I recently had the opportunity to attend PointClickCare’s annual user summit held in Orlando. Though the senior care market is not one I’ve spent a great deal of time covering, senior and long-term care are deeply interesting to me. There are several reasons for this interest: Seniors are becoming the largest population segment in the US and that has serious ramifications ranging from politics to economics, and because I’m interested in alternative care models. And, in some way, senior care effects all of us.
There are a number of differences between senior care and ambulatory or in patient, but the technology needs are still overwhelming and great. Senior care facilities across the US face tight budgets, extremely high levels of employee turnover and technology challenges, but the care they provide is still important, as is how the information they collect on behalf of their patients is similar to other sectors.
According to Mike Wessinger, CEO and co-founder, “PointClickCare’s goal is to enrich the lives of care providers through technology that will help them better care for their residents in ways that are effective and efficient.”
Dave Wessinger
PointClickCare’s primary reason for being is to deliver electronic health record and practice management solutions, but the company has an eye on mobile delivery, where both Mike and brother David Wessingner, CTO and co-founder, feel the future of health IT lies.
Mobile is king for its ability to deliver health data quickly and where needed, as well as to alleviate stress and confusion of overwhelmed healthcare employees.
Hospitals, too, are overwhelmed. Data flowing in from various systems often goes unnoticed or unpackaged, a particular troubling problem for the senior population. When there’s a patient transferring in from a senior home to a hospital for emergency care, a health record of some kind may accompany them. A fully loaded paper chart may only be shuffled through and details lost.
In a new policy approved at the American Medical Association’s (AMA) Interim Meeting, physicians continued to call for penalties to be halted in the meaningful use program. Physicians feel that full interoperability, which is not widely available today, is necessary to achieve the goals of electronic health records (EHRs) — to facilitate coordination, increase efficiency and help improve the quality of care.
The new policy comes on the heels of the recent release of new attestation numbers showing only 2 percent of physicians have demonstrated Stage 2 meaningful use. In response to the new figure, the AMA joined with other healthcare leaders to urge policymakers to take immediate action to fix the meaningful use program by adding more flexibility and shortening the reporting period to help physicians avoid penalties.
“The AMA has been calling for policymakers to refocus the meaningful use program on interoperability for quite some time,” said AMA president-elect Steven J. Stack, M.D. “The whole point of the meaningful use incentive program was to allow for the secure exchange of information across settings and providers and right now that type of sharing and coordination is not happening on a wide scale for reasons outside physicians’ control. Physicians want to improve the quality of care and usable, interoperable electronic health records are a pathway to achieving that goal.”
Guest post by Ken Perez, vice president of healthcare policy, Omnicell.
“Hope springs eternal” is a phrase from Alexander Pope’s An Essay on Man: Epistle I, written in 1733. For some reason, right now hope is in full bloom in Washington, D.C. for physician groups, such as the American Medical Association and the Medical Group Management Association, which are pushing for passage of a permanent repeal of the sustainable growth rate (SGR), also known as a “doc fix,” prior to the congressional recess that will start in mid-December.
The points that are being made by physician groups are not new. There is the spectre of a 21.2 percent reduction in Medicare physician fees effective April 1, 2015, when the current doc fix expires, and nobody wants such a drastic reimbursement rate cut to occur. Also, because of moderating healthcare costs, the most recent Congressional Budget Office estimate of the cost of holding payment rates through 2024 at current levels is “only” $131 billion, near the low end of the CBO’s historical range. And last, earlier this year, a number of permanent SGR reform bills enjoyed bipartisan and bicameral support.
In spite of all these valid points, the case for fixing the SGR this calendar year, as opposed the first quarter of 2015, does not seem compelling or possible, due to both political and fiscal realities.
Politically, as the name implies, lame-duck congressional sessions are not known for legislative productivity. Chip Kahn, CEO of the Federation of American Hospitals, commented, “I believe that the lame-duck session is going to be limited to measures that are either emergencies like Ebola or must do’s to keep the government open.” Similarly, Tom Scully, former CMS administrator under President George W. Bush, opined in Modern Healthcare that there is “1 in 10 million” chance of a permanent SGR repeal passing during the lame-duck session.
Guest post by John Backhouse, executive director of the Omni Program, Information Builders.
