Following the release today of the finalized modified rules for the current stage of meaningful use, CHIME released the following statement, summarizing the position of many in healthcare. Overall, the organization supports the modifications, including the adopted 90-day reporting period:
We are pleased that the Centers for Medicare & Medicaid Services today finalized modifications to the current stages of the Meaningful Use program and agreed to extend the comment period on Stage 3. CHIME and its 1,700-plus members agree with CMS that it is time to focus the meaningful use program on adoption of information technology systems that improve both the quality and safety of patient care.
The 752-page rule grants flexibility for providers who are doing their best to not only meet the intent of the federal program, but also ensure the adoption of health information technology that improves patient care.
Importantly, the rule adopts a 90-day reporting period for the current stages of the program, down from 365 days. CHIME has long called for a 90-day reporting period and applauds CMS for adopting this new standard. While several members are positioned to take advantage of this shorter period, others will be challenged to meet it since there are fewer than 90 days remaining in the year. We urge CMS to implement a hardship exemption for those unable to meet this timeframe.
CHIME also applauds the agency for modifying requirements surrounding patient access to electronic records. The rule stipulates that for 2015 and 2016, one patient discharged from a hospital view, download or transmit their electronic record.
With regard to Stage 3, the extra comment period will enable providers, CMS and other stakeholders to ensure that the next stage of Meaningful Use advances interoperability and takes into account new payment models being advanced by Medicare.
Also today, the Office of the National Coordinator for Health Information Technology finalized a rule on certification of electronic health records. CHIME supports key provisions in the rule that should lead to greater transparency regarding vendor products; improved testing and surveillance of health IT, and an improved focus on user-centered design.
We are reviewing the regulations and will have more detailed comments in the coming days.
TapCloud creates a real-time stream of data that enables care teams to quickly grasp whether a patient is getting better or worse, assess the effectiveness of treatments and medications and identify the onset of emerging complications. TapCloud is currently being used in settings from single practitioner to national hospital systems.
Elevator pitch
TapCloud allows patient’s and provider’s to communicate in ways never before possible to improve the doctor/patient relationship, focus clinicians on patients that need the most attention and insure that the patients that require services receive them in a timely manner to maximize health benefits to the patient (including quality of life, not just physical issues) and minimize the expenditure of health resources.
Product/service description
TapCloud is a solution for gathering key patient information in between clinical visits. There are two parts to the TapCloud solution: a patient facing instructional and information collecting APP and a web-based clinician dashboard. Typical use is for patients to follow/consume their provider-based care plan/educational info and enter their well-being, pain levels, symptoms, side effects, medication compliance and vitals into the APP (unique design allows patients to complete this in less than 1 minute per day). This information is then presented in a comprehensive dashboard that allows clinicians to rapidly interpret key insights into a patients overall well-being. Based on this patient reported information, clinical protocols will dictate if any specific patient needs to be seen, have a home health visit or meds adjusted, etc.
Origin story
Tom Riley
Our CEO, Tom Riley, is a former health insurance executive who spent the past 25 years living at the intersection of healthcare and technology. A few years ago, after his mom was diagnosed with ovarian cancer, his experience with the healthcare system became much more personal as he became a primary caregiver for her. During that time he attended office visits with his mom on a regular basis, and discovered that there is an inherent gap in communications between the way doctors organize/accept information from patients, and the way patients organize and deliver information to their doctors and other clinical staff.
Over and over again, he found himself serving as a translator between his mom and her doctors. He would help his mom by creating easy to understand checklists of things she was supposed to be doing each day, activity, medications, etc. And he would help the doctors by keeping track of his mom’s symptoms and watching for developing complications and then making sure that the information was shared during her appointments. It frequently made a significant impact on the diagnosis of issues, and the assessment of treatment effectiveness. It also helped his mom regain a measure of “quality of life” by making sure that even non-critical complications like chronic constipation were identified and addressed.
After his mom passed away, he decided to devote his time to taking what he had learned first-hand and developing a solution to improve patient-doctor communications in acute-care settings like post-surgical recovery and chemotherapy and since has morphed into a chronic disease management solution as well. TapCloud runs on smart-phones and tablets and includes personalized services for the patient, helping them organize and customize generic discharge/care plan instructions into a personalized daily plan for them to follow. At the same time, the technology uses a sophisticated, but incredibly easy to use, interface to probe for indications of developing complications and/or medication side-effects. It allows clinicians to effectively monitor patient progress remotely and focus their attention on the right patients. It also ensures that doctors are aware of all of the issues affecting a patient, not just the life-threatening ones that have their patients end up in the ED or admitted to the hospital without them even realizing their patients were experiencing any issues.
