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.

 

 

 

 

 

Interoperability gets a boost! Healthcare 3.0 and Meaningful Use Stage 3

I’ve often talked about Healthcare going through a paradigm shift these past few years. In summarizing the discussion that I had the opportunity to have with students at Miami University last week, when we discussed the what we called Healthcare 3.0. We will review more about MU Stage 3 in the weeks to come in this blog and I’ll also get some feedback in the future from guest bloggers as well. I thought about this as I reviewed the recently released final rules for Meaningful Use Stage 3 by CMS as they said would simplify the requirements and add some flexibilities for providers in order to make, electronic health information available, from what they have mentioned, “when and where it matters most”. The phrase that CMS used which said  that they wanted to shift the paradigm so health IT becomes a tool for care improvement, not an end in itself” really resonated with me and give some impetus to the focus moving forward which would be for healthcare providers and patients to be able to readily, safely, and securely exchange health information.

What CMS said was that they had received feedback from “physicians and other providers” about the challenges they faced in making these technologies work well for their practices and for their patient population so in being able to recognize these concerns, the regulations that they have come up with, apparently make drastic changes to the current requirements by making reporting less of a burden for providers and being able to support interoperability as well as improving patient outcomes. 

CMS has also mentioned that they are “encouraging providers’ to let them know if they are having difficulties with or switching their EHR vendor by applying for exemptions or experienced challenges due to the timing of the rules and EHR implementation. In addition, the new rules will apparently help in the development of new, “user-friendly” technologies, allowing individuals easier access to their healthcare information so they can be better engaged and empowered in their healthcare as we move forward towards, what Victor Simha and I presented last week at Miami University, Healthcare 3.0.

Happy Earth Day – Healthcare’s Green Initiatives

Earth DayCaring for our environment should be everyone’s responsibility. My Grandfather was what he called a ‘Forestry Consultant” and focused on reforestation in the 1970s and the 1980s. He founded a
National Park in the southern Indian city of Bangalore my family’s home town where he was very interested in the cultivation and use of bamboo for use in everyday life. The ability for us to think of ways use less plastic and have more biodegradable products will give future generations an opportunity to live a better life.

When I first heard about Earth Day (and bought a T-Shirt with that on it back in the 90s), it didn’t have as much meaning to me as it does now. As the world’s population grows and we need to think about how we can better utilize our limited resources to nourish and clothe the people of the world, we need to think about better conservation methods. Healthcare is also not immune to this, though going green in Healthcare IT is not a straight forward process. One way that healthcare has been better at conservation is the implementation and use of electronic health records, the biggest Go Green initiative ever by healthcare provider organizations. Tele-Health initiatives means that now, people in rural populations or anywhere for that matter, do not have to drive to a specific location for things such as specialist referrals and can cut gas emissions and improve population health. Data centers have leveraged the concept of server virtualization and reducing the carbon footprint of those data centers and also reducing hardware costs and power consumption. (Don’t forget to join us at our CSO HIMSS Spring Conference focused on mHealth and Tele-Health. Click here to see the agenda and register for the event – Not to be missed)

I’ll take this opportunity again to wish everyone a very Happy Earth Day!

Daylight Savings Time Ended – Did the hospital charge you less?

In the spring of 2014, I wrote a post about possibly getting over-charged for a hospital stay due to synchronizing EMR systems to the correct time. Similarly, this past weekend, when Daylight Savings Time ended, some patients may not have a second bed charge added for the hour that is repeated due to an occurrence in the system.

Many organizations may have the ability to manually update their charges in what is called the hospital billing account after a patient is discharged. This though is a step more than many organizations have the bandwidth to work on these days with all of the regulatory mandates that they are working on.

With Healthcare Payer organizations rejecting claims for even minor defects, this could be a major revenue loss for any provider and would need to have a consistent remediation for Patient Financial Services to be on track with their forecasts. It would be more than likely that they will not unless a patient reviews their charges more carefully. Data for the hour of the double 2am time on Sunday needs to be well documented and validated. Most responsible provider IT Revenue Cycle Management organizations have plans for the time change that have been scheduled far in advance and would be reviewed as I document this post. Is this another reason why we may not need to keep changing back and forth from Daylight Savings Time. Is this one of the reasons why the concept may be moot going into the 21st century? Time will tell.

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.

 

Physicians are people too…right?

When it comes to working with physicians,  we’ve seen their involvement in this healthcare technology world at opposite ends of the spectrum.

The younger,  more technologically savvier physicians who have been used to technology from the early 80s to now, seem to somewhat adapt to using EMRs. They are characterized by their comfort with all things digital and their disdain for a paper process and being eco-friendly. While this isn’t always the case, this is mostly attributed to younger, 45/50 and under physicians.

The older,  more experienced physicians who have been around practicing for 3 decades or more have generally been extremely resistant to the current change and have at times,  even retired rather than continue to use EMRs on the grounds that it takes away from their focus on the patient, which can make for an good debate. I’ve also heard that some of the older physicians don’t feel like they need to be “engaged with their patients” as “the way they have been practicing medicine all these years is fine”. Millennial physicians,  early to mid 30s take to technology as if they were born with it. As digital natives,  they have the ability to be the most productive and efficient when it comes to EMR usage.

Also, their has been a divide when it comes to adoption by small and large practices. Smaller practices have had to think about how they can deal with the process of purchasing EMR capabilities and this has not always been easy. During a project in California, we studied how we can get pediatricians to refer patients to the hospital I was working at and how to make sure the referral process was smooth for them; whether it was directly from their PC and their own EMR system or if they needed to login to a portal with their credentials and how it would then go to the correct clinic at the specialty pediatric facility I was working at the time.

For anyone in the care delivery IT arena, this is old news, but really needed to be said. The question is whether if the digital divide has an impact on the quality of your care and if this trend continues, will we lose our senior, experienced physicians to Meaningful Use?

According to an article out by USA Today (dated 6/30/2014), the United States is expected to need 52,000 more primary care physicians by the year 2025 based on research by the Robert Graham Center and funding for teaching hospitals expires in the latter part of 2015. Due to the Affordable Care Act, the need for family physicians to 8000. As a nation, we cannot afford to lose these experienced physicians at a juncture when more physicians are required than ever before.