2016 – The year of Disruptive Living

With 2016 behind us, it’s hard to believe we somehow survived this year. Whether we admit it or not, we’re not used to big changes and politics does play an important part of our lives. Whether it’s in that realm or in technology, we are creatures of habit and rarely like our world or ecosystem to change. The biggest challenge I’ve always encountered on a project is change; whether it’s process or technology changes, it’s always a challenge to get people to change and adopt a new way of working. Physicians are particularly challenging to change as they are very set in their ways.

Whether it’s the elections that occurred that seemingly swung the pendulum a different direction than what was in motion for the last 24 years or the endless march of technology like Amazon Go, (which I believe could have applications outside of Retail such as in Healthcare), our lives have been greatly disrupted as we see that the status quo is not acceptable anymore.

I’ve been asked by a few people whether MACRA will get scrapped under the new US administration or whether some of the current other reporting requirements will be changed. Currently the view has been only time will tell as there has been no specific policy that has mentioned anything one way or another. Will much of the work accomplished or investment over the last 5 years be set aside or will we be able to build off that and leverage this paradigm shift for the greater good?

Only time will tell. Whatever it is, there are many people that would like to see 2016 into a distant memory and hope that the new year brings with it better fortunes than the current one has dealt many.

In Memorium: Carrie Fisher aka Princess Leia (1956 to 2016)

“Help me Obi-Wan Kenobi, you’re my only hope.”

Are EHR vendors becoming Population Health corporations?

An interesting article surfaced in Healthcare IT News that suggested that executives at some healthcare software vendors want to transform themselves from generically being deemed as an EHR vendor and become a Population Health company like Cerner’s CEO Zane Burke told Healthcare IT News. 

Being able to access data relevant for patient care should be possible regardless of the format it is presently in or whether it is in an EHR,  national database or in pdf format. 
The constraints that “EHRs” are presently may not allow for this functionality  (yet). The article goes on to state that providers are also moving towards precision medicine, accountable care management, chronic care management and value based reimbursement. 
Movement for many on the ground is still in the initial stages and only those provider organizations with deep pockets and the ability to leverage collaborative working relationships with solution vendors can think about moving forward with all of the initiatives mentioned above in a meaningful way. 

Truly Epic! R&D Spending sensation 


In a story published on September 13th , 2016 by Healthcare IT News (HIT News), Epic Systems’ founder Judy Faulkner  ( just ‘ Judy’ to many in the Healthcare IT world) revealed that Epic invested something like 50% of its operating expenses on research and development, outstripping all organization in and out of the Healthcare IT ecosystem. 

HIT News verified through federal filings that Cerner spent 19%, Allscripts spent 34% and athrnahealth was at 10%. Google spent 45% of its operating expenses on R&D  (or $12 billion) and seemed to be the closest when it came to a percentage of operating budget. 

The thought that ran through my mind was ” Has this translated to better and more efficient and streamlined patient care at Epic’s customers versus provider organizations that have implemented a competing product? I’m all for R&D and believe that it’s really what makes America great  (I don’t think we’ve lost the ‘greatness’ since 1776 when the Founding Fathers declared independence, but that’s another story for another day). The technology of the 21st century has indeed been spurred by American innovation and ingenuity  (Facebook,  Twitter and the entire world of Social Media). R&D brings us medicines that have been life changing to many and previously were inconceivable even in the latter part of the 20th century, but with the cost of patient care rising and many Americans wondering how to get them within reasonable limits anymore, does this only add to our costs in the patient community or will it be the savior of millions and have a lasting impact for the country and the world. Makes you think. …

Holy MACRA! Patient Engagement rides again!

Regulatory-signage“What was that masked legislation? Why that, my boy was CMS! The greatest regulator in the west!” (Cue The March of the Swiss Soldiers in the William Tell Overture aka, theme song for one of my childhood heroes, The Lone Ranger).

What is MACRA?

MACRA is the abbreviated version of the “Medicare Access and CHIP Reauthorization Act of 2015” which was signed by President Obama on April 16th of this year. (Healthcare and CMS sometimes really can’t help it’s communication to the public when they make these abbreviations something that only so called “healthcare insiders” will understand).

The new law repeals Medicare’s sustainable growth rate (SGR) formula and creates a way to increased Medicare payments. At HIMSS16 this year, there was a focus was on “MIPS” or Merit Based Incentive Payment System which is the program that the SGR will be replaced with.

Physician rates are understood to be increased by 0.5% starting in July and each January through 2019 and then, bonuses could reach 12% and then 27% by 2022 (physicians could also face penalties for not meeting quality targets down the road).

On the CMS site, it asks the question, “How does the Medicare Access & CHIP Reauthorization Act of 22015 (MACRA) reform Medicare payment?”

Apparently, in a couple of ways:

It makes 3 changes to how Medicare pays those who give care to Medicare beneficiaries. The changes create a Quality Payment Program (Abbreviated to ‘QPP’).

  1. Ending the SGR formula for determining Medicare payments for health care providers services.
  2. Making a new framework for rewarding heal care providers for giving better care not just more care.
  3. Combining CMS’ existing quality reporting programs into one system.