Patient data resides in many systems and in multiple locations, which requires adept coordination and collaboration to deliver quality healthcare. However, sometimes pertinent data slips through the cracks – as demonstrated at Texas Health Presbyterian Hospital in Dallas.
Dr. Daniel Vargi of Texas Health Resources explained the breakdown in EHR miscommunication in a recent CNN interview: “While we had all of the elements of information that were critical to understand a potential diagnosis of Ebola, the way we built them into our clinical process – not only the process of gathering the information but then communicating the information between caregivers – was not as front-of-mind as it should have been.”
This gap in information sharing needs to be bridged, especially to mitigate risk when dealing with significant diseases such as Ebola. It is critical that healthcare systems obtain a 360-degree view of patients, and achieve EHR interoperability.
Providers wrestle with EHR technology to enter patient information that is often never reconciled with patient history or existing data on countless other data sources including ancillary services, and other healthcare organization’s electronic medical record (EMR) system.
The HITECH Act (2009) initiated governmental incentives and penalties designed to nudge healthcare to adopt certified EHR technology for better patient outcomes. As of 2013, 59 percent of acute care hospitals (non-federal) have adopted at least a basic EHR system with clinician noted.
Dell unveils findings from its first Global Technology Adoption Index (GTAI), uncovering how organizations truly using security, cloud, mobility and big data to drive success. The market research surveyed more than 2,000 global organizations and found that security is the biggest concern in adopting cloud, mobility and big data. Furthermore, while 97 percent of organizations surveyed use or plan to use cloud and nearly half have implemented a mobility strategy, big data adoption is trailing as approximately 60 percent of organizations surveyed do not know how to gain its insights.
“We know that security, cloud, mobility and big data are the top IT priorities in all industries, but we need a deeper understanding of the practical realities of how companies are using these technologies today and what, if anything, is preventing them from unleashing their full potential,” said Karen Quintos, chief marketing officer, Dell. “This research cuts through the hype and provides a clearer roadmap for how Dell can enable our customers to thrive.”
“Despite mounting security risks and increased reliance on the Internet and technology to run their businesses, many small and midsize organizations are underprepared to deal with today’s security threats, let alone those of the future,” said Laurie McCabe, partner, SMB Group. “These companies know that disruptive technologies like cloud, mobility and big data can drive innovation and create competitive advantage. But it’s often difficult for them to take a strategic approach and overcome security concerns in order to fully harness the potential.”
Security Concerns Are Creating Big Barriers The Dell GTAI found that IT decision-makers still consider security the biggest barrier for expanding mobility technologies (44 percent), using cloud computing (52 percent) and leveraging big data (35 percent). While security concerns are holding organizations back from further investing in major technologies, a lack of readily available security information is similarly preventing organizations from being prepared during a security breach. Only 30 percent of respondents said they have the right information available to make risk-based decisions, and only one in four organizations surveyed actually has a plan in place for all types of security breaches.
The security barrier becomes even more serious as the C-suite becomes less engaged. Only 28 percent of organizations polled have a C-suite mindset that is fully engaged with security initiatives. However, in organizations where executive leadership is involved in security, confidence is markedly increased. Among organizations that are very confident in their security, 84 percent of senior leaders are fully or somewhat engaged, compared to only 43 percent of senior leaders at organizations who are not confident in their security.
Other significant Dell GTAI security findings include:
CHIME and HIMSS are in the news again, and this time you’ve got to love that they are — for sticking up for what they, as organizations, believe in. Their flexing of a little muscle is for telling ONC that its leadership and its current efforts just are not good enough; referring to the announcement that Dr. Karen DeSalvo, current national coordinator for health information technology, is splitting here duties between ONC and HHA, where she’s battling Ebola.
CHIME, especially, is known for its bravado, one of the reasons I find it such an intriguing organization to watch. Its messages are always loud and clear, and unadulterated; just what we need in an overly PC public where “the folks” are supposed to take what’s given to them.
CHIME and HIMSS’ letter is more about the overall leadership changes taking place at ONC and the organizations’ apparent difficulty keeping leadership in place; DeSalvo has led the organization for less than a year. “We are concerned with leadership transitions currently occurring within the Office of the National Coordinator for Health Information Technology (ONC); changes which could have a detrimental effect on ONC’s role in HHS’ charge to positively transform our nation’s health system,” CHIME and HIMSS’ letter to ONC states.
