Medical Homes: Payers vs. Hospitals
November 29, 2010
Insurers are edging out hospitals in the race to dominate the emerging medical home model.
As an article in this week’s Modern Healthcare reports, hospitals are jumping on the medical home bandwagon in the hopes of retaining revenue. Their business strategies include converting their own hospital-owned physician practices into medical homes, acquiring practices already certified as medical homes and requiring practices being considered for purchase to convert.
Insurers, who have long encouraged capitated medical groups, an early form of medical home, are also seeking to line-up medical homes. For example, Humana has launched a rewards program where physicians who practice as a medical home can receive a subsidy covering 85% of the cost of implementing an electronic health-record system in an initiative aimed at improving coordination of care for Humana Medicare beneficiaries.
The article also reports on the race to “certify” medical homes. The National Committee for Quality Assurance (NCQA), which has a long history of rating the performance of health insurers, started a medical home program in 2008 and, since then, has recognized 1,161 practices as meeting its medical home standards.
Now the Joint Commission, which certifies the vast majority of the nation’s 5,500 hospitals, may start an accreditation program for hospital-based medical homes.
Physicians, who are usually suspicious of insurer-based initiatives, may feel more comfortable seeking accreditation from the Joint Commission, which is more “hospital friendly” than the NCQA.
Data Privacy-Does the Public Care?
November 26, 2010
If you were at an airport this Thanksgiving holiday, you were undoubtedly aware of the threatened “protest” by air travelers concerned about full-body scans.
Despite a lot of noise in the blogosphere about protests, nothing happened. Virtually everyone was happy to comply, they just wanted to have a safe flight.
Is all the noise about health data “privacy” for patients in the same category? Does the majority of the public really care about this issue?
I don’t believe so. There are several high-profile patient advocacy groups who have very legitimate concerns, but I don’t believe the average person understands the issue or cares about it.
The fact is a great deal of individual healthcare information is being shared by providers, pharmaceutical companies and health plans.
On November 23, a Vermont law that restricts companies’ use of information about the drugs doctors prescribe was ruled unconstitutional on free speech grounds by a federal appeals court.
Three companies that gather information on drugs ordered by doctors and then sell the info to pharmaceutical manufacturers — IMS Health, SDI and Source Healthcare Analytics — had sued over Vermont’s data mining law. Passed in 2007, it bans the sale, transmission or use of prescriber-identifiable data for marketing a prescription drug unless the prescribing doctor consents.
I understand why some people are concerned about sharing health information. Their concerns are legitimate and the current system works against the interests of some people. However, the genie is out of the bottle. The information has and will be shared and this system is apparently protected under the First Amendment.
New EHR Problem Center
November 23, 2010
Who you gonna call? Ghostbusters!
If you are over 40 years of age, you will remember that refrain from the hit song accompanying the movie “Ghostbusters.”
So who you gonna call when your EHR has a problem? Well, the vendor presumably, but it would also be a good idea to alert a clearinghouse, so other users of the same EHR would be alerted to the problem.
A new safety reporting organization, EHRevent.org, was launched last week to allow healthcare providers to report adverse issues related to the implementation and use of EHRs.
This is not like reporting a bad meal at a restaurant to Yelp! The information on the problem will be de-identified and stored in a Patient Safety Organization (PSO), a federally designated entity that would keep the information safe and secure.
According to Edward Fotsch, MD, CEO of PDR Network, one of the organizers of the new site, the purpose of the network is to put event reporting is at the fingertips of physicians. This will be done by integrating the system into websites of participating liability carriers, medical societies, regional extension centers, PDR Network and other partners, including EHR system vendors.
For example, a participating EHR vendor would have the link to EHRevent.org imbedded in its solution so doctors would only have to click on it to fill out a report form.
It sounds like a good idea on paper (or not on paper), but I wonder if the involvement of liability carriers will be a turn-off to physicians who will be wary of malpractice suits.
MU Gets Harder for Hospitals
November 22, 2010
It is not easy for federal agencies to agree on the meaning of “meaningful use.”
An excellent article in today’s iHealthbeat summarizes the challenges facing hospitals and physicians.
The article reports that CMS and the Office of the National Coordinator of Health IT recently provided a critical clarification on “meaningful use” that will make demonstrating the criteria more difficult.
Their guidance states that hospitals and EPs must implement all the meaningful use functionalities of the certified electronic health record. While hospitals and EPs are afforded flexibility in determining which of the five out of 10 menu set requirements they will report on for the purposes of demonstrating meaningful use, they are not afforded this same flexibility as it relates to implementation of the certified EHR.
One key challenge is that ONC requires providers to meet the first major requirement, i.e. utilize certified EHR technology by acquiring and installing certified software (complete or modular) that supports all the meaningful use objectives. Thus hospitals and physicians now only have a choice in which five of the 10 menu objectives they report on, not on which functionality they implement.
Complicating matters further is that the requirements for the Medicare and Medicaid programs differ.
For example, while hospitals and EPs need to implement all the functionalities of the certified EHR and report on all of the core and five of the 10 menu objectives to demonstrate meaningful use and collect Medicare incentives, providers only need to demonstrate tangible efforts to adopt, implement or upgrade to a certified EHR to be eligible for Medicaid incentives.
I love the term tangible effort. It reminds me of my teenage son doing his homework. He thinks a tangible effort is sufficient, while the teacher wants to see full functionality.
Medicaid MU Answers Posted
November 19, 2010
The National Conference of State Legislatures has posted a helpful FAQ on the Medicaid MU requirements.
