By Scott E. Rupp, publisher, Electronic Health Reporter.
Prior authorizations are hurting practices, the American Medical Association contends. According to the organization, prior authorization requirements have increased in the past five years, and 85 percent of physicians say the practice interferes with continuity of care. This is according to a new survey from the organization.
Prior authorization (PA) is a process requiring healthcare providers (physicians, pharmacists, medical groups and hospitals) to obtain advance approval from health plans before a prescription medication or medical service is delivered to the patient. While health plans and benefit managers say that PA programs are important to controlling costs, providers often find these programs to be burdensome and barriers to the delivery of necessary patient care.
The AMA’s report was conducted in partnership with the American Hospital Association, America’s Health Insurance Plans, American Pharmacists Association, Blue Cross Blue Shield Association and Medical Group Management Association, releasing the “Consensus Statement on Improving the Prior Authorization Process.” The statement “reflects agreement between healthcare providers and health plans on key reforms needed to reduce PA hassles and enhance patient-centered care.”
According to the 1,000 physicians interviewed, more than two-thirds of these fine folks said it’s difficult for them to determine whether a prescription or service needs prior authorization.
Alternatively, fewer than 10 percent of the physicians said they contract with a health plan that allows programs that can exempt providers from the requirement. Additionally, prior authorizations are primarily obtained by phone or fax, with just a bit more than 20 percent of physicians saying they are able to complete the requests through their electronic health records — which can be most efficient when that capability is allowed.
In a statement released with the survey findings, AMA charged insurance companies with a “year of foot-dragging and opposition” to prior authorization reforms.
According to the study, the AMA is encouraging the use of programs that selectively implement PA requirements based on stratification of healthcare providers’ performance and adherence to evidence-based medicine, but the results from the study show that only 8 percent of physicians report contracting with health plans that offer programs that exempt providers from PA. Likewise, the AMA wants an overall revision of PA requirements, including the list of services subject to PA, based on data analytics and up-to-date clinical criteria. A majority (88 percent) of physicians report that the number of PAs required for prescription medications and medical services has actually increased over the last five years.
From the payer’s point of view, prior authorizations serve as a cost control that limits unnecessary care, and the practice has supporters in high places. For example, a Government Accountability Office report released in 2017 found that prior authorization in Medicare saved as much as $1.9 billion through March 2017. The Trump administration’s proposed budget also includes expanded prior authorization measures for Medicare. The fight over them doesn’t appear head for anything but an ugly stalemate.
Life Image and swyMed announce a new strategic partnership to enhance telestroke capabilities. This engagement will improve the ability for physicians to collaborate and coordinate care while using swyMed’s offering by seamlessly integrating relevant clinical and imaging data into the telemedicine encounter. The agreement also deepens swyMed’s ability to connect to neurologists and primary stroke centers, which are already part of the Life Image network. Life Image is currently supporting more than 140 stroke centers within its U.S. network.
This new partnership will advance swyMed’s telestroke solution by combining the exceptional bandwidth management capabilities in its videoconferencing platforms, which are highly beneficial for rural area hospitals, with access to all relevant medical records, diagnostic imaging, and other critical clinical data.
This data is made available through the Life Image clinical image exchange, which is integrated into the workflows of 80 percent of all large health systems and academic medical centers in the U.S. The engagement will also provide Life Image hospital customers with a value-added telestroke solution as part of the Life Image Interoperability Suite, to extend neurology departments’ reach beyond the walls of the organization and deliver timely, high-quality care for patients affected by stroke.
Evie Jennes
“Despite widespread knowledge that every moment counts when it comes to treating acute ischemic stroke, a majority of stroke patients do not receive adequate treatment in time due to lack of access to primary stroke centers and appropriate specialists,” said Evie Jennes, CCO, swyMed. “We have dedicated extensive efforts to innovating solutions to overcome these challenges and optimize outcomes among stoke patients. By engaging with Life Image, we can now provide immediate access to imaging and clinical data to speed up diagnosis and treatment, as well as connect swyMed users to premier neurology centers and leading research facilities through Life Image’s extensive provider network.”
There are several access-related challenges associated with acute stroke treatment, which are further compounded by the fact that diagnosis and treatment are incredibly time-sensitive and require a specialist. Unfortunately, research shows a severe lack of stroke specialists in the U.S.: only 55 percent of Americans reside within 60 miles of a primary stroke center, and there are only an estimated 1,100 neurologists specializing in stroke nationwide.
This new strategic partnership between swyMed and Life Image will address these data access and specialist shortage issues by offering immediate connectivity, even in the most bandwidth-challenged areas, to stroke specialists across the U.S., and integrating all relevant medical data into the telemedicine encounter to allow diagnosis and treatment to begin before the patient arrives at the hospital.
atthew A. Michela
“Providers have long struggled with interoperability and data-integration issues across systems and locations, and these issues come to a head when caring for a stroke patient. Paramedics and emergency room doctors especially need to immediately reach stroke specialists and provide them with the patient’s neurological exam and other imaging and clinical data in order to achieve the best-possible outcome for the patient,” said Matthew A. Michela, president and CEO, Life Image.
