August 6, 2012 9:35 PM
Posted by: RedaChouffani
The Centers for Medicare & Medicaid Services (CMS) today issued a final rule that updates fiscal year (FY) 2013. Under this rule the payment rates for acute care hospitals will be increased by 2.8 percent in 2013.
“Hospitals are at the forefront of our strategy to both save money and improve the quality and coordination of care,” said CMS Acting Administrator Marilyn Tavenner. “This rule takes further important steps to ensure all patients receive the best possible care.”
As part of pushing for improved care, there are provisions that are meant to encourage the reduction of hospital readmissions post the following conditions: (heart attack, heart failure and pneumonia). The provisions will reduce payments beginning in FY 2013. For Hospital value-based purchasing program, the rule rewards for efficient and high quality care by adjusting the hospital payment based on the performance against a set of quality measures.
CMS has also finalized additional items regarding the SCHIP Extension Act Moratorium.
- An extension of the existing moratorium on the “25 percent threshold” policy as well as a providing a supplemental moratorium for certain LTCHs and LTCH satellite facilities, pending results of an on-going research initiative to re-define the role of LTCHs in the Medicare program.
- A 1.3 percent reduction (first year of a three-year phase-in) for a permanent prospective budget neutrality adjustment. The reduction would not apply to discharges occurring on or before December 28, 2012, because the law prohibits its application before that date. The budget neutrality adjustment reduces the update from 1.8 percent to 0.5 percent.
The document is currently available for review and public comment here
August 6, 2012 9:32 PM
Posted by: RedaChouffani
We live in very interesting times, our health care in transforming before our eyes. There have been many existing changes, and some that remain to be seen. Technology has been helping throughout this transition, but no matter what, the realities that we have is that whatever changes we endure, they must help improve care quality, increase access to care, and improve efficiency in order for hospitals and health providers keep their doors open for patients.
There are few areas that are contributing to the health care transformation we are seeing.
Telehealth: For rural areas, telemedicine has proven to be a valuable technology that truly helped patients receive care much faster and within remote areas. In a way this has helped improve care and convenience. Telehealth continues to improve and increase in value for health providers. In other areas, physicians are starting to adopt devices that are used to pull real time vitals on specific patients no matter where they are.
Fee for outcome not for service: The writing has been on the walls for sometimes. And for almost any new ruling and regulatory change, the focus has always been to improve care and access, and reduce health care costs. There is a good chance, as the shift we are seeing today will put for all payments to be based on outcomes and not procedures.
Retail health care: When we consider the popularity and success of minute clinics we can easily predict that more likely other retailers will consider adopting similar models. We already see optometrists in many of the Target stores and Wal-Mart’s. But with the infrastructures and financial capabilities, these giant retailers may one day compete with health systems in our communities and provide primary care services.
Artificial intelligence: When talking about AI the first thing that comes to my mind is Watson. The super computer by IBM that is able to help physicians diagnose patients based on input from EMR, as well as data collected during the differential, lab results and voice. The system is being piloted in few health organizations. It is highly anticipated that this system and others similar to it will be assisting care providers through their EMR with far more advanced capabilities. There have been other systems such as evidence based supporting tools that will be fully capable of taking input, searching big data, learning and performing fast and effective analysis will prove to be great tools that will further assist physicians during the care of their patients.
Health IT: Cloud computing and mobility are still making headway across several health organizations. And health organizations will continue to see less on premise systems, and more cloud based tools such as EHR, HIS, and other productivity products. The modern medical organization of tomorrow can have all of its technology and systems deployed with a day or less.
The regulatory changes and shrinking reimbursements are continually pressuring health groups. This will be one of the main driving forces behind the transformation. While there are many additional areas such as mobility, EHR, and advancements in effective drugs and genome that will continue to shape transformation in health care is, one constant will remain the same and that is the expectation of patients to receive improved care at an affordable price.
July 30, 2012 10:45 PM
Posted by: RedaChouffani
, cloud EHR
There has been a significant interest in cloud computing in the past few years. This area continues to help many adopters reduce operational costs by moving many of the business applications to the cloud. And as more end users begin to use cloud based Apps for day-to-day work (Google Docs, Office 365, SalesForce.com and many more), it becomes clearer that the cloud will one day host most of today’s business applications. For healthcare, EHR vendors have been providing a hosted or cloud based model. Most of them technically provision servers in a private cloud, configuration databases and then install the application in the different desktops and stations needed. With the exception of pure cloud based systems such as AthenaHealth or Practice Fusion, there isn’t a truly quick and easy process to get up and running on a EMR like many can get started on Microsoft Office 365 and other cloud based Applications.
