I woke up this morning, anxious about my doctor’s appointment. I quickly showered, dressed, walked and fed the dog, grabbed my phone, and hopped in the car for the 30-minute drive. As I took my seat in the waiting room I realized that I’d forgotten to set my home alarm.
Because of IoT the solution is now simple. I bring up the app on my phone and set the alarm to “Away”, and while I’m at it I decide to program my DVR to record the season finale of “Downton Abbey.” So, I bring up the DVR app on my phone and click-click-click, Downton Abbey will be recorded. Maybe I’ll watch last week’s episode right now, but with that, I’m called into the exam room for my appointment.
With IoT bringing convenience and luxury like this into the lives of everyone with a smart phone, it’s logical that this same technology has been extended for use by the healthcare community and the clinical laboratory in particular.
In 1999 when the article “To Err is Human—Building a Safer Health System” was published by the Institute Of Medicine, the number and complexity of medical errors shocked the whole medical community. Often, these errors could be attributed to human mistakes. Since that time the medical community has developed systems to help reduce those errors. Checklists during surgery, automated systems for testing blood in the laboratory, better procedures to prevent contamination. Even given these, eliminating errors has proven to be very difficult.
It is estimated that one-fifth of the U.S. population will be 65 years or older by 2030. According to Florida Atlantic University, out of the 1.6 million Americans currently living in a nursing home, 60 percent of that population is sent to the emergency room, while another 25 percent are admitted to the hospital each year. As a result, the care transition process between senior communities and acute care providers has become critical to ensure the best outcomes for patients.
Traditionally, when a senior care resident is sent to a hospital, the receiving healthcare provider may not have a complete view of the patient’s history. Ideally, documentation and medical records should travel with the resident so that all the information clinicians will need to properly treat the individual will be available upon arrival. Unfortunately, this is often not the case.
The good news is that there is technology to help improve this process in three main ways:
Reducing unnecessary hospital readmissions
Reducing paper and therefore medication errors
Increased focus on person-centered care
Reducing unnecessary readmissions
There is a lot of talk in the industry about how technology is helping to reduce hospital readmissions, but these conversations often lack tangible, measurable results. One thing is certain – providers have benchmarks to meet. On Oct. 1, 2012, The Centers for Medicare & Medicaid Services (CMS) implemented penalties for hospital readmissions at a rate of one percent. By Oct. 1, 2014 this rate increased to three percent. By 2018, CMS is mandating that those same penalties that apply to hospitals will apply to skilled nursing facilities.
Information Technology holds the promise to spur innovation in the healthcare industry. However, if IT investment is focused on simply meeting mandates and not on driving a specific differentiated business objective, then it begins to look a lot like what we are seeing today – extensive capital and resources spent on implementing and supporting IT initiatives that, so far, have provided little to no financial returns. But this does not mean that the promise of IT is empty. Instead, it calls attention to the need to look at IT not as a way to “check the box” and either collect federal incentive dollars or avoid eventual penalties, but rather as a key tool to remain competitive in the market as well as provide quality care.
In light of recent federal mandates under meaningful use regarding the implementation of electronic health records, many EHR vendors are now propagating the idea that their software is not only compliant with regulatory statutes, but is also a singular comprehensive and strategic IT investment. However, this is just half the truth.
Under the pressures of time and expiring incentives, many healthcare executives have leapt after EHR investments without understanding the real strategic reasons for making IT investments for their enterprises. Otherwise savvy and well-meaning healthcare leaders are allowing EHR vendors to convince them that an EHR is the answer to their business needs and will provide them with an edge over competitors in the market. In reality, EHRs fail to provide a competitive advantage once most or all hospitals in a geographic market have implemented the tool. How can an organization claim it is superior in IT if it is operating the same systems as every other provider in the market? EHRs must be approached as a one-time operational input or business asset similar to hospital equipment and not the core component of a broader IT solution needed to support a sustainable business strategy. As with most investments, it is what you do with it which matters, not that you simply own it.
With the dramatic changes that have taken place in the U.S. healthcare landscape over the past several years, it’s not surprising that healthcare CIOs increasingly find leading transformation and delivering on the organization’s core strategies and objectives included in their responsibilities. (See SSi-SEARCH Research “Healthcare’s Million Dollar Man”) The CIOs for small to mid-sized payers and third party administrators are no exception.
When it comes to freeing up IT resources for mission-critical strategic tasks, decisions regarding enterprise software solutions should not be overlooked, as they can have a significant impact on success for healthcare organizations in the small to mid-sized range.
While historical experience in these IT organizations may create a bias toward choosing on-premise software solutions, one should give serious consideration to three major benefits that cloud-based solutions can deliver to the organization: speed to market, scalability and total cost of ownership. These potential—and sought after—benefits hold the promise to deliver critical return on investment and serve the critical goals of both the IT organization and the business users within the company. Let’s take a closer look at each.
Speed to Market
At first glance, the initial deployment time for cloud or desktop (on-premise) applications can appear similar. However, two areas that impact overall deployment time should not be overlooked: capabilities and accessibility.