Guest post by Ken Perez, vice president of healthcare policy, Omnicell.
Ken Perez
“I get by with a little help from my friends.”– The Beatles
In simple terms, healthcare delivery reform under the Patient Protection and Affordable Care Act (ACA) is catalyzed by the Centers for Medicare and Medicaid Services (CMS) through establishment of performance standards or goals and application of behavioral economics—financial carrots and sticks—to encourage improved quality and reduced cost. The financial incentives—both positive and negative—are usually offered to healthcare provider organizations, such as accountable care organizations, which are on the hook to meet numerous quality measures and hold costs below targeted benchmarks, or commercial health insurers running Medicare Advantage plans, which pass along some of the onus to maintain quality performance onto providers.
However, these applications of behavioral economics do not directly target or impact the central player in the healthcare system—the individual member or patient. Engagement by the patient in their care is critical and explains why billions of dollars are spent each year on patient outreach and communications, as well as development and promotion of consumer-friendly apps and wearable devices. When patients are engaged, the healthcare system can more effectively and efficiently prevent, diagnose and treat health conditions.
On Sept. 1, 2015, CMS’s Center for Medicare and Medicaid Innovation (Innovation Center) announced the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model, an initiative that will test whether allowing health plans administering MA plans to offer targeted additional benefits or reduced cost sharing to enrollees who have certain chronic conditions will result in better quality and more cost-effective care.
The model’s goals are to enhance enrollee health, decrease the use of avoidable high-cost care, and reduce costs for MA plans, beneficiaries, and ultimately, the Medicare program. The model focuses on MA enrollees with the following chronic conditions: diabetes, congestive heart failure, chronic obstructive pulmonary disease (COPD), past stroke, hypertension, coronary artery disease, and mood disorders.
The MA VBID Model will take effect Jan. 1, 2017, and run for five years in seven states which were deemed representative of the overall national MA market: Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee.
It’s here. The day has arrived. The biggest thing to happen to the administration of healthcare in decades is upon us: Today is ICD-10 conversion day.
It’s been a long and winding road. But we’re here. The trip has certainly not been easy and there have been multiple detours. But, the destination has arrived. “Momma, are we there yet?”
Yes.
Take a breath. Stretch your legs and try to find some joy in the tumultuous trip. You’ve earned it. It’s been a long ride.
But the trip is not over yet. Like all road trips, there’s the way back. And that, too, is a long road ahead. There’s still much to see and do, and much to prepare. Much to look forward to on the road ahead.
For a minute, though, on perhaps the most important day, why not take a moment to reflect on the journey and congratulate yourself on a job done well, which you’ve done with integrity and professionalism, in which you have been filled with excitement and glib, where you’ve experienced pain, pressure and perhaps even a little joy as you pushed yourself to the max.
Many of us never thought this day would come. Some of you hoped it never would.
Now, thankfully, we can move on to a new goal, a new destination.
Though ICD-10 is upon us and there is little, if anything, that can be done at this point other than wringing your hands in disbelief or praying for peace with the patience of a saint (depending on your religious worldview and personality), we wait for the storm to hit, then pass and roll on a bit for a time. And it will pass. The storm will dissipate.
For some reason, when I think of the current state of ICD-10 and its impact to healthcare I’m reminded of a hurricane. The analogy of a hurricane seems like an apt example of the phase healthcare currently is in in regard to ICD-10.
The road here has been long – there has been much fear and anticipation of the coming storm. Surges of energy, wind and waves have met us and battled at the banks of the beach. The wind and thunder has been loud, the elements seem to have shaken the very foundation of our lives and our “homes.” Pain, fear, struggle and stress have been the order of the day. But at last we’re here. The storm is upon us, in fact it is half over, and we stand in its eye, one of the most beautiful and peaceful times one can ever experience.
Peace, calm expectation and a subtle excitement of the storm’s beauty are in the eye, as is anxiety of the anticipation of what’s to come — the second half of the storm. Having personally stood in the eye of one of the largest hurricanes on US record, and having survived one of the most terrifying storms of my life, I can tell you that the eye of the storm is a brilliant, calm and peaceful place in what is actually an extremely deadly and dangerous place to be.
However, when the eye passes, the storm rages again, even more fierce than the penetrating force of the first half of the storm. Again, there’s more fear; more stress; more panic. Finally, the storm passes, slowly and subtly. The wind disappears, the sun breaks free and among the chaos, birds sing with striking clarify and beauty. It’s as if their songs are the only remaining sound because the storm has sucked all else away. Their song is an encouragement as you assess your losses and determine the first steps required to put your life back together.