However with the new pressures from users demanding mobility, and the fact that end users are doing more with mobile devices, it becomes a great driving force to push EHR vendors to eliminate the complexity of the server side components and configurations needed and just allow new EHR users to download the App from the internet, and simply login and start using the product. Of course this would require some preliminary work, however I truly envision that the EHR of the future (if not some today), that you will sign up on a portal, enter practice information (NPI, UPIN, Contracted Payers, and other basic info), then the system will provide you a special ID that can be entered in the mobile App once downloaded.
Some of the reasons why it makes complete sense why more EHR vendors should and will adapt their applications to be cloud based and support stronger mobility:
End users are asking for it:
Clinicians today are looking for systems that are easier to use, and available on any device. Even medical students are now using tablets as learning tools and expecting the availability of mHealth Apps when they enter the professional field.
Many practices are looking to add more physicians and or merge with other practices. In some cases this can be a costly project from the IT prospective, but with a cloud-based product, scaling out is simply a built-in benefit of the having these services in the cloud. This would mean that the organization will simply pay for additional computing power and storage and they are done.
For some small practices, having a highly available system can be costly, and some may just rely on traditional backup methodology to protect their data. This can mean that the practice has the potential of loosing data, or being down for extended periods of time during a recovery process. With a cloud based EHR solution in almost all cases there is a much higher fault tolerance and data protection. With many of today’s data centers replicating to different data centers in different geographical areas.
Easy to setup:
In many of the traditional EHR systems, getting the system configured and set up can be daunting tasks for any physician and or practice administrator. In most cases the system was not design with the premise of new users signing up and configuring the system themselves. However, with a cloud based application, it is expected for an App vendor to ensure that the end user could easily sign up online, configure and begin to use the system quickly.
Lower total cost of ownership:
For many small to mid size medical organizations having hardware on premise is requirement for an EHR. This simply means that the practices are exposed to additional costs associated with having servers on site that need to be maintained and refreshed after so many years. With a cloud based solution these groups would simply not be required to make this capital purchase. By eliminating the up front costs of servers and other hardware, many can see that as a significant value add the cloud brings to the table.
With many of the current practices continuously struggling with complex interfacing and integrating set ups, Cloud based EHR will most likely have ready to go interfaces that simply connect to one or more HIEs, as well as other Lab companies.
With more users being exposed and using cloud based applications, many are recognizing the values it brings and are beginning to ask for more business apps like some of the existing ones to be cloud based. Some vendors have recognized this trend and began moving toward that, and others are simply ignoring the realities of end users demands and competition.
July 23, 2012 6:40 PM
Posted by: RedaChouffani
Whether you are looking to buy a new car or kitchen appliance, the Internet has provided us with plenty of information on what are interested in. This public content provides some insight and feedback from other users on what we intended on buying and can significantly influence our purchasing decision. But when it comes to our care provider it is a little bit more challenging.
While there are ways to view reviews posted on different sites on how a provider or medical practice was, but the truth is that it is clearly difficult to simply rely on just the Internet reviews to truly gauge if a health system is better than another. There are many areas that must be evaluated in order to properly compare and differentiate one hospital from another and one nursing home to another.
What matters to any patient is that they will receive the best care they can, and be cared for at one of the best facilities and one with the highest ranking. With those basis, Medicare has attempted to provide patients with some way to review how hospitals and nursing homes have done based on post discharge surveys as well as scores on quality outcome measures.
Some of the updates included to both web sites as listed in the CMS press release are:
- Narratives that detail specific findings from inspections of nursing home facilities;
- Two new measures that report a nursing home’s use of antipsychotic medications;
- Updated data for quality measures previously available on the site; and
- Information on nursing home ownership available thanks to the Affordable Care Act.
- Two new measures that cover potential health risks of imaging services, such as exposure to unnecessary radiation
- Updated data for existing quality measures.
There are also ratings and reviews published by commercial payers. These may also provide additional resources for patients to identify providers and organizations details.
Whether your next selection of a hospital is influenced by score cards provided through CMS or simply word of mouth, many of these organizations are aggressively promoting all their awards and achievements, and that can easily influence your decisions.
