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April 30, 2015  2:31 PM

ICD-10 survey: Physician practice worries ‘a little too high for comfort’



Posted by: ShaunSutner
ICD-10, ICD-10 conversion

With ICD-10 nearly certainly on its way in October, attitudes toward the sometimes controversial new medical coding system among many providers in small and medium-sized physician practices range from resistant to uneducated, according to a new survey from Nuesoft Technologies, Inc. a cloud-based practice management and billing software vendor.

Nuesoft, developer of the NueMD cloud platform for medical practices, surveyed 1,000 respondents from all 50 states and in settings including small and mid-sized practices and billing companies. More than half those surveyed (564) are at practices with one to three providers.

The largest segment of those surveyed, 30%, said there should be no transition from ICD-9 to ICD-10, effectively saying they don’t like the new generation coding system at all.

Some 25% said they aren’t familiar with ICD-10, which could mean they aren’t ready for the changeover in the fall and probably will have big problems handling the new codes.

Less than a quarter of the respondents, 23%, reported that they’re satisfied with ICD-10, though 6% said ICD-10 coding standards — which already represent a big expansion in the number of codes from ICD-9 — should be expanded further.

Meanwhile, 18% opined that the ICD-10 coding set should be abridged.

“Making the switch to ICD-10 will greatly improve our ability to understand medicine, but it can also introduce some serious struggles for practices while they try to maintain cash flow through the transition,” the Nuesoft survey designers wrote.

Not surprisingly, the great majority of the providers and staff who answered the survey expressed worry about the transition, with 28% highly concerned, 25% significantly concerned, and 27% moderately concerned.

Only a few were OK with the expected change – 14% said they were minimally concerned and only 6% said they weren’t concerned at all.

For the worried majority, the main areas of concern, in descending order, were:

  •  Training and education
  • Payer testing
  • Software upgrade cost
  • Claims processing
  • Compliance timelines and deadlines

Negative outlooks about ICD-10 also extended into expectations about how the transition will affect various aspects of their businesses, with 70.4% saying it would hurt operations, and 69.7% reporting it would hurt their finances.

Overall the findings were consistent with those Nuesoft found in similar surveys the last two years, though the current survey indicated a mild softening of resistance to ICD-10, the survey designers said.

“We think it’s fair to say the level of concern for ICD-10, especially among small practices, is a little too high for comfort,” they said. “We did see some small, yet positive shifts in respondents’ level of concern, but there weren’t any striking changes over the last three years.

“We know it’s tough to find the time to train and prepare for ICD-10, but every minute is worth it,” the company’s survey staff wrote.
To make the transition easier, Nuesoft is recommending that providers lean on CMS’ “Road to 10″ website.

April 29, 2015  4:10 PM

Remote patient monitoring: What CIOs can do to make it happen



Posted by: klee34
chronic diseases, healthcare CIOs, Interoperability, remote patient monitoring

Remote patient monitoring (RPM) is a viable solution to a costly and prevalent problem around the world: chronic diseases. Healthcare CIOs have a vital role to play in making RPM happen, Zafar Chaudry, M.D., and Thomas Handler, M.D., both Gartner Inc. analysts, wrote in a report.

Hundreds of millions of people across the United States, Europe and other countries suffer from one or more chronic diseases, and people with chronic diseases cost 3.5 times as much to take care of compared to others, the report said. In the U.S. alone, eight out of 10 older Americans struggle with one or more chronic diseases, the report said, and chronic diseases are responsible for 60% of deaths worldwide.

In terms of benefits, RPM:

  • Improves patient health outcomes and quality of life
  • Prevents emergencies and readmissions
  • Reduces hospital stays and decreases readmissions
  • Offers the ability to monitor patients in their own homes
  • Provides real-time data

Although CMS is pushing for healthcare organizations to adopt RPM—the agency penalizes hospitals if readmissions increase— there is still resistance; an issue that CIOs need to address.

The obstacles CIOs face

According to Gartner’s report, many healthcare providers and clinicians are uncertain whether RPM would actually save them money because the cost of devices remains high, and there is a lack of evidence to support clinical efficacy and cost savings.

“Many clinicians resist incorporating telemedicine technology into their practices because they do not wish to be dependent on this technology (and the failures associated with it), are already overworked, simply do not want to train on the equipment … are uncertain as to how they will be reimbursed to provide telemedicine services,” and because the adoption of RPM would alter clinicians’ workflow, the report said.