Certainly, ICD-10 is not deadly, nor is it as dramatic as surviving a killer storm, but the process has been stressful, and painful and chaotic for millions. We’re in the eye, half way between beginning and end. Much has happened, but there is still a great deal more to come. I image that’s how many of you are feeling today; trying to ride out the storm — in peace, in fear or maybe a combination of the two. So, on this occasion, as we wait, I thought I’d provide a few final thoughts about ICD-10 from those working alongside you, in the trenches, who are also weathering the storm. Hopefully these insights provide you some peace, and help you get through this stressful time.
With the transition to ICD-10, we expect three types of industry disruption occurring at different times. First, starting in the first few days after the Oct. 1, 2015 cutover, when providers start transmitting claims containing ICD-10 codes (between 10/3 and 10/10), we predict that providers that chose to ignore the ICD-10 mandate will receive a monumental wake-up call when clearinghouses and payers immediately reject their ICD-9 coded claims as non-clean HIPAA transactions. We believe that most of the nonconformists will be smaller, rural professional providers and small practices. They will scramble to get ready in short order if they wish to be paid for their services.
Second, by mid- to late-October, providers will start receiving payments based on claims submitted using ICD-10 codes. Most professional claims are reimbursed based on the CPT/HCPCS codes and therefore are not susceptible to payment shifts. Institutional claims are paid via a wide range of reimbursement mechanisms, mainly due to combinations of both ICD-10 diagnosis as well as procedure codes. ICD-10 testing between providers and payers illustrates that four out of five payment disputes are because of poor coding accuracy from the provider. We see an increase in phone calls to payers and an elongated revenue cycle collection timeframe.
Third, throughout 2016, we see overall data quality issues emerging as the industry stabilizes and acclimates to the new code set. Although CMS relaxed coding accuracy requirements for Medicare fee for service claims, commercial payers have not followed suit. Be prepared for an increase in chart reviews and ongoing adjustments to previously paid claims.
Coastal Orthopedics has been serving the coastal South Carolina region for more than 30 years, and has helped countless members of our community regain and maintain a full quality of life. In those years of serving our community, ICD-10 has without a doubt been one of the biggest challenges that our practice has faced to date. With major overhauls to our practice workflow and ultimately our ability to provide the best care to our patients on the horizon, we set out early to meet the demands of the ICD-10 transition proactively.
The success of our transition to ICD-10 has been two-fold. One: our software partners (SRS Soft EHR and Allscripts Practice Management) have continued to deliver exceptional tools that have allowed our practice to leverage the power of healthcare information technology to expand our ability to provide exceptional care exponentially. Two: The dedicated staff and physicians of our practice, who truly love getting to be a part of helping our patients live their best life, have invested countless hours of preparation into being sure that our patients continue to receive only the best care. After months of updating our office systems/processes, working with care partners across the community, working with our software partners to fine tune our systems, and working with insurance companies to ensure that our patients get the most of their benefits, we’re ready to take ICD-10 head-on.
October 1st will be just another day of providing exceptional orthopedic care to our community for Coastal Orthopedics.
The day before, the day of and the day after ICD-10 goes live, it will be too late. But, as we get closer to ICD-10 go live, there are some final preparations that you can do before it does, and some remediation that can be done post go live. Physician practices and hospitals can focus on the procedures and visit types that drive their practices. We call this focus, the Codes that Matter. A very small percentage of procedures and visit types drive 95 percent of revenue so focus on those key areas to protect your revenue.
In addition, the physicians and hospitals need to take a snap shot of financial and revenue cycle performance prior to going live. This is especially critical at this point. The hospitals and physician practices have to know where they are today so they can effectively evaluate their financial and revenue cycle performance post go live. Financial “fire drills” need to be conducted to practice and prepare for revenue cycle impacts. How to prevent 10 percent to 15 percent revenue hits? If we see those issues arising, how do we quickly address and how do we rapidly deploy teams to close the issues. Waiting until the day before, similar to cramming for the test will not work well for the October go-live. There are a couple of things listed above that can still make a difference so the time is now before the die is cast.
Michele Hibbert-Iacobacci, CMCO,CCS-P, vice president of information management support, Mitchell International.
Michele Hibbert-Iacobacci
With the October 1 implementation date for ICD-10 just around the corner, many providers are in need of a quick, at-a-glance refresher to their training. The implementation of ICD-10 has been delayed twice, so many providers that had solid plans for training in advance are not as prepared as they had intended to be.
Quick reference guides are in even higher demand considering the influx of codes required by ICD-10. Currently, ICD-9 includes 13,800 three to five digit, primarily numeric diagnostic codes. By contrast, the ICD-10 code set will contain roughly five times that number, totaling approximately 69,000 three to seven digit, alphanumeric codes.
