Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.
Abhinav Shashank
According to a survey almost 50 percent of the physicians do not understand MACRA. With less than five months to full implementation of MACRA, are we ready to embrace one of the most elaborate laws of US? And, most importantly, will it produce the needed positive outcomes? The program is expected to improve the current standards, sort the most persistent problems and create opportunities to rework and revise Medicare. How will all this happen?
With MACRA in place, there won’t be two digit payment cuts like in the current Sustainable Growth Rate (SGR) formula. Besides enhancing the use of electronic health records, MACRA is expected to increase the relevance of Medicare to the real world and reduce the administrative burden from physicians’ shoulders.
Decoding MIPS
MIPS stands for Merit-Based Incentive Payment System. It will streamline the three independent programs Physician Quality Reporting System (PQRS), meaningful use, and value-based modifier to ease the burden on the clinicians. The three components in MIPS will replace these programs. Besides this, one more component will be there to bring improvements in practice. Namely following components will be there in MIPS:
1.) Quality: This component will replace the Physician Quality Reporting System (PQRS). Under MIPS the methods of reporting and the various quality measures have been adopted from the old programs PQRS and VBM. There are some changes in the reporting methods and for the registry, EHR, and Qualified Clinical Data Registry (QCDR) reporting methods, a clinician can select minimum six measures which could be a combination of any quality domain. If the clinician faces patients, then he has to select in such a way that one of these measures is cross-cutting measure (cross-domain-cutting), and one is outcome-based measure. If there is no outcome-based measure, then a high priority measure has to be selected.
Besides these six measures, CMS will calculate two or three more measures depending on the size of the group of physicians. For instance, if there is an individual physician or a group less than 10 then two measures and if more than that then three measures. Additionally, for QCDR and registry reporting methods, the “data completeness” standard has been changed. The number of patients to be reported within a measure denominator has been raised from 50 percent to 90 percent.
2.) Advancing Care Information: According to MIPS the meaningful use program will see a lot of changes. Currently, the meaningful use program is everything-or-nothing; i.e., if one clinician achieves a performance rate of 20 percent on meaningful use measures and another achieves 90 percent then they both get rewards in a similar fashion. However, under ACI the latter one gets 10 out of 10 points, and the former gets three points.
More than 100 ACI performance points have been defined out of which base 50 are base points given for reporting either “yes” or a non-zero numerator. The performance scores are up to 80 points based on the performance on eight measures. Rest bonus points are awarded for reporting any other public health registry.
Guest post by Craig Musgrave, senior vice president, information technology, The Doctors Company.
Craig Musgrave
Healthcare entities remain the top target for cyber criminals. Not only do over 50 percent of all cyberattacks occur in the healthcare industry, but there have been 4,000 daily ransomware attacks—focused mostly on healthcare entities—since early 2016, a 300 percent increase over the 1,000 daily attacks in 2015.[i]
All types of organizations must take steps to ensure they are protected. The following are six questions you should ask your IT department to evaluate your cybersecurity readiness, and some answers to these perplexing problems most industries face today.
Does our organization use a security framework?
The National Institute of Standards and Technology Cybersecurity Framework is voluntary guidance, based on existing standards, guidelines, and practices, for critical infrastructure organizations to better manage and reduce cybersecurity risk.
The Framework will help an organization to better understand, manage, and reduce its cybersecurity risks. It will assist in determining which activities are most important to ensure critical operations and service delivery. In turn, that will help to prioritize investments and maximize the impact of each dollar spent on cybersecurity.
What are the top risks I should worry about?
Human interaction: Over 80 percent of attacks are made possible by human error or human involvement, such as downloading malicious files, clicking on malicious links, or running unknown USB on computer systems. You need to provide security training for all employees and maintain constant employee awareness of the risks. There should also be a significant investment in security solutions that can help prevent damage if an employee action leads to an attack.
