News about Healthcare IT Solutions & Services Industry

EHRs Help Cut Medicaid Costs, study says.

Aparna Prasad — Mon, 28 Jan 2013 17:40:00 GMT

Washington state program could be model for the nation.

Tracking Medicaid beneficiaries who frequently use emergency departments and adopting electronic tracking systems to exchange patient information is among one of the ways states can cut Medicaid costs, according to a new report by the Washington Health Care Authority (HCA).

According to a press release issued by The Washington Chapter of the American College of Emergency Physicians (WA-ACEP), preliminary data from the first six months of a study in Washington suggests the state is saving more than 10 percent in Medicaid fee-for-service emergency care costs by following seven best practices:

Tracking frequent users of emergency departments and adopting electronic tracking systems to exchange patient information;
Disseminating patient educational materials about appropriate settings for health care services — to be provided at arrival or at discharge;
Designating personnel and emergency physician personnel to receive and appropriately disseminate information on Medicaid clients;
Contacting primary care providers at the time of the emergency visit and relaying any issues regarding barriers to primary care;
Implementing narcotic guidelines that direct patients to primary care or pain management services;
Enrolling physicians in the state’s Prescription Monitoring Program;
Designating emergency physician and hospital staff to review and provide feedback reports— and taking appropriate action.

Andy Sama, MD, president of ACEP said, “Clearly, this is a model for the nation.”

The report, “Emergency Department Utilization: Assumed Savings From Best Practices Implementation,” analyzes the results of the best practices implemented through a partnership between the Washington Chapter of the American College of Emergency Physicians (WA-ACEP), the Washington State Medical Association, the Washington State Hospital Association and HCA.

Read the full article here.

More-complex care, not fraud, behind higher ER billing, doc argues

Aparna Prasad — Fri, 04 Jan 2013 00:36:00 GMT

Fraud isn't at the root of a spike in providers' billing for emergency services, a new opinion piece in the New England Journal of Medicine asserts.

Rather, the piece's author writes, higher ER billing reflects both increasingly complex care provided in emergency departments over the past decade and more-accurate coding of that care.

The emergency department has become "a central staging area" for the acutely ill, according to Dr. Stephen Pitts, associate professor in the emergency medicine department at Emory University School of Medicine, Atlanta. The perspective piece notes that Level 5—the most serious—ED visits have increased from 27% of all Medicare discharges to 48% between 2001 and 2010. The most common symptoms leading to these discharges—abdominal pain, chest pain and shortness of breath—can now be diagnosed and risk-stratified in the emergency department using high-tech imaging, leading to fewer calls for surgical consultations and fewer hospitalizations.

Also contributing to higher billing is an "increasingly interventionist ED practice style" that has led to the initiation of more laboratory tests and initiation of intravenous fluids, Pitts wrote.

"Whether this trend has truly improved patient safety and quality of care is unknown, but it has certainly increased the complexity of the medical decision-making component of documentation, which translates into higher physician billing," Pitts wrote.

Defensive medicine, too, may also play a role, he said.

"Failure to diagnose patients' conditions carries heavy penalties for ED physicians and hospitals, whereas 'overuse' of technology is ill-defined, and penalties for it are less direct," Pitts wrote.

Electronic health-record systems help emergency-room personnel document all care provided by "presenting clickable check-boxes that easily satisfy coding-complexity criteria," he said. This ensures that "no billable action goes unnoticed," he wrote—but that doesn't mean fraud is occurring, as a federal auditor's report from this fall on evaluation and management visits suggested.

Read full article here.

10 physician practice trends to watch in 2013

Aparna Prasad — Wed, 19 Dec 2012 18:03:00 GMT

To borrow the words of Lou Goodman, president of the nonprofit Physicians Foundation, "2013 will be a watershed year for the U.S. healthcare system." For physician practices, the upcoming New Year will be a pivotal one, in many cases, making the difference between folding and thriving in a post-health-reform world.

Here, in no particular order, are 10 existing trends we predict will affect your practice in 2013 and beyond.

