Guest post by Clyde Wesp Jr, MD and John T. Chang, MD, PhD, MPH, Zynx Health.
For years, physicians would – and many probably still do – advise patients with dust mite allergies to buy allergen-impermeable bed covers to control their symptoms.
The problem: The use of these high-priced linens has no clinical benefit for either allergic rhinitis or asthma, according to studies published in the New England Journal of Medicine.
This is just one example of the overutilization of an ineffective practice in medicine. Indeed, the problem runs rampant, according to a recently published Mayo Clinic study. In fact, researchers identified 146 common medical treatment protocols that offer no net benefits and that either have been or need to be reversed.
Such practices could have unfortunate consequences, according to Vinay Prasad, MD, one of the study’s authors. In a supplemental video to the article titled “A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices,” the oncologist points out that the proliferation of these ineffective practices could cause harm to patients, prompt patients to lose trust in the medical community, and result in unnecessary spending. Just think: Impermeable bedding was once a $26 million industry, according to Prasad.
The Mayo Clinic study, which was based on the analysis of 10 years’ worth of research in the New England Journal of Medicine, is valuable because it opens what we believe is a very worthwhile discussion regarding the value of evidence-based clinical content and clinical decision support (CDS) solutions. Such technology can be utilized to stay on top of emerging best practices and help healthcare organizations improve patient outcomes, enhance safety, and lower costs. By providing such clinical content electronically, healthcare organizations can work toward eliminating the overutilization of ineffective practices and work toward consistently applying standardized best practices at the point of care.
Start talking
Here are just a few considerations that medical professionals need to start thinking and talking about as they consider the need for CDS technology:
#1: Quite simply, why are clinicians implementing treatment plans that don’t work? To start, medicine is based on tradition. Typically, clinicians learn from their predecessors. Thus, many practices and treatment protocols took hold two, three, or even four decades ago. Therefore, these practices could be based on outdated or incomplete evidence. Indeed, some treatment practices came into being when there was absolutely no corroborating evidence. In such cases, clinicians based their decisions on logic and intuition, simply because that is all they had to go on.
There’s little argument that overwhelming responsibility is placed on practice leaders to protect the security of patient records. Maintaining the accuracy, privacy and control of this data is one of the most crucial roles within the care setting. Given the high level of risk for exposure of this information and because of expanded enforcement of HIPAA, practices managing the release of information (ROI) must be more vigilant now than they have been in the past. Their processes for handling ROI need to meet not only the requirements of the law, but what’s in the best interest of the practices’ patients.
Along with a significant rise in HIPAA enforcement, practices must remain sensitive of how they handle the data that’s released to third parties. Redaction of personal information from records is one important way practice administrators can improve security, though it’s not the only way. Automating the removal of PHI by integrating redaction solutions with existing practice technology – such as electronic health records – searching and removing any protected information becomes electronic, eliminating a manual, repetitive process.
Removing risks associated with the release of PHI is possible with automated solutions that can remove data fields like patient name, dates of service, medication lists and other general information in the health record. But, even though solutions exist to automate the redaction of protected PHI, most organizations process records manually even as they migrate to electronic systems in other areas. Continue Reading
The past year has been a turbulent one for U.S. physicians, according to the 2014 Practice Profitability Index (PPI). The PPI was conceived in 2013 as part of a partnership between leading cloud-based health technology provider, CareCloud, and Quantia, Inc., a leader in physician engagement and alignment. The research is intended to serve as an annual barometer for the operational wellbeing of U.S. medical groups in the year ahead. 5,064 physicians contributed their insights to the second annual PPI during March of 2014. To download the entire 2014 PPI, visit: http://www.carecloud.com/practice-profitability-index-2014/
Physicians Have a Darkening Outlook on their Practices’ Profitability
The key finding of the PPI survey was that U.S. physicians are now more than twice as likely to foresee eroding, not increasing, profits in 2014. Those with a negative outlook increased from 36 percent to 39 percent during the past year, while optimists declined from 22 percent to 19 percent. The issues weighing on finances are still led by declining reimbursements (60 percent);rising costs (50 percent); requirements from the Affordable Care Act (49 percent); and the transition to ICD-10 (43 percent).
Operational Challenges Impact Patient Care
“The 2014 PPI results show that physicians are experiencing increasing strain on their practice operations as a result of healthcare reform and government mandates. This strain, in turn, affects patients – including the millions of new ones entering the system as a result of the Affordable Care Act,” said Albert Santalo, Chairman and CEO of CareCloud. “Nearly half of physicians say they cannot take on these patients, foreshadowing an access to care issue. Meanwhile, despite the hype about emerging reimbursement models, physicians are most likely to seek improvements through programs that help them engage with their sickest and most vulnerable patients.”