Gartner warns CIOs that physicians and clinicians may assume that RPM platforms will result in an increased workload, which, according to Gartner, is not true.

Another issue CIOs face in order to make RPM happen is the lack of interoperability with electronic health record (EHR) platforms. This “can create transient datasets that reside outside of the EHR in the RPM vendor’s cloud,” the report said.

Recommendations for CIOs

When it comes to furthering RPM initiatives within the healthcare organization, Chaudry and Handler advise CIOs to make sure they include key stakeholders like clinical staff, senior management, patients and IT, in the process. CIOs are encouraged to have these stakeholders help determine what is considered a success and what is not. Clinicians should also be looped in and play a part in deciding which specialties would be best suited for RPM initiatives and which would not, the report said.

CIOs should also develop plans to not only help educate and train their patients and clinicians in the rationale for the use of RPM technology, the report said, but CIOs should also develop plans to pilot RPM technology. Chaudry and Handler advise that CIOs do this by:

  • Defining the scope
  • Setting objectives
  • Setting the terms of reference
  • Developing communication plans
  • Exploring information governance issues

The report also advises that CIOs make sure the technology they decide to use for RPM is reliable, compatible, cost-effective, easy to use, that they have the technical staff available to ensure reliability, and that the RPM technology can be supported in the patient’s home or care location.

When it comes to data collected and captured, CIOs should work closely with clinicians and RPM vendors to make sure the data collected has clinical relevance, the report said. After that, CIOs should then make sure that data is interoperable and sent to the patient’s EHR. In the same vein, CIOs should also be prepared to secure data and mitigate risk. If data storage falls outside the healthcare organization– whether in a cloud service or in a vendor’s privately owned storage resource– CIOs should know that “data encryption in transit and at rest is a basic expectation,” the report said.

Let us know what you think about the story; email Kristen Lee, news writer, or find her on Twitter @Kristen_Lee_34.


April 28, 2015  11:28 AM

CMS: Technology can tighten link between quality measures and improvement



Posted by: adelvecchio
AHRQ, EHR, quality measures

In publishing a final draft of its Physician Quality Reporting Programs strategic vision, CMS reiterated that it stands with the growing crowd of healthcare entities that are supporting a move away from fee-for-service payment models. The official CMS strategy document “supports CMS’ evolving approach to provider payment” and “continues its drive… to payment models that reward providers based on the quality and cost of care provided.”

In short, quality data leads to more easily measured health benchmarks, which in turn leads to improved patient care, CMS said.

Technology plays a large part in tightening the link between quality measures and improving the quality of care. “For example, providers may generate their own reports for quality improvement using their EHRs,” CMS says in the strategy document.

Eligible professionals that fall short of data reporting requirements on quality measures will face payment adjustments beginning this year, as part of the Physician Quality Reporting Programs. The payment adjustment in 2015 is 1.5% and jumps to 2.0% in 2016 and thereafter.

The Physician Quality Reporting Programs feed into the CMS Quality Strategy and the Agency for Healthcare Research and Quality’s National Quality Strategy, both of which aim to improve the delivery of healthcare. Patrick Conway, M.D., principal deputy administrator and chief medical officer at CMS, authored a blog post to pair with the release of CMS’ strategy document. In his post, Conway underscored the following five principles as pillars of CMS’ visions:

  • Feedback from healthcare professionals, patients and other caregivers will steer the programs
  • That feedback and other data will support swift quality improvement
  • Public reporting will provide actionable data to patients and providers
  • Consistent health IT quality measures will act as a foundation in support of CMS’ value-based purchasing programs, public reporting and quality improvement
  • All aspects of CMS’ quality reporting and value-based purchasing programs will be coordinated

Conway made it clear that CMS hopes its plan will benefit all sides of the healthcare industry. He wrote that the programs are designed to improve the delivery of care and provide information to consumers, patients and physicians. The CMS plan also aims to optimize how healthcare funds are spent and how care providers are paid.


April 22, 2015  12:25 PM

PHI at core of new HHS and EEOC corporate wellness rules



Posted by: ShaunSutner
HIPAA, OCR, PHI

The government continues to watch electronic protected health information (PHI), and it’s not just HIPAA enforcers who are doing it.

Both HHS’ Office for Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC) declared this month, within days of each other, that corporate wellness programs are OK.

That is, the agencies said in new and proposed rulemaking, as long as such programs are voluntary, guard employees’ PHI in accordance with HIPAA, and carry incentives that don’t exceed up to 30% of the insurance plan’s total cost of employee-only coverage.