“We see this partnership with swyMed as an important opportunity to advance the clinical practice of telestroke. Whether it’s a rural hospital with poor bandwidth or a hospital without stroke specialists, this new engagement will benefit all providers dealing with stroke management by uniting swyMed’s cutting-edge telemedicine platform with our powerful global network of data and integration into thousands of provider workflows nationwide.”
Life Image’s interoperable solution, which integrates into existing workflows, orchestrates the flow of more than 10 million clinical encounters per month. The network connects 1,500 U.S. facilities, 8,000 affiliated sites, 150,000 U.S. providers and 58,000 global clinics with a broader ecosystem of patients, life sciences, medical device companies and telemedicine companies.
DirectTrust announces that the U.S. Department of Veterans Affairs (VA) Direct Messaging has joined the association’s Accredited Trust Anchor Bundle, allowing VA personnel access to the full national network of 1.8 million Direct endpoints. DirectTrust is a health care industry alliance created by and for participants in the Direct exchange network used for secure, interoperable messaging of protected health information (PHI) between provider organizations, and between provider and patients, for the purpose of improved coordination of care.
Participating in DirectTrust’s trust anchor bundle means VA providers and staff will be able to seamlessly engage in interoperable Direct Messaging and exchange of patient information with thousands of their counterparts in community hospitals and clinics in all 50 states and US territories, through the use of the providers’ electronic health records (EHRs). Use of the DirectTrust trust framework enables a single trusted “on ramp” for providers exchanging health information across a network that currently connects over 1.8 million providers using over 350 certified EHRs nationally.
Scott Stuewe
“Admission to the DirectTrust Accredited Trust Anchor Bundle certifies that an organization has established and upheld a superior level of trust for its stakeholders, which is a significant distinction. Kudos to VA’s commitment to maintaining the highest standards in privacy, security, and trust in identity,” said DirectTrust president and CEO Scott Stuewe.
Margaret Donahue, M.D., Director of VA’s Veterans Health Information Exchange (VHIE) Program said, “VA Direct Messaging’s participation in the DirectTrust Accredited Trust Anchor Bundle will open significant new opportunities for VA personnel to securely share Veterans’ health information through Direct Messaging in every community in the country. This is a major step to increase care coordination with community (non-VA) providers who also provide care for our Veterans.”
DirectTrust Accredited Trust Anchor Bundle has as participants Health Information Service Providers (HISPs), Certificate Authorities (CAs), and Registration Authorities (RAs) that have achieved accreditation either through the DirectTrust HISP Accreditation Program for HISPs or the DirectTrust-EHNAC Trusted Agent Accreditation Program for CA/RAs (DTAAP-CA/RA).
The key value proposition of the DirectTrust Accredited Trust Anchor Bundle is to facilitate interoperable Direct Messaging between HISPs in a uniform and scalable manner that is consistent with industry best practices for security and trust, thereby avoiding the need for further one-off negotiations between relying parties who are participants in the bundle.
Mad*Pow’s Center for Health Experience Design and Health 2.0 Advocates announce a design challenge, funded by the Robert Wood Johnson Foundation, for the health and design communities to envision solutions that would reshape everyday life to be healthier by default. The focus of this Design Challenge is to imagine how, in the near future, technology might be used to make health a part of our daily routines.
Amy Heymans
“Our systems have made it hard to be healthy, and our healthcare system can’t keep up. The United States spends far more on healthcare than any country in the world but achieves disappointing results in comparison,” said Amy Heymans (Cueva), Mad*Pow founder and chief experience officer. “How might we design the systems we use every day so they support us in being as happy and healthy as possible, instead of worn down, stressed out, and sick? This Design Challenge seeks the most creative minds to imagine solutions that improve health, not just by focusing on healthcare and medicine, but also by taking a new look at the fundamentals of our daily lives.”
Design Challenge entries should include ideas that are feasible in five to ten years, change the environment to a healthier default, and incorporate multiple technologies or components. A Q&A webinar is scheduled for May 29, 2019, at Noon ET.
Interested participants should register by May 27, 2019, to receive more information about challenge requirements, criteria, rules, and deadlines. Final submissions will be due on August 31, 2019 by 11:59 PM ET. A panel of judges, including Vanessa Mason from Institute for the Future, Judith Anderson from Mass College of Art & Design, Stacey Chang from Dell Medical School, Allison Arieff from SPUR and the New York Times, Jeff Rison from the Gehl Institute, and Amy Heymans from Mad*Pow, will choose two winning solutions: one design that targets specific healthy behaviors and one design that envisions broad, systemic change. These two winning entries will be announced on Oct. 16, 2019, and will share up to $10,000 in prizes.