The complete 2014 PPI survey results, which also explore physicians’ opinions on technology adoption; time spent on administration rather than patient care; impact of healthcare reform; intent to stay independent or sell their practice; and strategies for improving operational performance, can be accessed at www.carecloud.com/PPI
Additional key findings from the 2014 PPI included:
Two healthcare organizations have agreed to settle charges that they potentially violated the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules by failing to secure thousands of patients’ electronic protected health information (ePHI) held on their network. The monetary payments of $4,800,000 include the largest HIPAA settlement to date.
The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) initiated its investigation of New York and Presbyterian Hospital (NYP) and Columbia University (CU) following their submission of a joint breach report, dated Sept. 27, 2010, regarding the disclosure of the ePHI of 6,800 individuals, including patient status, vital signs, medications, and laboratory results.
NYP and CU are separate covered entities that participate in a joint arrangement in which CU faculty members serve as attending physicians at NYP. The entities generally refer to their affiliation as “New York Presbyterian Hospital/Columbia University Medical Center.” NYP and CU operate a shared data network and a shared network firewall that is administered by employees of both entities. The shared network links to NYP patient information systems containing ePHI.
The investigation revealed that the breach was caused when a physician employed by CU who developed applications for both NYP and CU attempted to deactivate a personally owned computer server on the network containing NYP patient ePHI. Because of a lack of technical safeguards, deactivation of the server resulted in ePHI being accessible on internet search engines. The entities learned of the breach after receiving a complaint by an individual who found the ePHI of the individual’s deceased partner, a former patient of NYP, on the Internet.
Caring in Place helps family members become family caregivers for their aging loved ones. Based on the loved one’s health conditions, family members are taught what to do, when to do it and how to care for their aging loved ones. All instructions are doctor recommended and often include audio, video, images and text.
Elevator pitch
Caring in Place helps family members learn to become family caregivers for their aging loved ones. Through intelligent checklists, caregivers are taught what to do, when to do it and how to care for their seniors.
Product/service description
Caring in Place is a technology platform designed to help family members learn how to become family caregivers for their aging loved ones. Through an iPhone app, and a web portal (Android to be launched in the next few weeks), families are provided caregiving instructions based on the health conditions of their aging loved one. The platform also enables caregivers to coordinate care with other family members, friends, neighbors and even paid caregivers.
Founders’ story
Co-founders Josh Fotheringham and James Jarman met in 1996 while attending the University of Utah. Although they went separate ways with their careers, they knew that at some point they would join forces. In 2010, a friend running a skilled nursing facility in California asked for assistance with his facility. After several improvement attempts associated with Medicare billing, Josh and James began studying and interacting with family caregivers. Quickly they identified with the difficulty of caregiving and decided to help. Leveraging their backgrounds in technology, marketing and business, they started Caring in Place. In 2013 they received their first external investment from Blue Cross Blue Shield of Massachusetts and also participated in a four-month healthcare accelerator program called Healthbox. Today they are building partnerships across the healthcare ecosystem to find new and improved ways to help family members in their role as family caregivers.
Guest post by Michael Howard, worldwide security practice lead, managed services, printing and personal systems group, HP.
Michael Howard
As the information technology landscape continues to rapidly evolve, healthcare providers increasingly find themselves faced with new challenges on how to best serve their patients and protect their privacy. The Health Insurance Portability and Accountability Act (HIPAA), which introduced privacy and security regulations in 1996 for providers that use electronic transmission of data, made securing patient data a prominent issue.
If you are skeptical about potential costs associated with implementing a new security strategy in your office, consider this startling fact: According to the Ponemon Institute, the average cost per incident of corporate information theft is $5.5 million1. That number alone should be reason enough for providers to consider upgrading their security protocols. While computers and servers are often the first pieces of technology to be secured within the IT infrastructure, paper documents and printers are often overlooked. With the extensive amount of security offerings available, IT managers can have greater confidence that patient records remain safe. Below are the top three ways that healthcare providers can better secure their print infrastructure:
Store medical records in the cloud
Recent data from the U.S. Department of Health and Human Services indicates that paper still accounts for a large percentage of HIPAA breaches. Between Jan. 1, 2011 through April 15, 2014, 500 patient data breaches have been reported with 203 related to paper (more than 40 percent)2. One easy way to reduce the likelihood of a paper breach – and to save time spent shuttling from one file cabinet to another – is to transfer your hard copy medical records to an electronic health record (EHR) format and store them in the cloud. Securing the paper to digital data process can be a less painful process by implementing a software solution that makes it easy for users to scan documents, convert them to electronic files and then distribute them to predetermined destinations. Not only will you simplify the data storage and retrieval process, but you will also save office space by reducing the need for file cabinets and limit excess paper.