Technology vulnerabilities: Vulnerabilities in your defenses may be known—or newly discovered when an attack happens. Invest in tools that scan for hardware and software vulnerabilities and invest in IT staff to constantly update and patch software.
External intruders: Addressing non-stop attempts to access your network through unsecured or vulnerable access points involves investing in technologies and strategies like multi-factor authentication, advanced firewalls, web application firewalls, external monitoring, and penetration tests.
Data loss: Protected health information (PHI) could be lost through an unapproved employee data transfer. Invest in tools that encrypt data-in-transit and educate employees on proper data transfer procedures.
Delayed detection: This is the inability to detect an intrusion due to an unknown vulnerability, misconfigured technology, or employee error. Invest in constant IT training on event management, security threat detection, incident response, and technology configuration. Execute threat simulations (penetration tests) and do a continual review of system configurations.
Attacks through privileged accounts: Hackers try to gain access to privileged accounts—such as domain admin, database admin, or external vendors—to reach secure areas within computer networks. For example, the major Target hack occurred when an employee of Target’s third-party HVAC vendor responded to a spear phishing e-mail. The utilization of Privileged Account Management systems enables one-use passwords for evaluated accounts.
Guest post Ken Perez, vice president of healthcare policy, Omnicell.
Ken Perez
A recent poll conducted by Monmouth University concluded that “fully 70 percent of American voters say that this year’s presidential campaign has brought out the worst in people.”
Undoubtedly and sadly, in this era in which fact-checking of candidate statements is essential, a majority of Americans believe that all politicians lie or at least that they lie often.
That prevailing sentiment is what made former President Bill Clinton’s candid riff about the Affordable Care Act at an Oct. 3 Democratic rally in Flint, Mich. so extraordinary. He stated, “…the current system works fine if you’re eligible for Medicaid, if you’re a lower-income working person, if you’re already on Medicare, or if you get enough subsidies on a modest income that you can afford your healthcare. But the people who are getting killed in this deal are small business people and who make just a little bit too much to get any of these subsidies. Why? Because they’re not organized. They don’t have any bargaining power with insurance companies. And they’re getting whacked. So you’ve got this crazy system where all of a sudden 25 million more people have healthcare, and then the people out there bustin’ it sometimes 60 hours a week end up with their premiums doubled and their coverage cut in half. It’s the craziest thing in the world.”
Unlike the ACA’s expansion of Medicaid, which has been blocked by 19 states that have declined to go along with the law, the health insurance exchanges have been operational for a number of years in all fifty states and the District of Columbia.
So how are the health insurance exchanges of this “crazy system” really doing and, to Clinton’s point, what’s happening to people who don’t qualify for subsidies?
Clinton was generous in saying that the “system works fine” for those who get subsidies. State regulators have used terms such as “near collapse,” “emergency situation,” “meltdown,” and “financial death spiral” to describe the condition of their exchanges. In total, the health insurance exchanges are way over budget, serve fewer people, and show signs of being unsustainable, which pushes health plans to cost shift by raising premiums for non-exchange insurance policies, especially employer-sponsored health insurance. The population paying for those policies include the people Clinton described as “bustin’ it sometimes 60 hours a week.”
Originally, the federal government was supposed to spend $136 billion from 2015-2019 on health insurance exchange subsidies. However, as more states than expected opted to have the federal government run their exchanges and because of the higher-risk pool of individuals participating in the exchanges—which led to premium hikes—the Congressional Budget Office (CBO) in August projected $278 billion in federal outlays for health insurance exchange subsidies for that period, leading to an overspending or budget deficit just for the subsidies of $142 billion for 2015-2019, a staggering amount, considering that it would basically cancel out the projected 10-year budget surplus for the entire health reform law. With even greater average premium hikes expected for 2017—24 percent for the non-group market—the CBO’s projection is clearly conservative and will certainly be revised upward.