Payment reform

Most of the United States is in the middle of a difficult transition from still-dominant fee-for-service reimbursement to a variety of emerging value-based payment models. With a cost-containment law passed in 2012, Massachusetts continues to be a state to watch as you evaluate options for your own practice going forward. In addition, the American Medical Association has released ahow-to manual to help physicians understand and negotiate new payment models.
Alternative care models

According to a report from Accenture, only 36 percent of physicians in the United States will practice independently in 2013. Of this remaining minority, one in three is expected to resort to subscription-based models, such as concierge, direct-pay or online consultations, to sustain profits. Whether these models represent your future or your competition, keep a close eye on such businesses to emulate their strengths and learn from their mistakes.
Physician employment

This trend has become so prevalent that the American Medical Association released a set of guidelines designed to protect patient care and physician interests in various employment arrangements. FiercePracticeManagement also spoke to top experts about how physicians can negotiate employment contracts, something they're not typically trained to do. Our sources told us that they would like to see contract negotiation included in medical school curriculum, but for the time being, physicians can look to medical societies and trade publications for help.
Conflicts of interest

Regardless of when the Centers for Medicare & Medicaid Services begins collecting data related to the Sunshine Act, media reports describing physician ties to pharmaceutical and other industries has drawn patients' attention to potential physician biases and conflicts of interest. And as physicians and patients increasingly interact online, doctors are left to figure out the best way to disclose any conflicts when using social media--a a tricky thing to do in 140 characters or fewer.

Read full article here.

EHR algorithm can ID, classify diabetes.

Aparna Prasad — Wed, 12 Dec 2012 19:16:00 GMT

Algorithms applied to electronic health record data can identify more cases of undetected diabetes in patients than claims codes, and discriminates between type 1 and type 2 diabetes, according to a study published recently in Diabetes Care.

Diabetes can be better controlled if detected and treated early. The researchers surmised that simply analyzing claims codes was not an adequate way to identify individuals who have undiagnosed diabetes.

To that end, they created an algorithm to analyze four years of data from the EHR of a large multisite, multispecialty ambulatory practice. The algorithm was applied to the EHR data in new and multiple combinations to flag patients who may have diabetes, reviewing lab test results, diagnosis codes and prescriptions.

The researchers found that the algorithm provided more complete diabetes surveillance and increased case capture. The positive predictive value of the combinations of data was 94 percent for type 1 codes alone; comparing type 1 and type 2 codes, the algorithm correctly identified 100 percent of patients with type 1 diabetes.

Other studies have shown that EHRs can improve the treatment and control of diabetes. EHR data also can improve care from a public health standpoint, as the use of diabetes registries can help improve research and create more effective prevention and treatment techniques.

Read an official abstract of the study here.

EMR Cuts Rx Errors for HIV Hospital Patients

Aparna Prasad — Mon, 22 Oct 2012 21:13:00 GMT

SAN DIEGO – Use of electronic medical records technology reduced medication errors among hospitalized HIV patients from 16% to 1.1%, a 93% reduction (P=0.002), researchers said here.

Patients living with HIV who are hospitalized for non-HIV illnesses often experience prescribing errors, researchers said here at IDWeek 2012. The most likely cause of those errors is believed to b a lack of familiarity with complex antiretroviral regimens among hospital staff, said Jean Lee, PharmD, clinical pharmacist for HIV medicine at St. Mary's Health Care, Grand Rapids, Mich.

Lee and colleagues reported results from a small EMR study at IDWeek.

At a press briefing, Lee said that the use of electronic medical records "improved patient safety and showed a financial benefit." The reduction of errors was estimated to save the hospital and patients about $25,000 for the 20 patient outcomes analyzed in the retrospective study.

The error rate experienced in Grand Rapids was considerably lower than errors in prescribing drugs for HIV patients at the Cleveland Clinic and at the University of Chicago, other researchers reported. Elizabeth Neuner, PharmD, an infectious disease clinical pharmacist at the Cleveland Clinic found that in a 10-month period, prescribing errors occurred in about half of the 162 HIV patients who were admitted to the hospital – mostly for non-HIV related treatments.

"We had a similar rate of errors," said Natasha Pettit, PharmD, a clinical pharmacy specialist at the University of Chicago. She reviewed data over an 18-month period among 155 patients receiving highly active antiretroviral therapy at her institution.

In her study of 20 patients selected at random, Lee explained that most of the errors involved the timing of medication. "For example," she told MedPage Today, "many HIV patients take their medications at night, but when they were inpatients at the hospital they were given their medications in the morning. That can cause fluctuations in medication levels, which can be problematic for HIV patients."