One characteristic typical of cloud applications is that they generally have more robust capabilities than on-premise software. This makes them easier to use and manage by a broader group within the organization and readily delivers on the promise of fast deployment. Overall deployment of cloud applications often takes less time than desktop applications because so much of it can be performed by a wider range of (less technical) users, rather than being dependent on the schedule and resources of IT.
On Apr. 17, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update fiscal year (FY) 2016 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The proposed rule, which would apply to approximately 3,400 acute care hospitals and approximately 435 LTCHs, would affect discharges occurring on or after Oct.1, 2015.
The IPPS pays hospitals for services provided to Medicare beneficiaries using a national base payment rate, adjusted for a number of factors that affect hospitals’ costs, including the patient’s condition and market conditions to the hospital’s geographic area.
The proposed rule proposes policies that continue a commitment to increasingly shift Medicare payments from volume to value. The administration has set measurable goals and a timeline to move the Medicare program, and the healthcare system at large, toward paying providers based on the quality, rather than the quantity of care they give patients.
This fact sheet discusses major provisions of the proposed rule.
CMS pays acute care hospitals (with a few exceptions specified in the law) for inpatient stays under the IPPS and long-term care hospitals under the LTCH PPS. Under these two payment systems, CMS generally sets payment rates prospectively for inpatient stays based on the patient’s diagnosis and severity of illness. A hospital receives a single payment for the case based on the payment classification – MS-DRGs under the IPPS and MS-LTC-DRGs under the LTCH PPS – assigned at discharge.
By law, CMS is required to update payment rates for IPPS hospitals annually, and to account for changes in the costs of goods and services used by these hospitals in treating Medicare patients, as well as for other factors. This is known as the hospital “market basket.” LTCHs are paid according to a separate market basket based on LTCH-specific goods and services.
Changes and Updates in FY 2016 Policies
Proposed Changes to Payment Rates under IPPS
The proposed increase in operating payment rates for general acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record (EHR) users is 1.1 percent. This reflects the projected hospital market basket update of 2.7 percent adjusted by -0.6 percentage point for multi-factor productivity and an additional adjustment of -0.2 percentage point in accordance with the Affordable Care Act; like last year, the rate is further decreased by a proposed 0.8 percent for a documentation and coding recoupment adjustment required by the American Taxpayer Relief Act of 2012.
Hospitals that do not successfully participate in the Hospital IQR Program and do not submit the required quality data will be subject to a one-fourth reduction of the market basket update. Also, the law requires that the update for any hospital that is not a meaningful EHR user will be reduced by one-half of the market basket update in FY 2016.
The Centers for Medicare & Medicaid Services (CMS) for the first time introduced star ratings on Hospital Compare, the agency’s public information website, to make it easier for consumers to choose a hospital and understand the quality of care they deliver. According to the organization, “This announcement builds on a larger effort across HHS to build a healthcare system that delivers better care, spends healthcare dollars more wisely, and results in healthier people.”
The Hospital Compare star ratings relate to patients’ experience of care at almost 3,500 Medicare-certified acute care hospitals. The ratings are based on data from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) measures that are included in Hospital Compare. HCAHPS has been in use since 2006 to measure patients’ perspectives of hospital care, and includes topics like:
How well nurses and doctors communicated with patients
How responsive hospital staff were to patient needs
How clean and quiet hospital environments were
How well patients were prepared for post-hospital settings
“The patient experience Star Ratings will make it easier for consumers to use the information on the Hospital Compare website and spotlight excellence in health care quality,” said Dr. Patrick Conway, acting principal deputy administrator for CMS and deputy administrator for Innovation and Quality. “These star ratings also encourage hospitals and clinicians to strive to continuously improve the patient experience and quality of care delivered to all patients.”
HIMSS released the results of the 2015 HIMSS Mobile Technology Survey at the annual HIMSS conference. This year’s study, of more than 200 healthcare provider employees, found that nearly 90 percent of respondents are utilizing mobile devices within their organizations to engage patients in their healthcare. The report also showed that respondents believe that mHealth technologies are beginning to drive cost savings and improve the quality of care delivered.
The adoption of mobile technologies has been rapid in recent years with 90 percent of American adults owning a mobile device. The healthcare industry continues to keep up, as these technologies are critical to the industry’s shift to patient-centered and value-based care. Respondents of this year’s survey reported leveraging a variety of mobile tools including: app-enabled patient portals (73 percent), telehealth services (62 percent) and text communications (57 percent). Of these technologies, 36 percent of respondents believe the use of app-enabled patient portals is the most effective tool in patient engagement to date.
“mHealth continues to evolve as a tool to drive healthcare efficiencies. The proposed Meaningful Use Stage 3 rule realizes this with the concept of APIs and patient generated health data, and this year’s survey showed that the wide spread availability of mobile technology has had a positive impact on the coordination of patient care,” said David Collins, senior director of HIMSS mHealth Community.