To alleviate the last minute training scramble, ICD-10-focused readiness material and courses from widely accepted and well-known organizations may help ensure a smooth transition come October 1.
American Association of Professional Coders (AAPC) have go-at-your-own pace online courses for both ICD-10-CM and PCS.
Are you ready to transition to ICD-10? The countdown is on. As those of us in healthcare know, next week the industry in the United States will (finally) undergo a significant change as we transition from ICD-9 to ICD-10. ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems and is used primarily to document diagnoses in a codified manner. The most recent revision has nearly five times more codes than its predecessor because of its increased complexity and specificity of ICD-10 codes.
Healthcare organizations in the U.S. have been preparing for the ICD-10 transition for nearly five years. Multiple delays, brought on by substantial lobbying efforts against the transition, led to elongated wait time, but the time has come and we’re ready to launch. Personally, I’m glad. I look forward to healthcare moving beyond this conversation; the infighting ICD-10 has caused among members and associations in the community has done us all a disservice. Perhaps, on October 2, the day after the implementation deadline, we can begin to move on to other issues — slowly, of course — so that the brilliant minds in healthcare can once again focus on more pressing, important issues than the dollars and cents of claims and the numbers needed for them to be paid by our payer partners.
As the transition date draws near, make sure you’ve got all your priorities and details in line. ICD-10 is no lightweight matter, as you have likely discovered. Cerner created the following video, “10 Things You Should Know to Get Ready for ICD-10,” that I’m posting here, with the company’s permission. Though my publishing it is a bit last minute, the video offers some tips that might help you prepare for “doomsday.”
This video reviews what Cerner considers the top 10 things you need to do to prepare for ICD-10; it also covers technical pieces related to Cerner’s Millennium solutions, as well as operational pieces to help with the transition. Overall, it’s a nice resource that may provide you a bit of last minute ICD-10 insight and comfort for the change again. Here’s to your ICD-10 health. Enjoy!
Guest post by David Thompson, senior director, product management, LightCyber.
David Thompson
A targeted data breach is one of the most vexing problems facing healthcare organizations today. Just in the first three months of 2015 alone, 99 million patient healthcare records were compromised—that’s about one-third of the entire U.S. population, and those are just the ones we know about. According to some sources, 90 percent of healthcare organizations have already been breached, but we aren’t sure which ones.
The cybercriminals behind a targeted data breach do not want to be exposed—and make no mistake, these breaches are run by people, not autonomous software. Unlike the hackers of earlier days, these operatives want to stay hidden and conduct their work in secret. Even if they have successfully completed their initial goals—let’s say exfiltrate patient medical records—a cybercriminal team will likely want to stay undiscovered to continue to steal more data as it is collected, or leverage this access to break into another company. Often this will involve commandeering valid credentials from the first organization to gain access to another, perhaps a partner healthcare organization, an insurance company, an independent lab or some other entity.
The simple truth is that most healthcare organizations lack the means to detect an active data breach. First, let me define a data breach, since there is so much confusion over the term. A breach is the entire process—from initial network penetration through data exfiltration— cybercriminals go through to achieve their goals.
Often a breach is perceived as only the initial penetration into the network or infection of a machine. This one act is over in an instant, but it is the focus of considerable security resources. In other words, a large proportion of security resources are devoted to preventing single step in the breach process that lasts less than a minute, but is only the first step toward a goal.
Also, initial penetration is not as easy to spot and block as you might guess. Since the way into the network may be accomplished through the use of valid credentials acquired through social engineering or clever spear phishing, detecting the intrusion can be difficult. Effective prevention of intrusions is based on use of statically defined descriptions of software code or behavior (signatures and hashes), so it is successful mainly when known malware is used to conduct a breach. So, preventing an intrusion has a marginal success rate, but it is often seen as the last change an organization has in defeating a targeted breach.
Once an attacker is inside the network, most organizations lack the ability to find them. At the same time, an attacker is inherently at a disadvantage, having landed inside an unfamiliar network. This disadvantage is quickly dissipated since they can often go completely undetected for weeks, months or even longer. The industry average dwell time is around six months, plenty of time for an attacker to explore a network and get at assets.
Why is it that organizations are seemingly powerless to find an active data breach once an intruder has penetrated a network? There are four main reasons.
TapCloud creates a real-time stream of data that enables care teams to quickly grasp whether a patient is getting better or worse, assess the effectiveness of treatments and medications and identify the onset of emerging complications. TapCloud is currently being used in settings from single practitioner to national hospital systems.