She also noted that hospitals tend to dose patients at 9 in the morning and 5 in the afternoon "while we tell our patients taking twice daily medication to take the drugs about 12 hours apart," she said.

Before intervention with the electronic medical record, 14 of these "timing" errors occurred in patient treatment, but that was reduced to one such error after implementation of the system, she explained.

Read the full article here.

Sharing EHR notes benefits patients and doctors

alok.prasad@revenuexl.com (Alok Prasad) — Wed, 03 Oct 2012 21:49:00 GMT

Providing patients with access to their physician's notes benefits those patients and does not add to a doctor's workload, according to a new study published this week in the Annals of Internal Medicine.

The one-year quasi-experimental study of 105 primary care physicians and 13,564 patients conducted at Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Pennsylvania, and Harborview Medical Center in Washington alerted patients by email each time their physician posted a note about the patient into the patient's electronic health record. The patient then could access the note through a patient portal.

A large majority opened at least some or all of the notes, and reported an increased sense of control, greater understanding of their medical issue, improved recall of their plans of care, and better preparation for future visits. A whopping 99 percent of patients surveyed recommended that this transparency continue; almost 90 percent believed that open notes would affect their decision when seeking care in the future.

Three out of five patients agreed that the concept should be expanded to allow patients to be able to add to the notes.

The physicians, who initially were concerned that allowing patients to view their notes would increase their burdens and/or worry or offend patients, found that the note-sharing strengthened relationships with some patients and may have improved patient satisfaction and safety, reinforced office visits and provided additional patient education. Almost three-fourths (74 percent) reported that the open access did not cause changes in their practice.

The study's authors suggested that "open notes may be a powerful intervention for improving the health of patients and point to many avenues for future elaboration and inquiry."

Studies have shown that patient access to their EHRs can reduce discrepancies and improve patient safety. They can also boost member loyalty and retain membership.

Read the original article here.

Largest Study Ever Links EHRs With Improved Patient Outcome

Aparna Prasad — Tue, 02 Oct 2012 15:56:00 GMT

A study conducted at HMO giant Kaiser Permanente involving nearly 170,000 patients with diabetes found that use of electronic health records helped significantly reduce A1c levels (average blood glucose over the previous three months) and LDL cholesterol in patients with the highest levels, indicating better monitoring and treatment. Those with lower A1c and LDL values experienced incremental improvements. Since their target levels were under control, they underwent less testing, suggesting electronic health records could actually reduce overtesting.

The study, which appears tomorrow in Annals of Internal Medicine, was conducted between 2004 and 2009 at 17 medical centers in Northern California. During that period, Kaiser Permanente was making the transition from a patchwork of health IT systems and paper charts to Epic Systems at a cost of $4 billion—the largest implementation of a commercial electronic health record. The National Institute of Diabetes and Digestive and Kidney Diseases funded the study.

Patients who were tracked had been Kaiser members since 2003. “We wanted to determine whether an EHR had a positive or negative impact on diabetes patients,” says Marc Jaffe, an endocrinologist at Kaiser, and an author of the study. “It [use of EHRs] helps us target patients.”

Jaffe and his colleagues, including lead author and research scientist Mary Reed, looked at blood tests taken at intervals recommended by the American Diabetes Association, and drug prescriptions. They excluded patients on insulin, because intake was more difficult to gauge, and the bulk of diabetes patients in the registry were on pills. Jaffe posits that the drop in A1c and LDL levels was not only due to a readjustment in dosage or a switch in medication, but also possibly to better compliance to existing medication in patients with the most elevated levels.

At the very least, electronic health records didn’t harm patients. “Skeptics who say the effort and energy that go into implementing an EHR detract from care have clearly been disproved,” says Jaffe. Hopefully, those kinds of promising results can be replicated elsewhere.

Find orginal article here.

No Cap on EHR Incentive Payouts

alok.prasad@revenuexl.com (Alok Prasad) — Thu, 13 Sep 2012 18:29:00 GMT

WASHINGTON – There are no set appropriations for how much the federal government can spend on rewarding providers who adopt and use electronic health records under the Medicare and Medicaid meaningful use EHRincentive program, according to National Coordinator for Health IT Farzad Mostashari, MD.