“Many of the tech industry’s early attempts to encourage healthy lifestyles rely on prompting people to make healthy decisions in the moment, while doing nothing to address the underlying infrastructure, norms, and culture that guide our behavior,” said Stephen Downs, chief technology and strategy officer, Robert Wood Johnson Foundation. “This Design Challenge will encourage creative thinkers to envision how technology could shape our everyday routines in ways that make healthy lifestyles the default.”
With more than 4 million nurses, the largest segment of the U.S. healthcare sector, nurses have indisputably demonstrated an ability to improve healthcare outcomes. We are just beginning to utilize Healthcare IT data and AI to improve patient outcomes. One of the key benefits of AI will be the ability to leverage the data from nursing care plans and nursing diagnoses to perform work load balancing for nursing staff. This is a key solution to future management of the problem of the shortage of nurses.
Another problem that needs attention is the possible disconnects which can result from nurse to nurse hand offs with the use of virtual nurses who remotely monitor patients. They enter data into their own EHR system – not the same one in use by the hospital where the patient is located. We will discuss here the nature of the data, technologies and frameworks, the nursing information model and the structure of the data elements needed to provide care needed to implement solutions for staffing, interoperability and workflow improvements.
The National Academy of Medicine’s committee background report on the Future of Nursing 2020-2030, Activating Nursing to Address Unmet Needs in the 21st Century, found the worsening health profile in the United States requires “more than a traditional medical response.” As professionals in the care team, nursing documentation requires a standardized framework to achieve consistent data quality in healthcare communications about the work of nurses. This standardized framework recognized for professional nursing documentation is the American Nurses Association (ANA) Nursing Process. This ANA framework is essential to nurses for managing and improving healthcare outcomes, safety and reimbursement as proposed by the Institute for Healthcare Improvement (IHI).
In most electronic health information record systems, the standard nursing data implemented (sometimes called the system terminology, data dictionary, or nomenclature) is proprietary with a pre-existing data structure/framework. The proprietary framework acts as a barrier to nursing documentation by constraining the available concepts for nursing documentation and the nursing care plan fields.
Without interoperable electronic data concepts available for documentation, nursing care notes become unstructured free-text and are not included in coded health information exchanges. Due to the highly structured design of EHR systems, nursing practice is determined by the system’s terminology and ontology framework configuration. If nurses do not select the ANA framework; nursing care data takes on the sedentary shape of the local proprietary data structures, rather than nesting in a flexible, portable and universal tool to enable nurses and other episodic care providers to improve future nursing interventions, practice and care outcomes.
The American Nurses Association (ANA) describes the common nursing framework of the documentation of professional nursing practice as the Nursing Process. The Nursing Process is the foundation for the documentation of nursing care. Yet, in the EHR, nursing documentation is reused during the patient’s stay, over and over, with the documentation being done from the nursing assessment as if the documentation was a template. The Nursing Process is the framework and essential core of practice for the registered nurse to deliver holistic, patient-focused care.”
Producing effective EHR systems for nursing requires a deep understanding of how nurses create and conduct cognitive documentation as well as task-oriented documentation. Most EHR systems dictate rather than adapt to nursing workflows and nursing information is not organized to fit the ANA model of care. The EHRs often assume a nursing care delivery model that is represented as algorithmic sequences of choices, yet nursing care is iterative with reformation of patient goals, revising interventions and actions and updating care sequences with individual patients based on encountered condition changes and constraints. In the dictated workflow of EHRs, nursing data is collected as care assessments with nursing diagnoses, interventions and actions in formats used to create single patient encounters.
To help professionals in skilled nursing facilities (SNF) prepare for the largest payment reimbursement change for their industry in 20 years, the American Health Information Management Association (AHIMA) collaborated with the American Health Care Association (AHCA) to provide in-depth coding and clinical documentation improvement (CDI) training programs.
Beginning Oct. 1, 2019, the Centers for Medicare and Medicaid Services (CMS) will change the reimbursement model for SNFs to a new, value-based Patient Driven Payment Model (PDPM) that will require CDI skillsets and knowledge of ICD-10-CM diagnosis codes in order to accurately support the qualifying stay and demonstrate the need for care and treatment best suited for each patient.
AHCA enlisted AHIMA to help develop in-depth coding and CDI education courses to help prepare SNF providers for the major payment overhaul. The courses include two options: the first provides webinars for coding in ICD-10-CM and requirements in CDI case studies and concludes with a 50-question assessment. The second option is a shorter course for non-coders that includes a webinar with a high-level review and basic information on ICD-10-CM coding guidelines to provide an introduction to the PDPM reimbursement model. Both courses offer AHIMA CEUs and CNE contact hours. In addition, the non-coder course offers NAB continuing education credits.
