Guest post by Bill Walker, chief technology officer, Aegis Health Group.
Fo r the last several years, there has been an increasing emphasis by the federal government on digitizing the healthcare industry. The allocation of meaningful use dollars to physician practices for converting to electronic health records was only the beginning. The Affordable Care Act (ACA) was the seminal event that demonstrated without a doubt that electronic management of patient information was going to be an absolute if hospitals and health systems are to survive.
The ACA puts healthcare organizations at financial risk for duplication of services, lapses in care coordination and questionable patient safety practices. Population health management demands that electronic patient records be accessible for planning, managing and tracking care coordination. But the fact is fully managing the continuum of care for a patient cannot be achieved without data collection both inside and outside the hospital’s walls. This is a trend that will take on increased importance as healthcare reform rolls out in 2014.
Health systems with forward-thinking HIT executives saw the writing on the wall after the ACA became law and began converting their organizations to electronic medical records. Systems that are considering becoming accountable care organizations (ACOs) – and accepting value-based reimbursement, which will become the predominant reimbursement model – need to find ways to track the health status of individuals in their community before they become patients. How? By embracing the use of technology that closes the healthcare loop before people even know they need those services.
The Centers for Medicare & Medicaid Services announces a delay of meaningful use, and on Dec. 6, 2013, proposed an extension of Stage 2 through 2016 and beginning Stage 3 in 2017 for those providers that have competed at least two years in Stage 2.
In a post on its site, Robert Tagalicod, CMS’ director of Office of E-Health Standards and Services and Jacob Reider, MD, acting national coordinator for Health Information Technology of ONC, the goal of the change is two-fold: “First, to allow CMS and ONC to focus efforts on the successful implementation of the enhanced patient engagement, interoperability and health information exchange requirements in Stage 2; and second, to utilize data from Stage 2 participation to inform policy decisions for Stage 3.
“The phased approach to program participation helps providers move from creating information in Stage 1, to exchanging health information in Stage 2, to focusing on improved outcomes in Stage 3. This approach has allowed us to support an aggressive yet smart transition for providers.”
The two also point out that the timeline allows for enhanced program analysis of Stage 2 data to inform to the improvements in care delivery outcomes in Stage 3, the primary goal of the extension, to give all involved more time to prepare for the future of the reform.
This is the time of year for speculation regarding which teams will play in the various college football bowl games, but also, unfortunately, whether Congress will finally pass a permanent repeal of the unpopular Medicare Sustainable Growth Rate, which once again threatens to impose a sharp decrease to the physician fee schedule, reportedly 24.4 percent on Jan. 1, 2014.
Just as most every college football team had a sense of optimism when the season began, throughout the summer and fall it seemed like politicians on both sides of the aisle were, to switch metaphors, singing from the same hymnal, railing against the Medicare Sustainable Growth Rate and arguing for a permanent “doc fix.” And, of course, physician groups provided supportive background vocals.
But here’s the problem: A permanent solution will be costly, very costly. According to the latest estimate by the Congressional Budget Office (from May), freezing (i.e., holding flat) all Medicare physician rates for 10 years would cost $139 billion, and proposals that are more generous to physicians would obviously cost more. The Medicare Sustainable Growth Rate remains the elephant in the room of deficit reduction. As for temporary patches, I’ve seen ballpark estimates of $18 billion for a one-year doc fix and $36 billion for a two-year freezing of rates, but both of those solutions would simply “kick the can down the road” yet again.
Why is the challenge of meeting meaningful use Stage 2 much more difficult, and why are many finding it to be a more rigorous certification process? To start, the requirements are more complex, and vendors are facing challenges in building solutions that are truly interoperable – which is the goal that all EMR/EHR vendors are pursuing as they upgrade their software to meet MU2 requirements.
While MU1 required that patient data be shared with patients or other healthcare professionals, MU2 has more in-depth requirements for sharing that data using advanced document architecture. EHR software needs to electronically connect and securely share data with patients, other practices, laboratories, hospitals, etc. Challenges arise for vendors when trying to build software that will easily integrate with other proprietary clinical systems. This means working with those other entities on their time frame. Because of the large number of EMR systems that need access to these entities, prioritization of these interface requests have led to long wait times and in turn, further delay certification progress.