July 16, 2012 7:55 PM
Posted by: RedaChouffani
, Google Glasses
, Google Glasses project
, mobile health
When you pause and look around at all innovations that have helped shape health care and other industriesthis century, one can easily get giddy just thinking about what tomorrow will bring. A quick peek at what vendors like IBM, Google, Apple, Microsoft and others are submitting to the patent office can feed many of today’s technology enthusiasts’ thirst of innovation.
When Google introduced their latest product during this years IO called the Google Glass project, many welcomed the device with applause and excitement. Google Glasses are basically a set of glasses that a person can wear loaded with a computer. It is literally like wearing a smart device running an Android platform and the display is projected on the lenses for the eye to see.
Similar to many previous technologies that made it to the consumer world that those in the health care industry are making good use of, Google Glasses are bound to be used in hospitals and other health facilities. It will take some time, but eventually technology enthusiasts will develop and discover meaningful uses of the glasses within health care.
But when you start to consider the capabilities of Google Glass for health care, one can also begin to imagine some of the use cases that could significantly help with patient care, patient satisfaction and in improving efficiency:
The ability for nurses, physicians and front desk staff to recognize patients during the first visual encounter and be able to view any health and billing related alerts without performing look-ups on a computer.
For caregivers performing specific procedures that may require assistance or expert oversight, Google Glasses can be the best option for a front seat view of what the surgeon or nurse is seeing and receiving active feedback via the display or audio.
Hands free work:
Whether it is a nurse assisting a patient who is experiencing a seizure or severe bleeding, a care giver cannot spare a hand in these situations. Google Glasses enables one to have full use of both hands while still being in full communication with others.
Visual recognition system:
Whether you are indoors or outdoors, Google Glasses can help its user by identifying various landmarks and objects by simply looking at the it and get detailed information on the item without the need of text based search.
Hands free notification system:
For many who work in the health care setting, it is common for clinicians to take frequent breaks to review the different alerts generated by nursing call systems, EHRs and other coworkers, which causes significant interruptions. But with these glasses, notifications are pushed to the users and delivered directly to their eye. This can be very useful for care providers when they are caring for a patient or during a surgery and specific alerts are triggered and need to be delivered immediately.
While this may be just a small set of use cases possible with Google Glasses, there is a true opportunity to see a technology that will yet again help change the way we interact with information in the health care. Tomorrow’s innovation might even deliver content via contact lenses one day.
July 16, 2012 7:52 PM
Posted by: RedaChouffani
RTLS continues to be an attractive hospital solution, which helps many executives resolve some of the challenges that nurses, and bio engineering face. All these help hospitals improve on patient safety, compliance, and improve efficiency. But for many, there are simply too many vendors and technologies to choose from. One common question that comes up frequently is what hardware should the hospital decide on or more towards?
In todays market, the tags which are the devices that can be attached to either patients, staff, devices and other assets require specific means to communicate their location to a centralize system. These methods of communication range from the following:
- Radio frequency
- Ultra sound
For many health systems Wi-Fi seems to be one of the most cost effective option if the current wireless infrastructure has the appropriate support for Wi-Fi device triangulation. With vendors such as CISCO and Aruba dominating that market, many hospitals with those wireless infrastructures can locate vendors that provide tags, which support these platforms.
It is however very important to recognize some of the limitations to some of these technologies. For Wi-Fi based RTLS systems, battery life tends to be a major issue for some. Since wireless can if not configured properly drain the battery very fast and lack of high accuracy on some wireless RTLS systems, many have resorted to using mixed mode tags that provide a fall back method and additional devices to guarantee locating.
Ultra Sound based RTLS system have also been selected by many. Some of the limitations that have been associated with it is the potential of disruption due to possible interference from other systems that may generate high frequency sound waves. While it is fully possibly, there has not been a significant disruptions reported from many of the hospitals with similar systems from Sonitor.
Sound waves are mechanical and require additional energy to push them out where they need to be. They can also be easily disrupted by any nearby generator of high frequency sound waves (e.g. “anything that makes noise”). This noise can distort or even totally block the location data.