Many states are reporting individual market rate hikes in 2017 well above the aforementioned national average. Minnesota’s approved increases range from 50 to 67 percent. Blue Cross Blue Shield of Tennessee will raise its rates by 62 percent. Golden Rule Insurance Co. in Kentucky received approval for a 47.2 percent rate increase, while Wellmark in Iowa will raise its rates by 42.6 percent. In Delaware, Highmark Blue Cross Blue Shield received approval for a 32.5 percent average rate increase, and Utah’s individual exchange health plans will rise on average 30 percent.
Did you hear the one about the disbarred lawyer who embezzled more than $1.2 million from a hospital in Kansas City over four and one-half years? This is not the start of a joke; it is unfortunately all too true. The long-trusted attorney supposedly served the hospital by collecting past-due payments from patients. Money collected was to go into a trust account. However, his fingers were more than a little sticky when checks were mailed back from patients and found their way into his personal account.
Slow-/no-pay patients have become a much more important aspect of hospital financial management as high deductible health plans (HDHP) become the norm across America. What once was considered little more than an annoying write-off, keeping bad debt to an absolute minimum is very much a priority. Gone are the days when more than 90 percent of revenue came from the insurance companies. Hospitals must look to patients for 50 percent, or more, of that revenue now. My bet is the number of checks embezzled by the attorney has only recently become material, which is why it took so long to catch him.
We can criticize the hospital for not staying on top of its account receivables. Certainly, payment plans, offered at the time of service can help keep A/Rs down as can reminders emailed to the slow-poke-paying patients. But that’s misses the larger point.
Unfortunately, any time checks are directed to third-party services, the potential for maleficence exists. Any point in a process where the payment can be touched, there is an opportunity for a redirection of those funds as in the case of the hospital in the city of fountains.
A significant portion of this could have been avoided if the hospital used an online paperless solution to bill their patients. It cuts off those sticky fingers, figuratively speaking. A paperless method keeps out crooked collectors because there is no reason or way for them to get their hands on the funds since they are not deposited directly into the hospital’s bank account and reconciled nightly. There’s nothing to touch or divert.
I am of the opinion that this crime in Kansas City is not all that unusual or isolated. Perhaps a perpetrator is uncovered and reparations are made under the cover of a sealed agreement, but it happens entirely too often.
In the past year I’ve seen reports of CEOs, CFOs and directors shown the door for embezzling millions from healthcare facilities in Alabama, Idaho and Wyoming, among others. The Alabama case involved a whopping $14 million.
Cash flow has become a top priority for all segments of healthcare, but especially hospitals. As I already suggested, the presence of HDHPs has made it so. But the manner in which these institutions bill for services rendered and go about seeking payment, is opening them to the same fate as these other organizations who were robbed and so the time to change is now.
Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.
Abhinav Shashank
The digitization of healthcare was a much-needed change brought after years of hard work and effort. One might wonder how could one justify the expenditure of $10 billion in a span of five years just on digitization. The problem intensifies when after several studies we find out that EHRs only reciprocate around 30 to 35 cents on a dollar and sometimes the figure dips to 15 cents.
Why have we digitized healthcare when the efforts required to get the desired result is still too much? I think we haven’t used the available technological aids appropriately. It is like driving a car at midnight and not knowing that you have headlights. You can have a clear view of your path, you can get to your destination fairly fast but can’t because you don’t know what is going to help you and in what way, your performance is reduced to a great extent to be able to achieve what you desire
Justified use of EHR could create the needed ecosystem
According to a report, 10 percent to 20 percent of savings are possible if a value-focused healthcare organizations capitalize on EHRs and interact with their patients better through technology. The amount that could be saved annually per bed is in between $10,000 and $20,000.
Meaningful Use
There are incentives for meaningful use of EHRs, but the truth is that the return through meaningful use incentives is somewhere around 15 or 20 cents on a dollars. There have been implementation, stabilization and optimization problems that have made it hard for healthcare organizations to extract the best out of EHRs. Practices will have to start using data as a source of innovation and come up with solutions that’ll not provide them better incentives but assist them in providing even better patient-centric care.