The casualty claim arena involves evaluating and payment of claims for claimants who have suffered from an auto accident or workers’ compensation injury. This side of the health payment continuum has been omitted from the Health Insurance Portability and Accountability Act (HIPAA) as a covered entity.
This means that casualty claim insurers are not required to abide by the standards set forth in HIPAA and that these standards only apply to the health payer. Omitting the ICD-10 in casualty claims from standards does have merit, but when it comes to standardization, all health claims should be adjudicated and paid in the same manner. Why should a provider charge differently and be paid differently when the payer of the claim is not on the health side? This is a question many casualty payers ask and not being part of the standardization only raises the question more.
There is no option for submission of claims by the covered entity to not be compliant by October 1, 2014 with the International Classification of Diseases, 10 Revision (ICD-10). Why is it a good idea to omit the casualty payer from these standards if the majority of health payments are made using this new standard? In addition, if providers are covered entities, then why would the casualty payer not speak the same code language? It’s almost like trying to communicate in a foreign country without the benefit of knowing the language.
Over the past year, economic pressure and regulatory changes have increased scrutiny around areas of inefficiency within the healthcare industry. With new policies like the Affordable Care Act creating the need to improve patient outcomes and prevention, 2014 will be the year for much needed efficiency upgrades across the board at hospitals. And with mounting pressure to cut costs amidst anticipated physician and other major shortages, new and innovative ways to leverage technology will be called upon to usher in changes for the healthcare industry.
The business of care will continue to be a major area of focus for hospitals in 2014. Preventable, adverse events because of medical errors cost the healthcare industry more than $29 billion in 2013 and have led to between 50,000 to 100,000 deaths each year. Healthcare professionals and hospitals cannot afford to continue accepting medical errors as balance sheet losses, which are not only jeopardizing profitability, but patient care. To save money and improve patient care at the same time, hospitals will look to learn from technology being used successfully by other industries in 2014 to enhance real-time analysis and, thereby, prevention and outcomes.
PricewaterhouseCoopers released its 2013 third quarter healthcare mergers and acquisitions report and there a small uptick over the first two quarters in the number of healthcare deals with 138 total transactions so far. The value of the deals announced is $15.8 billion, up 35 percent over the second quarter, but 2013 is still behind 2012 with volume down 4.6 percent and value down a whopping 25 percent.
For-profit deals were up, continuing the serge from the second quarter, marked by Tenet Healthcare Corporation’s proposed acquisition of Vanguard Health Systems for $4.3 billion, and the third quarter opened with the announcement of Community Health System’s $3.9 billion offer to purchase Health Management Associates (HMA).
Hospital Deals
During Q3 2013, deal volume and value were up when compared to Q3 2012 with the total volume of hospital transactions increased 59 percent from 12 in Q3 2012 to 19 in Q3 2013. Overall deal value increased significantly from $38 million in Q3 2012 to $12.3 billion in Q3 2013. This is largely the result of two $1+ billion transactions in Q3 2013.
The two $1+ billion transactions announced in Q3 2013 were responsible for the significant increase in total deal value.
According to a recent Accenture survey, more tech-savvy seniors are seeking digital option for managing their health services remotely. With an estimated 3.5 million U.S. citizens a year expected to reach 65 years-old through 20231, many want access to healthcare technology, such as virtual physician consultations (42 percent) and self-serve tools (62 percent) like online appointment scheduling. Only a third of healthcare providers currently offer such capabilities.
Accenture says that the rising population of seniors are active online. Internet use between 2000 to 2012 tripled for those 65 and older and doubled among those 50 to 64 years old. Accenture says that at least three-fourths of Medicare recipients access the Internet, at least once a day, for email (91 percent) or to conduct online searches (73 percent) and a third access social media sites, such as Facebook, at least once a week.
Two-thirds of seniors (67 percent) surveyed say that access to their health information is important, but only 28 percent currently have full access to their electronic health records. Similarly, 70 percent of those surveyed believe it’s important to be able to request prescription refills electronically, but, fewer than half (46 percent) say they can do so today. And, the majority (58 percent) want to be able to email healthcare providers, but only 15 percent say they currently have that capability.
“Just as seniors are turning to the Internet for banking, shopping, entertainment and communications, they also expect to handle certain aspects of their healthcare services online,” said Jill Dailey, managing director of payer strategy, Accenture Health.