The changes have been named QPP and replace other Medicare reporting programs with a flexible system that allows providers to choose from 2 paths that link quality to payments either MIPS or something called Alternative Payment Models (APMs)

MIPS – This combines parts of the PQRS (Physician Quality Reporting System), the Value Modifier (VM or Value Based Payment Modifier) and the Medicare Electronic Health Record (EHR) incentive program in which EPs (Eligible Professionals) will be measured on:

  1. Quality
  2. Resource Use
  3. Clinical Practice Improvement
  4. Meaningful Use of Certified EHR technology.

APMs – Alternative Payment Models give new methods to pay healthcare providers for the care they give to Medicare recipients as from the year 2019 to 2024, CMS will pay some participating healthcare providers an incentive lump sum; increase transparency of physician focused payment models and starting in 2026, offer some participating healthcare providers higher annual payments.

 

 

 

 

 

We don’t “Lobby” in Healthcare IT, we “Advocate”

As someone who grew up in other countries before becoming a naturalized American, there’s always been some kind of fascination when it comes to what is called “lobbying” in the United States. I’ve never been able to understand it as it always seems that it goes against the grain of what I’ve always thought of the United States through history books and the Founding Fathers, whom I so admire for their simple vision that has overcome the tests of time. Yet, hiring professional lobbyists in the United States is perfectly legal and healthcare has been leveraging this legal loophole for sometime now. Just this year as an example, lobbying has come into the news through the change in the regulatory date for ICD-10 from October 1st, 2014 to October 1st, 2015. Most believe that this was the result of pressure from care delivery professionals that wanted more time to get their act together (I for one was against this).

Recently, it was reported in “Modern Healthcare” (September 10th, 2014) that Epic retained a lobbyist and as it was reported the filing said that it was “to educate members of Congress on the interoperability of Epic’s healthcare information technology.”

Last week, HIMSS delegates from across the country had their yearly visit to Washington D.C. for their HIMSS Policy Summit, held during National Health IT week where (as reported by Healthcare IT News) HIMSS had certain asks of the nation’s representatives, which were:

  • Minimize disruption in our nation’s health delivery system emanating from federally mandated health IT program changes.
  • Fund the National Coordinator for Health IT to achieve interoperability, improve clinical quality and ensure patient privacy and safety.
  • Expand telehealth services to improve patient access and outcomes and decrease healthcare costs.

The role of politics and healthcare will remain inextricably tied to one another. As we continue to move through this paradigm shift, these areas will ultimately focus on the future of our country’s care delivery and outcomes and the way that we, the patient, will receive our care.

Advancing Clinical Processes with Meaningful Use Stage 2

As provider organizations work on the completion of stage 1 and think about implementation of stage 2, they will have their hands full with how to implement these initiatives with the constraints on their resources and bandwidth. The CMS site states that:

“Stage 2 uses a core and menu structure for objectives that providers must achieve in order to demonstrate meaningful use.

Core objectives are objectives that all providers must meet. There are also a predetermined number of menu objectives that providers must select from a list and meet in order to demonstrate meaningful use.

To demonstrate meaningful use under Stage 2 criteria—

  • Eligible professionals must meet:
    • 17 core objectives
    • 3 menu objectives that they select from a total list of 6
    • Total of 20 objectives
  • Eligible hospitals and CAHs must meet:
    • 16 core objectives
    • 3 menu objectives that they select from a total list of 6
    • Total of 19 objectives

In a recent article in Healthcare IT News (dated 8/4/14), it stated that only 3% of eligible hospitals and 1% of eligible providers attested to stage 2, which is anything but great as we are in the middle of 2014, when all of the provider organizations were expected to be greatly involved in completing their attestations. Have we reached “MU Fatigue”? I can imagine. I met a nurse earlier today who has now been in IT for sometime and she said that she did not believe CMS anymore after the ICD-10 delay occurred. I think that set off a wave of disinterest in the ecosystem that is still feeling the repercussions of a twice delayed regulatory mandate. “It doesn’t pay to be first!” said one CIO to me a few months ago. Going by the frequent delays in the provider world, one can empathize with that sentiment.

Will CMS give out “Red Cards” to Eligible Hospitals and Providers and penalize them or will there be some relief for the regulatory weary? In the same article, it mentioned that “71% of hospitals plan to attest by the end of 2014 and 22% in 2015”.

What of the HIEs and their ability to give the prospect of intereoperability it’s day?If we are truly to believe the data from the news article, the next 13-14 months will be a busy period for many as ICD-10 comes back around; payer testing, dual coding, physician training and organizational communications will be again an extremely busy period for many provider organizations.

 

News Flash! Cerner just bought Siemens Healthcare

This just in. According to news reports by the Kansas City Star, Cerner just announced the $1.3 billion dollar purchase of Siemens Healthcare making Cerner a 20,000 person company worldwide and their organization at $4.5 billion dollars in size and reportedly the largest healthcare IT workforce in the world. Siemens announced a strategic relationship with Cerner as well in the deal and the report goes on to mention that Cerner will go on to finance the deal with cash on hand.

This news is monumental.

Read the article here http://www.kansascity.com/news/business/article1067499.html