Wylecia Wiggs Harris
“To stay up-to-date with the ever-changing healthcare industry, it is critical that professionals have the resources they need to continue to provide exceptional care,” said AHIMA CEO Wylecia Wiggs Harris, PhD, CAE. “This is why we’re happy to work with AHCA on this important training program, which will equip professionals working in skilled nursing facilities with the knowledge and understanding of ICD-10 needed to thrive under the new payment system, and ultimately improve patient outcomes.”
“ICD-10 is a driving force behind the new PDPM payment system for skilled nursing care,” said Jennifer Shimer, AHCA/NCAL COO and senior vice president, member services. “AHCA partnered with AHIMA to develop the best ICD-10 curriculum possible to prepare our members for this massive Medicare payment change.”
CDI is at the core of every patient encounter and through this collaboration, AHIMA and AHCA will help SNFs understand ICD-10-CM guidelines for coding and reporting and how to apply the guidelines to coding for the PDPM Medicare reimbursement. The courses will also help SNFs assess coding and diagnostic perspectives when identifying high quality clinical documentation and classify SNFs into appropriate clinical categories as defined by the PDPM.
Just like a book, a website is a mode of communication through which the owner tries to communicate to the larger audience. So, it is imperative that the site should be as catchy and as informative as possible. This website should do all the talking for you. The same goes for the medical website. Sites related to the medical field needs to be more should be out of the box. It does not need to be catchy with fancy themes and designs. It can be plain and simple yet be different.
We need to remember that it is the home page that is the most critical section of a website. Similarly, you have got only 20 to 30 seconds to impress your client or prospective client. If the so-called first impression is lost, then half the battle is lost and so is the purpose of having a website.
When it comes to websites related to medical and healthcare it is noticed that more often than not them chose and the information provided are the same. There are many themes attractive and different ideas presented in WordPress.
Let us have a look at some of the different WordPress themes that are there to be chosen from. WordPress themes are the cheapest way to make a website.
The healthcare system seems to become better every day. The growth and development of digital platforms have provided a unique dimension for this particular industry to grow tremendously and provide an excellent service to the seekers. In this context, Apple, the most reputed smart phone and electronics manufacturer in the world, has launched a brilliant personal health record (PHR) platform in beta-version. This new version of PHR is released as part of iOS version 11.3.
This Apple health news is the beginning of a new era where the patients can easily share their personal health information with the entitled service providers. This step can be initiated by hospitals and other healthcare related firms so as to provide the best and safest treatment solutions. An iOS App Development Company will not become sufficient to provide such elegant applications that will maintain the industry standards and meet with the specifications of the contemporary healthcare system.
Apple’s new venture
For the very first time, the world’s largest manufacturer of smart phones, Apple has launched the beta version of a personal health record application. Currently, it has incorporated this application in iOS version 11.3. It has developed this unique platform based on the specifications provided by Fast Healthcare Interoperability Resources (FHIR) constructed by HL7, a non-profit standard developing organization. It is considered to be the new face of health records app. This application is being developed and advanced in collaboration with 12 hospitals such as Cedars Sinai, Penn Medicine, Geisinger Health System, and John Hopkins.
Jeff Williams, the COO of Apple, said that the prime motto of this particular application is to aid the consumers spread across the world to lead a better and safer life. The healthcare organizations have provided immense insights and professional aid to make this Apple health records epic better and more efficient. The biggest challenge is to keep these records safe in the cloud system so that any service provider related to this process can access them without any hassle. This PHR can be easily carried on the phone and can be shown to the entitled professionals for better and faster treatment response. The news and rumors of Apple to launch Health Records system have now surfaced and the consumers are hoping for a better day in the future.
Features of Apple health records app
This app will be the first of its kind that will maintain the FHIR standard of specifications fabricated by HL7. This particular smart phone application will carry personal information such as medications, allergies, present condition, ailments, immunization records, etc. In fact, the interoperability feature of this application will also allow the medical professionals to access the information and also to check electronic health records for lab results and other information. The Apple health records app is currently released as a beta version to find out the reaction of the users and its compatibility. All the information enlisted in this app will remain encrypted to keep it safe.
Apple announces Health Records platform and is currently developing a better platform for all the consumers that can be accessed by the entitled professionals as well. As per the plan, this information can be availed by the following professionals or organizations:
Prior authorizations are hurting practices, the American Medical Association contends. According to the organization, prior authorization requirements have increased in the past five years, and 85 percent of physicians say the practice interferes with continuity of care. This is according to a new survey from the organization.
Just like a book, a website is a mode of communication through which the owner tries to communicate to the larger audience. So, it is imperative that the site should be as catchy and as informative as possible. 