As we look at the market and see all the hardware offerings available, Biomed engineers, CNOs and IT executives must evaluate all the different options available based on their tracking needs. Some of these technologies are better fit for staff and patient tracking better than others, which maybe better suited for asset tracking. With the existence of vendors such as Centrak which offer tags as small as a matchbox that are packed with over three different technologies (Wifi, RF, and IR) all in one tiny device, these next generation tags and hardware can provide different solutions for the different use cases at a much cost effective rate.
July 9, 2012 9:45 PM
Posted by: RedaChouffani
, Windows 8
, windows mobile
During the June month, Microsoft announced the introduction of their own tablet named surface. Microsoft described the availability of two tablet models toward the end of 2012 one Intel based and the other ARM processor based. Having a vendors such as Microsoft enter the tablet arena complicates things a bit for healthcare organizations when it comes to choosing a platform and supporting them. Currently many had only two options to choose from between Apple’s iPad and Android supporting hardware. However adding a third one and talks about a forth one from some of the ex employees of Nokia may further complicate and add to the vendor pool.
Competition in this arena will continue to drive improvements in features, functionality as well as drive price down. This is welcomed by many, however it will mean that IT departments as they are rolling out initiatives BYOD will now need to plan on understanding how they can ensure security, and management of the newer platforms including windows 8 based tablets.
For vendors who are rolling out their mhealth Apps to iPad and Android tablets, they will now have to decide new windows mobile development will be needed. For some who elected to follow the web based App route will not face significant challenges and will find it easy to adjust and adopt to the new platforms to its support for HTML5. However sometimes certain features and functions require native Apps. This would force software vendors to develop new code base for the new platform(s).
No matter what angle you look it, having more tablets and platforms to choose from brings both good and bad things. As many IT executives will realize, that evaluating the platform that overall suites the group the best would need to be the platform of choice. The areas that would be part of the evaluation criteria are:
- Data Security
- Application support and availability
- Deployment and Implementation costs
- Battery life
- Quality and overall reliability
- Manageability and ease of use
- Vendor history
All these would be areas that should be part of the evaluation and selection of the mobile platform for clinicians and any other healthcare professional looking to implement mobility.
July 9, 2012 9:38 PM
Posted by: RedaChouffani
The number of new accountable Care Organizations (ACOs) continues to rise. Recently Health and Human Services (HHS) announced that over 89 new organizations as of July 1st, of 2012. This most recent announcement brings the total ACOs who have entered into agreements with CMS to 154. These are the organizations that took the responsibility to providing high quality care and coordinating it for patients. With over 40 different states and Washington DC, the participation is gaining momentum across almost all states.
“Better coordinated care is good for patients and it saves money,” said Secretary Sebelius. “We applaud every one of these doctors, hospitals, health centers and others for working together to ensure millions of people with Medicare get better, more patient-centered, coordinated care.”
While all future applications for the shared savings program will be accepted yearly, this will sure provide ample time for many more organizations to review and evaluate their options in order to decide whether or not creating or joining an existing ACO would be part of their strategic road map. There have been many multispecialty groups and hospital lead efforts to ease and encourage the adoption through. For some entities, hospitals facilitated the task by offsetting some of the technology costs or leveraging existing infrastructures while others had already been working within the same health system and collaboration on care was already occurring within the facilities.
As ACOs continue to attract more physicians, and as more adopt this model they will new sets of challenges. However, as we continue to face the different changes in healthcare, one focus of ACOs will continue to be the delivery of higher quality care, and reducing healthcare costs.
July 2, 2012 9:13 PM
Posted by: RedaChouffani
This past week, we have heard of outages of Twitter, Netflix and others online services being down for several hours due to some outages in data centers located in north Virginia from some severe storms. Some have seen that as a sign weakness and concerns for cloud computing.
While the data centers suffered mostly from power loss, and have caused some interruptions for thousands if not millions of users, no data has been reported lost, and all systems resumed within few hours. These disruptions did happen to one of the market leaders in cloud services (Amazon), and it is certainly important to realize that this is not uncommon especially when natural disaster hits.
For healthcare organizations contemplating the use of the cloud for electronic medical records and other health related data storage require much more reliable resources that are highly available. And it is equally important to note that these outages are not as frequent as some may think.
The fact is that whether medical information is cloud based, or on premises, downtime is never welcomed. With the need of systems to constantly be up during the critical care of patients, one task IT will need to address when selecting and evaluating cloud services is that downtime can happen. This would mean that the best defense against it, is to be appropriately plan for it through the review and plans of DR and BCP.