of cloud computing — the utilization of remote and cloud-based server technologies driving recent newsworthy items of note, such as the iTunes pending cloud-based rollout, forthcoming Google web-based computing initiatives, and “software as a service” applications found in many on-demand resources.
A recent survey [PDF] pegs healthcare orgs getting into the act. One-third of healthcare organizations responding said they are implementing or maintaining cloud-based systems, just ahead of respondents in government but behind higher education and large businesses. According to the survey: cloud users expect to spend approx. 21 percent of their health IT budget on cloud computing in the next two years. Videoconferencing, email storage solutions, and online learning represented the most commonly cited cloud-based apps among those organizations.
For all of the enthusiasm of President Obama’s digital initiatives within the scope of healthcare reform, the specter of securing data in healthcare related databases is always a required consideration. It’s an upfront cost for organizations ready to implement the transition to the electronic health record after years of deliberate planning. When breaches in security involve an insurance provider, things can get complicated very quickly. One such company based in California has apparently lost sensitive employee and consumer information on “some of its hard drives”. In a prepared release, the company wouldn’t say if the hardware was actually stolen, or if this were a software and data breach.
Turns out this isn’t the first time the insurer has had a lapse in security. Just two months ago, the company agreed to pay $55,000 to settle a similar case with the Vermont attorney general’s office involving the loss of a portable drive containing sensitive patient information. In return for the anticipated concern of its customers, the company said that it will provide two years of credit monitoring and identity theft insurance as a consolation. Well, that’s good…I guess.
President Obama’s push for the digitization of the medical (health) record continues its march toward the goal of complete adoption nationwide by mid-decade. The administration’s desire for this goal as a part of reform is as much a laudable task as it is a daunting one. Cost of complete market saturation among healthcare facilities and systems is one issue. The other? Some providers in more rural and urban areas where care is provided are concerned that EHR adoption will not immediately benefit healthcare delivery to the economically disenfranchised.
Call it the “digital divide” as it relates to the electronic record. Sure, cost of adoption is one thing — but the realization that private and government initiatives over the next four or so years will continue to favor larger systems with heftier resources is quite apparent. To be fair, the feds have allocated some $300M in stimulus funds for this problem. But, just how far will funds go not only to ensure access for the poor and uninsured in economically deprived care environments but also to begin to reverse the all too familiar correlation between poorer health outcomes and lower income levels among patients? | LINK
UPDATE & RELATED: A graphic shows the penetration of EMR adoption by state (criterion: any EMR component use as defined by the CDC in 2010). Happy to see Minnesota at the top of that list! | LINK [PDF]
Starting today, CMS will allow registration for its EHR incentives program. Designed to get providers and health systems on board with initiatives outlined by newly installed chief Don Berwick, the program’s availability launches today in a number of states. The balance of participants are to be in place by the summer.
The agency hopes that streamlined reimbursements to providers, along with more generous payment amounts, will be enough of an incentive for participation. Programs exist for eligible providers participating in both Medicare and Medicaid. There is the specter, however, of what CMS terms as “payment adjustments” for non-participants or those who fail to demonstrate “meaningful use of EHR technology” during the incentive program. | LINK
Beginning today, healthcare consumers will be able to access their patient-oriented electronic health record via MediConnect, a leader in this space. As a matter of fact, consumers will have access to over 6 million such documents, said to be the internet’s largest database. Free access is the initial step to creating one’s EHR.
One of only four personal health record systems chosen by the Obama administration[1] for its Medicare and Medicaid pilot project, MediConnect Global has built a massive database of digitized paper records and charts, becoming an early worldwide leader in the electronic medical record repository and its digitization and management. | LINK
The principles of root cause analyses, process improvements, and quality redesigns are important parameters in the culture of accountability in the age of the electronic dissemination of information. Ambulatory care accounts for more than 900M visits/year, as opposed to 35M hospital discharges. Yet, the flow of information — and the systems that guarantee their goal of 100 percent receipt and processing of that data — is much more prevalent in the acute hospital care setting than in the ambulatory care arena.
MediConnect Global, a leading company in medical information management technology and retrieval, is headed in the right direction. Its CEO, Amy Rees Anderson, who has interviewed for Doctor Pundit, today announces innovation designed to close the quality gap between these and other care settings — ensuring patient safety with the most accurate transfer of data currently available between patients, providers, and large care organizations. A secure portal is able to efficiently process that information amid full HIPAA-compliance.
Very nice. And it doesn’t hurt that Rees Anderson’s company is one of only four personal health record (PHR) systems chosen by the Obama administration to participate in the current Medicare PHR pilot program as part of the admin’s current reform initiatives on quality. | LINK
CMS has informed state Medicaid directors the terms of qualification for federal matching funds for administrative costs toward information technological infrastructures. Specifically, states must comply with the following stipulations: administration of Medicaid incentive payments to Medicaid eligible professionals and eligible hospitals; oversight of the Medicaid electronic health record (EHR) Incentive Program; and the pursuit of initiatives that encourage the adoption of certified EHR technology for the promotion of health care quality and the electronic exchange of health information.