As many healthcare providers are in the process of transitioning from paper to EHRs, it is important to be well informed on what happens to your data once it enters the cloud. Most cloud-based solutions offer bank-grade encryption for data transfer, in addition to highly protected data centers. By saving your EHRs to the cloud, you will be able to update patient records in real-time and reference past prescriptions and treatment plans while in the room with your patient. This promotes more personalized and convenient care and helps reduce duplications and inaccuracies.
Tapan Mehta, global healthcare lead, Cisco, brings more than 15 years of healthcare information technology, marketing and business development leadership as Cisco’s global healthcare lead. Mehta is responsible for managing the development and marketing efforts for healthcare solutions including clinical workflow improvement, telemedicine, patient safety, regulatory requirements and EHR integration.
Here he discusses the demand for telehealth, the changing role of hospital health IT, wearable technology and patient monitoring and what Cisco is doing to serve its healthcare clients.
Tell me about Cisco and how it serves healthcare.
At Cisco, we see the healthcare industry as ripe for technology disruption. After doing things the same way for years, we think technology can be the catalyst that brings positive changes to how care is delivered. Drawing from our experience as the worldwide networking leader, Cisco is well positioned to help improve the future of healthcare through networked technologies that transform how people connect, access and share information, and collaborate. New healthcare technologies, like those offered by Cisco, benefit everyone – from patients to providers, payers to life sciences organizations.
What is your role, specifically, and what is the most challenging aspect of it?
I have a global marketing role where my team is tasked to develop healthcare specific solutions, go-to-market strategy and field enablement, as well as serve as the “voice of the customer” by bringing the outside-in view to Cisco and its various business groups. Healthcare is at a very critical inflection point in the industry whereby there are several key underlying currents in areas such as mHealth, telehealth, data analytics, wearables, etc. While there are several interesting opportunities to pursue, what makes it difficult is to prioritize them as each segment has substantial market opportunity and growth prospects.
What inspires you and does this translate to your leadership style?
Healthcare is very personal. It touches everyone in the society in some shape or form. I have been in the healthcare space for the past 15 years and I am extremely fortunate that I am in an industry that is going to go through a transformational change over the next decade. Historically, healthcare has fundamentally lagged behind most industries when it comes to technology adoption, but I perceive that changing over the next several years. Healthcare “consumerism,” combined with government mandates around the globe, is going to force the industry to adopt technology if it truly wants to improve quality of patient care and workflows throughout the continuum of care. I am really excited to be part of this healthcare eco-system, whereby I can make a difference in how our customers do their business and more importantly how quality of patient care can be vastly improved.
Guest post by Ken Perez, vice president of healthcare policy, Omnicell.
On April 30, 2014, the Centers for Medicare & Medicaid Services issued its proposed rule for the Inpatient Prospective Payment System (IPPS), which pays about 3,400 acute care hospitals, and the Long-term Care Hospital Prospective Payment System (LTCH PPS), which pays about 435 LTCHs.
The issuance of this proposed rule is a significant event, as it discloses CMS’s intent regarding the average change (increase or decrease) to the IPPS reimbursement rate, what one might call an “annual inflation adjustment.”
While CMS projects that the payment rate update to general acute care hospitals will be 1.3 percent in FY 2015—which on the face of it doesn’t look too bad—it’s important to understand how CMS arrived at that figure, what is the projected overall impact on hospital payments because of other regulatory changes, and how the proposed update compares with the recommendation of the nonpartisan Medicare Payment Advisory Commission (MedPAC).
How did CMS arrive at the 1.3 percent update (adjustment)?
CMS started with a proposed annual market basket update (inflation projection) from research firm IHS of 2.7 percent. That starting point was then reduced, per the Affordable Care Act, by a multi-factor productivity adjustment of 0.4 percent and a specified reduction to the market basket update of 0.2 percent, yielding 2.1 percent. Then CMS reduced it by a documentation and coding recoupment adjustment (basically to correct for past, unintended documentation and coding over payments) of 0.8 percent, resulting in a net update of 1.3 percent.