According to a new report from InMedica, a subsidiary of IMS Research, American healthcare providers are turning to telehealth in large numbers to help cut costs and projects patients using telehealth services to grow by nearly a factor of six by 2017. While 51 percent of HIMSS Mobile Technology Survey respondents indicated budget tolls as a key barrier to further implementation of mobile technologies, 54 percent indicated they had achieved cost savings when asked if the deployment of mobile technology had a positive effect in this capacity. Specifically, areas of impact included preventative support care (24 percent), telehealth interventions (23 percent) and resource utilization (21 percent).
Healthcare organizations having reached Stage 7 on the Electronic Medical Record Adoption Model (EMRAM) in 2013 and earlier will receive notification and instructions about the Stage 7 revalidation process by year-end, HIMSS Analytics announced.
Going forward, the Stage 7 validation lifespan will be three years. All Stage 7 organizations wishing to revalidate will be required to complete the process in the year between the second year anniversary of the original validation and its expiration.
“As the health IT industry rapidly evolves, EMRAM standards must continue to reflect industry best practices,” said John P. Hoyt, executive vice president, HIMSS Analytics. “The revalidation process will ensure that Stage 7 organizations continue to reflect the optimal use and sharing of patient data toward improved healthcare quality and safety.” HIMSS Analytics plans to implement the EMRAM revalidation process globally, Hoyt added.
In most cases, the revalidation process will include a pared down site visit to verify that new requirements put in place post validation are being met. “For the majority of organizations a one-person site visit should suffice,” Hoyt said. “The exception may be if the organization has implemented a new core clinical vendor or changed ownership since its last validation. In those instances a full three-person site visit will be required.”
More than 30 organizations representing over 2,400 clinic locations and 219 hospitals have earned Stage 7 status since 2009. In the United States, 3.6 percent of hospitals and 6.2 percent of ambulatory facilities had achieved Stage 7 as of the fourth quarter of 2014.
Stage 7 organizations are virtually paperless. Clinical information can be readily shared electronically with hospitals, ambulatory facilities, medical offices and other entities within health information exchange networks, as well as with patients and consumers. Stage 7 organizations also use advanced data analytics techniques to help improve quality, safety and efficiency.
HIMSS Analytics developed the EMR Adoption Model in 2005 as a methodology for evaluating the progress and impact of EMR systems for hospitals in the HIMSS Analytics® Database. Eight stages (0-7) measure a hospital’s implementation and utilization of information technology applications. The Ambulatory EMR Adoption Model was introduced in 2012 to address the specific needs of ambulatory facilities. It follows a similar eight stage (0-7) model.
HIMSS released the results of the 26th Annual HIMSS Leadership Survey of more than 300 participants, examining key trending issues impacting the business of healthcare including patient considerations, security concerns, insurance models and policy mandates. This survey revealed that 72 percent of respondents report that consumer and patient considerations, such as patient engagement, satisfaction and quality of care will have a major impact on their organization’s strategic efforts over the next two years.
The strategic value of information technology (IT) continues to be top of mind with healthcare leaders as 81 percent of respondents indicated IT is considered a highly strategic tool at their organizations and 76 percent noted that their IT plan fully supports their overall business plan. Participants also answered questions related to how IT was being used to facilitate the goals of the Triple Aim – a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. While more than two-thirds of respondents (68 percent) indicated an improvement within the patient health experience, more than half also felt that IT was reducing the cost of healthcare (53 percent) and improving population health (51 percent).
“This year’s survey showed that more than one-third of participants report that their organization was able to demonstrate improvement in all three areas covered in the Triple Aim as a result of their IT use,” said John H. Daniels, vice president, strategic relations for HIMSS. “These numbers are critical as they prove the continued progress healthcare is making as IT integrates with value-based care strategies and the growing influence of the patient in health encounters. It will be important for providers to capitalize on this momentum to ensure improved patient satisfaction as the sector begins the transition from Stage 2 to Stage 3 of meaningful use.”
The Leadership Survey also indicated that IT is supported from the top down– 79 percent of respondents indicated their organization’s executive team is highly supportive of IT and 72 percent of respondents indicated their organization’s board of directors was also on board with IT growth within their organizations.
According to Patient-Centered Primary Care Collaborative, the patient-centered medical home (PCMH) is a “model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety.” PCMHs power business and clinical processes by using clinical decision support tools to connect patients with members of their healthcare team to improve both the patients’ and the providers’ experience of care. This coordination encourages a stronger physician-patient relationship, leading to better care delivery, more involved and engaged patients and reduced avoidable costs. According to the National Committee for Quality Assurance (NCQA), these models are “transforming primary care practices into what patients want, focusing on patients themselves and all of their healthcare needs. They also are foundations for a healthcare system that gives more value by achieving the ‘triple aim’ of better quality, experience and cost.”
The NCQA recognizes over 10 percent of U.S. primary care practices as patient-centered medical homes. In order to be recognized by the NCQA, these primary care practices must offer access both afterhours and online, allowing patients to receive care when and where they need it. They work with patients to make treatment decisions based on individual preferences and help patients engage in their own health. The practice as a whole works as a team to coordinate care from other providers and community resources to maximize efficiency. Additionally, PCMHs focus on preventive care and the management of chronic conditions to prevent complications and emergencies.