See the document at http://www.ncsl.org/documents/health/HIT_FAQ.pdf
For example, it notes that the incentive program will launch in January 2011 for states that have an approved State Medicaid HIT Plan. In May 2011, states can begin awarding incentive payments to eligible providers. States can produce their own definitions of “meaningful use,” but they must “complement those promulgated by CMS.”
MU Glass Half Empty
November 18, 2010
Is the meaningful use “glass” (i.e. progress) half-full or half empty?
On Monday HIMSS Analytics reported a new survey found “9.6 percent” of hospitals can meet “most” of the meaninful use requirements. HIMSS tried to put a positive spin on it by saying the results showed “healthcare organizations continue to move toward implementation.”
Modern Healthcare HITS took a skeptical view, noting that “fewer than one in 10″ hospitals can meet the requirements. Today, the publication ran a letter from a reader noting it is “worse than it looks.”
The letter writer pointed out that “most troubling is this: 22% of hospitals can meet zero of the core objectives, and 33% can meet zero from the menu set.”
At a healthcare IT conference I attended earlier in the month, the corridor talk was that the government was going to have to postpone the meaningful use deadlines because few hospitals would be able to meet them.
Zagat Rates, Doctors Object
November 17, 2010
Zagat’s, the famous restaurant review organization, has now begun rating physicians in Illinois.
And physicians – at least those in the AMA – don’t like it.
As the Chicago Tribune reports, more than 30 different online services now grade doctors, however, assessing a doctor’s skills has turned out to be much more complicated and controversial than ranking hotels or restaurants.
Critics, including the American Medical Association, say that most sites have too few reviews per doctor to offer statistically significant information, and the medical establishment has vocally questioned the concept.
According to Dr. Jeffrey Segal, chief operating officer of Medical Justice, which works to protect doctors against online defamation, there are just not enough reviews posted by patients to give an accurate portrait of a physician.
“The average doctor sees between (1,000) and 3,000 patients a year, yet the typical reviewing site has zero to three posts. That doesn’t even come close to a scintilla of statistical significance,” Dr. Segal said.
I think this has a lot to do with age. Young, single people, who are the biggest restaurant goers and reviewers, tend not to visit physicians as much as parents with children.
Target’s Medical Director
November 15, 2010
Healthcare products and services accounts for $6 billion of Target’s annual revenues. It is such an important part of the giant retailer’s business that they have their own medical director, Dr. Josh Riff.
According to a recent story in MedCityNews, many of Target’s 1,800 stores include pharmacies, fitness equipment, private-label nutritional products and they promote full-scale national campaigns in partnership with the American Cancer Society (smoking cessation) and the Centers for Disease Control (vaccinations).
For example, Target launched its private label Archer Farms Simply Balanced line of foods that meet certain nutritional standards.
Target clinics offer a quick and affordable $75 visit with a nurse practitioner.
According to Dr. Riff, the retailer’s goal is to somehow package all of these healthcare-related goods and services under one banner for a specific group of consumers. For example, the company envisions marketing essentials like glucose meters, slippers, exercise gear, fruits and vegetables to diabetics.
“Our vision for the consumer is, how do I take care all of my healthcare needs” at once? Dr. Riff said. “We haven’t quite figured it out yet.”
I’m going to go out on a limb and predict that Wal-Mart will also soon hire a “medical director” or similar position. Health care is too big a market to ignore.
Unclear Outlook for 2011
November 12, 2010
What will happen next year in healthcare? Will the new Republican Congress defund some of President Obama’s healthcare programs? Will physicians be forced to take a 23% cut in Medicare payment?
As an AP story reports today:
“The scheduled cuts — the result of a failed system set up years ago to control costs — have raised alarms that real damage to Medicare could result if the lame-duck Congress winds up in a partisan standoff and fails to act by Dec. 1. That’s when an initial 23 percent reduction would hit.”
“Neither Democrats nor newly empowered Republicans want the sudden cuts, but there’s no consensus on how to stave them off. The debate over high deficits complicates matters, since every penny going to make doctors whole will probably have to come from cuts elsewhere.”
Today, Health Data Management ran an “e-poll” on its web site, asking if readers thought that Republican wins would mean major changes in health IT policy.
The results showed 39% of readers felt there would be “no change,” while 33% believed there would be major changes. Smaller percentages chose “minor changes” in the law.
Bottom line: no one really nows what will happen in 2011. What we do know is that the current trajectory – with healthcare taking up an ever-increasing portion of GDP – is unsustainable.
Will ICD-10 Deadline Be Delayed?
November 10, 2010
The short answer is “possibly.”
I was at an HIT conference last week and sat at a table with two hospital CIOs and three vendor executives. The consensus was the government would have to extend the upcoming 2013 deadline because many organizations will not be able to meet it.
Currently, the CMS has in place an Oct. 1, 2013 deadline for all “covered entities” (hospitals, health plans) to submit their bills according to the ICD-10 CM codes.
Right now, providers are using the ICD-9 code catalog, which contains 16,000 medical procedure codes. The new ICD-10 catalog (already in use in Europe) contains 140,000 codes. The vast increase in codes is designed to improve accuracy and cost accountability.
Unfortunately, it also means a tremendous amount of additional work on the provider end. AHIMA estimates coder productivity will drop 50%. As one hospital CIO at my table said, “We’ve currently focused on meeting the meaningful use requirements. We have just not gotten around to the ICD-10 yet. I’m assuming our vendors are on top of it.”