Besides the latter bullet point above, the entrance of individual states into EHR IT initiatives carries with it a commitment to Medicaid funds in this era of reform. Some states are already on board, like California — whose governor couldn’t be more excited to get the ball rolling.
“What we are launching today is a new era for healthcare,” Schwarzenegger said. “Through a simple broadband link, this state-of-the-art system will save lives by instantly connecting people from across the state, including under-served and rural areas, with the best and brightest doctors. The California Telehealth Network marks the beginning of a new digital highway that will fundamentally change the future of how healthcare is provided.”
Others, like Minnesota, are leaving some state government agencies — and patients they serve — in a lurch.
Millions of dollars in health care funds seemingly destined for Minnesota after last week’s emergency session of Congress have yet to clear a final hurdle: the signature of Gov. Tim Pawlenty, an outspoken critic of the new federal spending.
UPDATE: In an unsurprising PR move, leading Dem candidate for Pawlenty’s job come November — former one-term U.S. Senator Mark Dayton — wants Pawlenty to just accept fed funds. | LINK
The push for widespread adoption of the electronic medical record has been viewed as an attractive by-product of health reform — a rather sexy “distraction” amid the legislative haranguing that has slowed the ongoing acceptance of reform as law. Perhaps our president is to blame. The electronic health record has an aura about it that sounds compelling at first, but its allure to many organizations considering its incorporation morphs into increasing trepidation as that day draws nearer.
For the Obama administration — assuming reelection — that “day” is the year 2014. The lofty goal of the creation of an e-record for every American by that time doesn’t seem to be taking into account the costs inherent in its smooth transition. That transition includes everything from logistical commitments to hidden costs that have yet to be accounted for, usually because of poor planning in the race to the early adoption for many health systems. For many of those systems, the reality of medical errors as a result of snafus in massive roll-outs is setting in. | LINK
HIT alert: The HHS is proposing new privacy guidelines designed to protect consumers’ (patients) health information when that health information is handled by third parties. The proposed rules come as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act — enacted as part of the American Recovery and Reinvestment Act of 2009 under Obama. The ubiquitous HIPPA legislation signed into law in 1996 is essentially strengthened, and hopefully clarified, as finer points in patients’ health records in the past have been exploited and mismanaged under perverse interpretations of that law by third party entities — many of which are payers.
Among the expansion of HIPPA parameters expanded by these proposals by HHS:
It only follows that if consumers have and expect access to their personal health information in whatever form desired, then they have to be encouraged to expect safety mechanisms are in place to protect the delivery of and accessibility to that information. These proposals are to go into effect later this year. | LINK to HHS’ privacy site | LINK to 60-day public comment site
HHS is preparing to evaluate the results of a year-and-a-half pilot program utilized as part of the Obama initiative on health reform. Specifically, the program strives to inform CMS how Medicare beneficiaries use their personal health record (PHR). The pilot, which is about to conclude, is being implemented in Utah and Ariz.
Doctor Pundit has interviewed one of the CEOs of the vendors chosen by Obama in this effort — Amy Rees Anderson of MediConnect.
Current PHR business models represent broad and varied uses, from disease management to health promotion, with sponsors consisting of commercial vendors, heath plans, employers and healthcare providers. We know very little about why consumers, and specifically Medicare beneficiaries, elect to use PHRs and what functionality they want from a PHR.
Fair enough. Can’t wait for the results. Perhaps the Obama administration’s effort to eliminate fraud, waste, and abuse within Medicare will get a jolt of sound information from this enterprise. | LINK
Originating from Saint Paul, Minnesota, [doctorpundit.com] is a weblog about the policy of healthcare and where it intersects with politics and public opinion; it is edited by Michael Douglas, MD, MBA. Welcome, and please consider my take on what is Healthcare 2.0, complemented by a few of my thoughts on my personal avocations and guilty pleasures: music, prose, and writing. Follow Doctor Pundit via RSS above.
Both sides have weighed in on constitutionality of #ppaca setting stage for #SCOTUS hearing on #healthreform in March http://t.co/wa1dbvay
Class Ii Se Bk in Black from The Medical Outlet http://t.co/E7nYw3NB #nurses #doctors #littmann
RT @PorteNawak: How Europe is Growing Health Apps http://t.co/asZBAx0G #mhsm #mhealth #hcsm #pharma via @berci
RT @dailycamera: #Boulder Community #Hospital receives $1M for #cancer unit. http://t.co/JQnNDAe8
DOCTOR PUNDIT @ ONE YEAR | An occasional DP series from 2010 highlighting healthcare policy trends over the period from 2009-2010 in a compare/contrast format.