The EEOC proposed rules apply to wellness plans that include disability related questions or medical exams, explains the National Law Review (NLR).

While the EEOC and OCR HIPAA-based rules largely overlap, a subtle difference between them is that the HIPAA regulations don’t put limits on incentives unless based on health status-related issues, according to the National Law Review.

Tobacco use is another difference.

Here’s how the NLR parses it.

”When tobacco use is a component of the incentive, the HIPAA regulations allow the incentive to go as high as 50% of the plan’s cost of providing employee only coverage,” the NLR says. “However, if the plan is going to be testing for nicotine use, the EEOC regulations will not allow that incentive (along with any other incentives that require a “medical exam” of some sort) to exceed 30% of the plan’s cost of employee only coverage.”

As for OCR’s HIPAA-based rules, they apply to corporate wellness programs for HIPAA-covered entities when wellness programs are part of a group health plan.

Importantly, when a workplace wellness plan is offered by an employer directly, not as part of a group health plan, the PHI the employer collects is not covered by HIPAA. However, OCR notes that other state or federal laws may apply and regulate the use and collection of such data.

 

 

 


April 21, 2015  4:04 PM

HIMSS mobile survey shows link between patient engagement and mobile tech



Posted by: adelvecchio
HIMSS, HIMSS 2015, mHealth, patient engagement, patient portals, telehealth

Last week was the most significant one of the year for the Healthcare Information and Management Systems Society. In the midst of its health IT mega-conference, HIMSS 2015, the group made time to publish the results of the 2015 HIMSS Mobile Technology Survey.

Of the 238 respondents to the HIMSS mobile survey, nearly 90% said they use mobile devices to engage patients in their own care. Tailoring patient’s mHealth experiences to fit their needs and those of the healthcare organization appears to be occurring with greater frequency. Nearly one-third of respondents said their facility offers organizational-specific apps to their patient populations, with an additional 30% indicating such an app is in the process of being created for their organization.

Though a fair amount of those surveyed believe mHealth deployments should be part of the future of their organization, not all of them are satisfied with their current mobile infrastructures. Slightly fewer than half responded that mobile implementations to permit access to information should be a top consideration for their organization. However, only 18% classified their mobile environments as “highly mature.”

Many providers want to expand mHealth operations but are concerned about the return on investment. Those organizations can stew over the following tidbits gathered in the HIMSS mobile survey:

  • More than half (51%) of respondents cited budgetary concerns as a reason to hesitate in supporting more mobile processes and interactions within their facility
  • Nearly the same amount of people (54%) reported they saved money by deploying more mobile technology

Also, app-enabled patient portals (73%), telehealth services (62%) and text messaging (57%) were three mHealth tools most frequently used by survey participants. “The widespread availability of mobile technology has had a positive impact on the coordination of patient care,” David Collins, senior director of HIMSS mHealth Community, said in the HIMSS mobile survey brief.


April 16, 2015  3:02 PM

HIMSS 2015 delightfully chaotic



Posted by: ShaunSutner
athenahealth, Cerner, Epic, HIMSS 2015, HL7, Interoperability

CHICAGO — Overheard on the show floor at HIMSS 2015: “Hey, I like that analytics engine.”

HIMSS 2015 was a health techie’s wonderland, with plenty of partying, delightful chaos among hundreds of vendors and more than 43,000 attendees hoofing it across the vast expanses of the McCormick Place convention center, North America’s largest.

The conference and exhibition delivered on its promise of showcasing the startling breadth of the health IT business. It wrapped up today, April 16, with a closing keynote by Karen DeSalvo, M.D., the national coordinator for health IT. The keynoter the day before was former president George W. Bush, an unlikely forefather of modern health IT as the creator of Office of the National Coordinator of Health IT (ONC), in 2004.

One of the more entertaining plot lines of the show was the behind-the-scenes tussle over potential customers and sometimes quite public battle between the two giant EHR vendor foes, Epic Systems Corp. and Cerner Corp.

When Epic, a day into the show, abruptly suspended or canceled (we don’t know yet which) its $2.50- per-transaction fee for interactions with its homegrown health information exchange (HIE), Cerner, which had long called attention to the fee as an alleged price-gouging ploy, trumpeted the news on the walls of its expansive show floor booth.

Epic, meanwhile, dispatched its irrepressibly techie chief operating officer, Carl Dvorak, to an unlikely venue: a high-profile morning panel on HL7 International’s FHIR (Fast Health Interoperability Resources) draft standard, a rallying point for interoperability advocates.