"Whoever qualifies, gets paid; there's no hard cap," said Mostashari, who gave a keynote at the Annual Policy Summit for the Health Information Management and Systems Society (HIMSS) on Wednesday.

Mostashari said the federal government estimates it will pay out around $20 billion in incentives before the program shifts to a penalty in 2015, but there is no fixed budget set in the HITECH Act that mandated the program. The government recently announced it has paid out nearly $7 billion since the program began in 2011.

The federal health IT czar said he couldn't imagine health IT advancement – which enjoys widespread bipartisan support – losing the backing of Congress after the election, no matter the party in control.

It would be hard to picture Congress cutting or capping the program after doctors and hospitals have made major investments in health IT "on the good word of Congress," he said.

An attendee of the HIMSS Policy Summit – a sort of pep rally for HIMSS members to promote HIT on the Hill – recommended that Congress all be encouraged to use Blue Button to access their personal health data. This would "crystalize quite clearly" where things stand with regard to health IT today. We need more time and support, the attendee said, and Mostashari and other attendees agreed.

Mostashari praised the meaningful use incentive program, noting that "we've made great steps." He predicted that Stage 2, set to begin in 2014, will bring about even more "incredible progress."

The use of electronic health records is "ulitmately about population health," Mostashari said. "You have to care more about the people who didn't walk into your door, than those who did." The meaningful use program is intended to go from measuring quality at the start, to accounting for population health. "That's why doctors are doing what they're doing, [and] that's why we're doing what we're doing," he said of federal regulators.

Government EHR incentives near $7Billion

alok.prasad@revenuexl.com (Alok Prasad) — Fri, 07 Sep 2012 23:19:00 GMT

WASHINGTON – Medicare and Medicaid electronic health record payments are approaching $7 billion since the program's beginning, with $6.9 billion paid out to 143,800 physicians and hospitals in total program estimates through the end of August.

Final figures will be available later this month as the Centers for Medicare and Medicaid captures more complete data.

In August, the agency paid about $500 million in incentives, with about $325 million going to Medicare providers and $175 million to Medicaid providers, “which will bring us knocking on the door of $7 billion in incentive payments issued as of the end of last month,” said Robert Anthony, a specialist in CMS’ Office of eHealth Standards and Services.

As of July, nearly one of five Medicare eligible provider, or about 18 percent are meaningful users of EHRs., he said. Additionally, one of every five Medicare and Medicaid eligible providers has made a financial commitment to an EHR, he said. And 55 percent of eligible hospitals have received an EHR incentive payment for meaningful use.

As of July, 271,105 Medicare and Medicaid physicians and hospitals have registered to participate in the incentive program, tracking at about 10,300 monthly, he said. Breaking down the total, that’s 180,513 Medicare physicians, 86,708 Medicaid clinicians and 3,884 hospitals.

Read the full article here.

Five groups named permanent EHR certifiers

alok.prasad@revenuexl.com (Alok Prasad) — Fri, 31 Aug 2012 20:18:00 GMT

Even though the new regime for testing and certifying electronic health-record systems under the federal EHR incentive program won't take effect until October—and testing against newly released criteria might not begin until year's end—federal authorities have given five organizations the OK to certify software for that program.

HHS' Office of the National Coordinator for Health Information Technology has authorized the Certification Commission for Health Information Technology, the Drummond Group, ICSA Labs, InfoGard Laboratories and Orion Register to serve as certification bodies under the EHR incentive payment program, according to ONC spokesman Peter Ashkenaz. The program was established by the American Recovery and Reinvestment Act.

C. Sue Reber, spokeswoman for one of the five, the Chicago-based CCHIT, said the news came in a conference call with the ONC on Tuesday.

In July, all five organizations were accredited by the American National Standards Institute as certification bodies and by the National Voluntary Laboratory Accreditation Program as accredited testing laboratories for EHR systems.

Back in January 2011, the ONC published a final rule creating permanent and separate EHR testing and certification programs for the incentive payment programs run by Medicare and state Medicaid agencies. The permanent programs replace a temporary testing and certification regime set up to get the EHR incentive program off the ground. Under the temporary program, EHR testing and certification functions were combined and performed by the same organizations.

Read the full article here.