Guest post by Jonathan Zimmerman vice president and general manager, Clinical Business Solutions, GE Healthcare IT.
With key deadlines looming, 2014 will be a critical year for the healthcare industry, one marked by important industry milestones and advances. As ICD-10 implementation and meaningful use Stage 2 attestation approach, many are saying we have reached healthcare’s tipping point – where first of its kind opportunities for collaboration and innovation intersect with challenging regulatory standards and population health demands. In order to better facilitate these updates and solve potential market challenges, healthcare providers will need to blend innovative technological solutions with current operational systems.
As the industry evolves, we anticipate three key opportunities for 2014.
#1: Smarter Collaborations
New industry partnerships and alliances are being created to collectively address standardization and implementation. Healthcare IT organizations are working to adopt common standards and protocols to provide sustainable, cost-effective, trusted access to patient data. Payers and providers are coming together to ensure healthcare providers are setup up for success. Regulatory agencies, manufacturers and providers are working diligently to approve more devices, streamline communications and update payment codes in time for ICD-10 implementation. We are also seeing CIOs/CTOs work closer than ever before with physicians in order to reap the benefits of incentive driven initiatives like meaningful use Stage 2.
Guest post by Scott Parker, senior marketing analyst, CureMD.
Healthcare needs to be efficient in delivering care to the patient. What if iPad and iPhone apps provide the services healthcare professionals need? Wouldn’t that be a dream come true? The mobile healthcare market is talk of the town in healthcare circuits. The amazing thing is, mostly mobile EHRs are free. Soon to be launched CureMD’s app Avalon will be free too. It is free because you only pay for the services you use.
Medical history on fingertips: Healthcare professionals only dreamt about a day, when the ease of access in terms of patient data could take a step further, and somehow make them get off their boring computer screens. All of patient’s data is just a few taps away with mobile EHR. Providers can access an up-to-date list of current and past diagnoses of the patient; along with list of medications the patient has been formally prescribed.
Empowering patients: Mobile EHRs are not just for care providers. They are for patients as well. Patients can use mobile EHR to view their test results along with clinical summaries of their visit to the practice. They can keep track of their vaccinations, making it convenient for the providers and staff to arrange an appointment. If providers are able to empower patients through mobile EHR they are essentially empowering themselves.
Accurate sharing of patient information: Mobile EHRs provides a coordinated system of care through its function of interoperability. It allows for secure exchange of data among multiple providers, practices and healthcare facilities in real-time. This will provide a better support structure for informed clinical decisions. All in all, it reduces manual medical errors caused by humans trying to provide information through lethargic channels.
Given the spirit of #mHealth13, I thought the following infographic was appropriate: mHealth stas: mobile apps, devices and solutions. Created by xcube labs, a mobile apps developer, it details the current use of mobile apps in healthcare by patients. Since mobile health, #mHealth, is now more than a $1.3 billion industry and it’s expected to grow to more than $20 billion by 2018, according to mhealthshare.
Not surprising, the use of smartphones is the most prominent device of physicians in the care setting, and an estimated 62 percent of physicians using tablets. Likewise, 72 percent of nurses and other caregivers are using smartphones in the care setting.
From a patient perspective, almost every person in the US – 247 million – have downloaded a healthcare app for their personal use, and there are more than 40,000 apps available for use by patients.
The sector is clearly burgeoning. For example, Becker’s Hospital Review recently reported that the vast majority of clinicians use mobile devices in their day-to-day practice. About four in five clinicians currently use smartphones every day, a rate which will increase to nine in the 10 next years.
Additionally, more than half of physicians use tablets daily. “Half of clinicians are ‘digital omnivores’ who routinely use a smartphone, tablet and computer currently, and 82 percent plan to within the next 12 months. Tablet and smartphone usage accounts for more than 40 percent of clinicians’ at-work digital time.”
Top uses for smartphones are using generic search functions (46 percent), accessing professional resources (38 percent) and communicating with colleagues (38 percent).
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).
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.