Epic is a charter member of the Argonaut Project, the HL7-bred coalition that is developing FHIR, but the privately held company still has a reputation, fair or not, for building somewhat closed EHR systems.

For his part, Dvorak played his role with abundant good humor, jousting playfully with fellow panelists, including John Halamka, M.D., the celebrity CIO at Beth Israel Deaconess Medical Center in Boston. Halamka participated via a clunky phone connection that HL7 CEO Charles Jaffe, M.D., conducted by holding his mobile phone up to the podium microphone.

When it was Dvorak’s turn at the podium after Halamka delivered an animated speech about the benefits of FHIR and what he painted as the shackles of government over-regulation, Dvorak gestured toward Jaffe’s phone, which had just stopped crackling with Halamka’s voice:

“Can we put him on mute?” Dvorak asked.

The packed room erupted in laughter.

Over at the distinctive Epic booth, the installation was decorated in sort of a homey style with faux exposed brick, giant butterflies suspended from the ceiling and fanciful statuettes of the odd, dragon-like creatures that play a part in Epic’s unusual corporate culture.

The sheer volume of visitors to the show and the distances they needed to travel by foot – unless opting for one of the small, electric, wheeled “trollies” that cautiously criss-cross McCormick’s huge South and North exhibition halls – created some pretty amusing moments.

On Monday, the first day exhibits were open to the public, show-goers crowded four or five deep at the entrance to the South Hall just before the 11 a.m. opening bell as seen-it-all security guards shouted to the mass of eager HIMSS people to walk, not run, as they entered.

“We’re talking about safety here,” the security chief bellowed.

As for partying, the athenahealth, Inc. shindig at the Hard Rock Café Tuesday night was reportedly rocking, and it featured an appearance by the cloud EHR vendor’s famously exuberant CEO, Jonathan  Bush, who arrived at the party with whipped cream on his face after being “pied” at a previous venue.


April 15, 2015  1:09 PM

It’s feet first for all HIMSS 2015 attendees



Posted by: Scott Wallask
HIMSS, HIMSS 2015, wellness

This morning as I came down the hotel elevator for breakfast, it stopped at a floor and in came a young guy carrying two stuffed bags and sporting a HIMSS 2015 badge.

“You ready to walk another 10 miles today?” the fella asked. “My feet are in pain. I told my boss no offense, but I’m not wearing shoes today.” Sure enough, the guy had his work slacks on with sneakers.

Ah, the life of a HIMSS attendee in Chicago.

The logistics of the show are impressive. Having done some prior work in event planning — on a much smaller scale than HIMSS, for the record — I know what a hellish week organizers are going through. Their role ranges from VIP handler to problem solver, to zookeeper.

If you’ve never been to McCormick Place — the huge conference center at which HIMSS 2015 takes place — it is a sprawling complex with four convention halls. Its buildings rise in a no-man’s land south of downtown Chicago that you can’t easily escape once you’ve arrived, unless you want to compete for a shuttle bus with few thousand of your colleagues or brave a taxi ride.

Watching the cabs come and go outside McCormick resembles the scene at O’Hare Airport a short distance away, except McCormick has a longer taxi line. And if you’re a cabbie, you’d better have strong skin to withstand the verbal assault thrown at you from the traffic directors who make sure the cars keep moving and the pedestrians have a clear crosswalk. One of the crossing guards — and “guard” is truly the appropriate word — was smoking a cigar while barking out orders from the side of his mouth like NBA coaching great Red Auerbach.

And then there are the feet — the feet of 43,129 attendees that are throbbing because of all the steps they take. For those who track their walking with wellness devices or pedometers, HIMSS is more like Mecca. For those of us — like me and the attendee in the hotel elevator — who are more concerned with comfort rather than calisthenics, there is no relief coming until we sit on a plane flying home.

I’m sure Alexis Normand, the healthcare development director at Withings, would disagree. Normand told my colleague, Shaun Sutner, that before he flew to HIMSS 2015, he ran a marathon in France. You won’t be surprised to hear his company produces wellness watches.

I should have taken the offer of a trip on the “HIMSS trolley” in the exhibit hall, a large, souped-up golf cart that rolled people from one end of the exhibit hall to the other. I laughed to myself the first time I saw the trolley; my feet and I are not laughing now.