“Health IT is a dynamic field; to successfully address the needs of patients, providers and developers, ONC’s leadership team must be in place over the next two years. Such constancy will pay huge dividends in navigating all the changes that must occur for positive transformation.”
CHIME and HIMSS point out the obvious in their missive: That ONC faces a public that perceives its leadership as not wanting to be at the organization, much in the same vein as what’s going on at the White House amid reports that a disengaged Obama is counting down his last days as President.
As ONC’s leadership publically takes a willy-nilly approach, CHIME, HIMSS and others are done looking on wondering what’s up and are starting to demand some action. A half-hearted approach to leadership is not going to work, not now, not after so many of its programs that ONC lobbied for and put in place while practices and health systems looked on wondering how to deal with the swarm of new mandates and regulations.
Being adiehard Kennedy fan, this is what I’d normally quote to someone purchasing the latest commodity, or acquiring the latest service that everyone is flocking to stores to get – Conformity is the jailer of freedom and the enemy of growth. However, outsourcing medical billing is a different ballgame altogether.
I’m often confronted by worried physicians who are already overwhelmed by a recent deployment of an electronic health record (EHR) system at their practice when they hear that the clinic next door is outsourcing medical billing. With an expression that could easily pass off as ICD-9 code number 564.0 (a person suffering from constipation), the hesitantly ask me this: “Why is everyone outsourcing medical billing; and even if they are, why should I?”
In response to all those people and all the physicians out there having similar questions, here’s why:
1. It costs significantly lesser
Medical billing companies charge rates as low as three percent of your monthly collections to handle this process for you. Compare this with the costs of a dedicated medical billing department at your practice, and the difference will be significantly lower.
The salaries of the staff won’t be the only cost there, as they’ll need a room or office space to work in, desks and chairs to work on, dedicated equipment (computers, fax machines, printers), and miscellaneous expenses, such as stationary in addition to utility costs. Now when you accumulate all of this with the insurance packages of these staff personnel and the maintenance of this equipment, you’ll realize that the percentage of collections work out a lot cheaper.
2. A large staff base
Each practice assigns a specific budget for billing according to which many small and medium sized practices are able to employ one or two billers who handle all of the practice’s billing related tasks.
More often than not, these understaffed and overworked personnel come across situations whereby they have to decide between negotiating over denied and underpaid claims, or moving on to the numerous pending cases. Given their constraints, they choose to move on, settling for lower (sometimes zero) payments on such claims.
The large staff base of a medical billing company will rid you of this problem as they’ll have different personnel to handle different processes, resulting in the maximization of reimbursements.
Guest post by Ken Perez, vice president of healthcare policy, Omnicell.
In the wake of the U.S. 2014 midterm election, it’s natural to turn our eyes toward the future and begin to speculate about possible legislative developments, such as a permanent repeal of the sustainable growth rate (SGR), often referred to as a “doc fix.”
The SGR is a formulaic approach intended to restrain the growth of Medicare spending on physician services. The SGR requires Medicare each year to set a total budget for spending on physician services for the following year. If actual spending exceeds that budget, the Medicare conversion factor that is applied to more than 7,400 unique covered physician and therapy services in subsequent years is to be reduced so that over time, cumulative actual spending will not exceed cumulative budgeted (targeted) spending, with April 1, 1996, as the starting point for both.
In part because of the effective lobbying efforts of physicians, Congress has temporarily suspended application of the SGR by passing legislative overrides or doc fixes 17 times from 2003 to 2014. As a result, actual spending has exceeded budget every year during these years. Because the annual fee update must be adjusted not only for the prior year’s variance between budgeted and actual spending but also for the cumulative variance since 1996, the next proposed update, effective April 1, 2015, is a reduction in Medicare physician fees of 21.2 percent.
There are three reasons to be optimistic that a permanent doc fix will be passed in 2015.
Reason for optimism #1: It’s much cheaper than before.
Since 2012, the Congressional Budget Office (CBO) has released some 15 estimates of the 10-year cost of SGR fixes, usually assuming a freeze in rates (i.e., 0 percent annual updates to the physician fee schedule). These cost estimates have ranged from a low of $116.5 billion to a high of $376.6 billion. In August 2014, the CBO estimated that holding payment rates through 2024 at current levels would raise outlays by $131 billion, a figure near the low end of the range and relatively more affordable.