There are certain key points one can work on to make their healthcare ecosystem more efficient and patient-centric. Only judicious data usage from data disparate sources can help in so many ways, imagine what else is possible with advanced solutions. The integration of EHR with different disparate sources could be really beneficial in understanding the factors that drive value-based care. For instance, with the help of various data one can perform:
Population Health Management: With the help of data collected from different sources, impact at a population could be created and analyzed. Once you have the data of millions of patients, imagine all the things that are possible. Identification of at-risk patients, stratification of patients on the basis of various disease registries, better decision making, and a lot more. According to a study, due to disease management programs the cost of care were reduced by $136 per member per month because of reduction in admission rates by 29 percent.
Variations in Care Delivery: Efficient analytics and data management can help answer many questions. The medication process could be streamlined on the basis of past cases, and identified opportunities could be capitalized. Also, a thorough data-driven analytics could provide substantial insights on the performance of various facilities and how they differ when it comes to care delivery process.
Guest post by Todd Greenwood, PhD, MPH, director of digital strategy, and Benjamin Dean, digital and business strategist, Medullan.
Todd Greenwood, PhD, MPH
Once upon a time, all that pharmaceutical companies had to do to get their drugs on formulary was to package their clinical data and convince payers that their products performed better (or better enough) in clinical trials. Contracts were struck and the revenues flowed. For most new specialty drugs, those days are now history.
With the average retail price of a specialty drug used on a chronic basis exceeding $53,000 (according to an AARP study), nearly 200 times the average price of generics, payers are demanding that pharmaceutical companies make data-driven, value-based cases before access is granted. Even when payers are convinced , they build stipulations into value-based contracts that require manufacturers to prove that outcomes are being met with their covered lives, or else the pharmaceutical company will face additional penalties or further restrictions.
This all means that the data that manufacturers have used to drive regulatory approval are insufficient for garnering payer formulary access. Companies are being required to prove that their drugs work in the real world – not just within the carefully controlled environment of a clinical study. Across therapeutic areas from osteoporosis to oncology, payers have and are currently using real world evidence studies to define their formularies. Payers want to know how expensive specialty drugs will perform as patients adhere to (or in most cases don’t adhere to) their medications, and outside of the rarified air of a traditional clinical trial.
Benjamin Dean
Equally importantly, payers want to know how drugs affect the most important (and most expensive) health outcomes. Clinical data showing that a drug performed some percentage better than either a category leader or a placebo is now insufficient for new specialty drugs. Instead, payers need to know how health outcomes improved and how effective the drugs were at keeping patients out of the hospital and away from the catastrophic costs.
While it may sound easy, providing this kind of data is far from simple. Clinical trial data is controlled, clean and contained. Surveillance data (AKA real-world data) is a different beast, because patients are complicated. We have multiple conditions, take multiple medications, and we are inconsistent, rarely complying with our doctors’ orders. Moreover, the outcomes that payers care about – hospitalization, disability and death – can be difficult to distill. The data needs to be compiled from a variety of sources: medical and prescription drug claims, electronic health records, the lab (genomic and pathology data) and directly from the patient. Compounded with this, different populations of patients have different risks, and comparing one to another is fraught with difficulty. Finally, real world data can take time to accumulate. In order to know if a drug is working “in the wild”, researchers need to follow enough patients, for long enough, to observe negative health events of interest.
Take, for example, the new class of hyperlipidemia drugs, PCSK9-inhibitors. These injection drugs have been shown to cut LDL cholesterol levels in half, compared with about a 20 percent reduction for statin-class drugs like Zetia. But given the high price of these drugs ($14,000 per year in the US) plus their potential to be prescribed to a significant percentage of the population, payers have largely refused an access foothold. Payer organizations in the US and around the world are asking the same question: how well do these drugs work in real patient populations and to what end? Given that these drugs will be sanctioned for high-risk patients (many of whom will continue to use statin class drugs as combination therapy), payers are concerned about adherence, and ultimately if there is lower cardiac risk and fewer related cardiac events in patient populations. Many economists are asking: can’t we achieve the same ends for far less money by getting patients to adhere more faithfully to their statins?