April 14, 2015  12:01 PM

Proposal would shrink 2015 meaningful use attestation period



Posted by: adelvecchio
CHIME, EHR incentive program, Meaningful use, meaningful use attestation

Following through on a promise made earlier this year, the Centers for Medicare and Medicaid services released a proposal to relax meaningful use reporting requirements in 2015. A major piece of the proposal would shrink the meaningful use attestation period for eligible professionals from a full year down to a consecutive 90-day period.

The 90-day attestation period would also be offered to providers attempting to demonstrate meaningful use of EHRs for the first time in 2016 — if the proposal is accepted as it’s currently written. The CMS proposal aims to align the EHR reporting period with the calendar year, instead of the fiscal year. That move means repeat meaningful use participants will have to successfully attest to meaningful use requirements from Jan. 1, 2016 to Dec. 31, 2016.

CMS’ publication of a blog post in January, in which it declared its intention to shorten the 2015 reporting period, felt like a response to the pleas of groups such as the College of Healthcare Information Management Executives (CHIME). CHIME was on record as opposing the year-long reporting requirement in 2015, and had hoped CMS would replace it with a 90-day version before the end of last year.

The recent release from CMS offered changes to the patient engagement portions of the meaningful use criteria. As it stands, more than 5% of patients seen by an eligible professional (EP) during an attestation period must view, download or send their health information to third party. Instead, CMS now suggests only one patient must view, download or transmit their health information — only to prove this capability is in place and supported by the EP.


April 13, 2015  10:39 PM

HIMSS 2015 attendees just want to find their way



Posted by: Scott Wallask
EHR, health IT innovation, HIMSS 2015, precision medicine

When I got into the taxi to catch my plane from Boston to the HIMSS 2015 conference, my cabbie didn’t know how to get to Logan Airport. He needed a GPS to guide him.

Then, in Chicago, the conference shuttle bus driver’s first words to those of us boarding for Sunday’s sessions: “I’m lost.” He had to use his brainpower to guide him to the McCormick Center, the home of the HIMSS event.

Attendees are also trying to find their way – in their case, through the rapidly evolving technology that flows through health IT.

“We’ve got security that’s a big issue. We’re looking at innovation. We’ve got big data . . . It’s overwhelming,” said Sonney Sapra, CIO at Tuality Healthcare in Hillsboro, Ore.

himss15_homepage_banner

 

Even large vendors are feeling the uncertainty.

“We are excited we are now in the post-EHR world,” said David Delaney, M.D., chief medical officer at SAP. “But now it’s: So what?”

For SAP and other product developers in healthcare, the path to the future lies partially on the yellow brick road of precision medicine. Data volume, analytics, and EHR integration all promise to tailor patient treatment, such as for oncology, into a new model for care plans.

At Sapra’s hospital, IT staff members find new direction through organization-sponsored hack-a-thons to see if there are ways to penetrate the IS system. “It’s a lot of educating our staff right now and really getting them up to speed,” he said.

This week, as I raced between the rows and rows of vendor booths in the huge HIMSS 2015 exhibit hall in search for an upcoming interview, I took in all the choices before healthcare providers. Which way to go? Which product to explore?

As you find your way through HIMSS 2015 – the correct session room, the best place to avoid lunch lines, heck, even what half of the exhibit hall to head for – remember that your colleagues and product developers walk the same hazy route.

And just like my cabbie and bus driver, you’ll get there.

 


April 8, 2015  4:06 PM

With a punch list in hand, CMS readies for ICD-10



Posted by: ShaunSutner
CMS, ICD-10, ICD-9

The march toward ICD-10 is on in earnest.

Along with apparent solid congressional and industry support for ICD-10 after last year’s surprise one-year delay in stepping up medical coding from ICD-9, it appears that CMS is addressing some of the last technical details before the planned Oct. 1 switchover.

CMS recently asked the Office of Management and the Budget (OMB) to approve an Outcome and Assessment Information Set C-1 set for ICD-10 that CMS had to change to a data set that could accommodate the continued use of ICD-9 for a year.

The data set now has to be revised to reflect a few technical coding changes to allow the implementation of ICD-10.

It includes five items mainly affecting home health agencies and the data they are required to collect in order to participate in Medicare. They are:

  • Listing of each inpatient diagnosis and ICD-9 code at the highest level of specificity for only those conditions treated during an inpatient stay within the last 14 days
  • Diagnoses requiring medical or treatment regimen change within the past 14 days
  • Primary diagnosis and degree of symptom control
  • Other diagnoses and degree of symptom control
  • Payment diagnoses

As part of the OMB approval process, home health agencies can comment on the proposed changes until April 24.


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