The need is clear: pharma companies who have invested significantly to develop and launch new specialty drugs have to prove their worth with real world data. But in markets like the US, where providers are typically siloed and disconnected, it’s challenging to capture patient-level condition and drug utilization data, and effectively append it with hospitalizations, other outcomes evidence and costs in order to develop a complete picture.
But there’s hope. As the specialty drug market begins to shift to a value-based model, new ways of tracking real-world usage and connecting it to outcomes are emerging. This is where digital health is poised to play a critical role.
Whether you’re a student in school to become a medical assistant or already working in the field, we can bet that you’ve had a question or two that wasn’t easily answered by an instructor or coworker. The beauty of education and training today is that when that happens you needn’t spend hours flipping through books and manuals to find the information.
While it’s always best to have your questions answered “from the horse’s mouth,” these free medical apps can help put your mind at ease and get you an answer in a pinch.
Epocrates is the #1 medical reference app and go to mobile tool for U.S. physicians and medical providers. It’s hard to believe that it’s free with all of the features it offers. Through the app you can:
Look up OTC and name/brand drug information
Identify potential drug interactions
Access news and up to date research
Perform drug calculations
athena text messaging
athenatext messaging might be the most interesting feature of this app. You can set up a texting service within your care group to share images and communicate with people in your office about patients while still adhering to HIPAA laws.
Medscape is a similar alternative to Epocrates that has many of the same features in an easy to use design. One thing that sets it apart from Epocrates is that it is not just one app but a family of three that each serves a slightly different purpose.
Medscape
Look up OTC and name/brand drug information
Identify Interactions
Perform Drug Calculations
Medscape Medplus News App
Get up to date news related to your field of specialty
Follow medical trends and share information with your followers
Search topics and personalize what’s shown to you
Medscape CME and Education App
Earn CME/CE credit directly from the app
Train with a variety of formats including video and audio
Guest post by Tatsiana Levdikova, copywriter, Effective Soft.
Tatsiana Levdikova
Hospital managers want to be sure that hospital staff constantly improve their skills and share relevant information with their colleagues. Automated solutions cannot become a substitute for a discussion where healthcare professionals can exchange their knowledge and share their ideas, but routine tasks can be arranged in the form of a workflow portal.
Usage of such a portal has a number of advantages:
It will help employees to save their time;
It will enable hospital managers to assign different access privileges to users, thus restricting access to medical data;
The portal can automatically create and send out reports like the ones covering employee performance.
This portal can be used to create its own medical knowledge base for the hospital.
A hospital is a place where like-minded people work and spend much time together. Not to lag behind other healthcare professionals, hospital staff must keep abreast of the latest trends and developments in medicine. However, being extremely busy during their working hours, the personnel has not time to discuss medical trends and developments on the fly: according to the National Center for Health Statistics the mean wait time in U.S. emergency departments increased 25 percent, from 46.5 minutes to 58.1 minutes from 2003 through 2009.
A hospital communication portal seems to be the right choice in this case. However, it should be noted that developers of custom hospital software and such portals in particular must pay close attention to the specifics a medical organization has.
The portal will enable the personnel to share valuable medical information, such as aspects of people, companies, news and other things of interest in a convenient, efficient, and fast way. Besides, it is important to give users an ability to comment.
Users would have their own profiles enabling them to connect directly with each other. The profiles could also include basic information on departments where users work, room numbers, working hours, specializations, and more.
Capabilities of the portal could be extended further by adding elements of social networks by making it possible for users to upload videos and images, tagging other users to them, etc. A general chat or forum could also be launched. All in all, the portal could become an important part of the HRM reporting system and assist hospital managers in managing sources and personnel.
Such a portal has the potential to become much more than a communication tool. It could become an effective hospital automation tool:
