Federal Grant Program Geared Toward Rural Health IT Adoption

The Health Resources and Services Administration at HHS has announced it will dole out $12 million in up to 40 grants to help rural hospitals and physicians meet meaningful use criteria, AHA News reports.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments (AHA News, 4/28).

Grant Details

The grants will be distributed through the Rural Health IT Network Program to rural health care providers who work in formal alliances, coalitions, networks or partnerships (Barr, Modern Healthcare, 4/28).

The grant funding can be put toward:

• Buying health IT equipment;


• Developing strategic plans; and


• EHR training (AHA News, 4/28).

The grant synopsis said that after finishing the grant program, "a network should have completed a thorough strategic planning process, business planning process and have a sound strategy in place for sustaining its operations."

This article was originally posted at http://ping.fm/xNcyw

Physical Security for Data Centers

Well-publicized health information breach incidents are serving as important reminders that paying attention to the physical security of data centers is a vital component of any information security strategy.

For example, in the largest breach reported so far under the HITECH Act breach notification rule, insurer Health Net says 1.9 million individuals may have been affected when server drives were discovered to be missing from a data center managed by IBM (see: Health Net Breach Tops Federal List). While details about the incident remain sketchy, the breach reinforces the need to pay attention to physical security details.

The HIPAA security rule spells out more than a dozen requirements for physical security, says Andrew Weidenhamer, audit and compliance manager at SecureState (See: Physical Security: Timely Tips). The National Institute of Standards and Technology offers HIPAA security rule compliance guides, he points out.

Key Physical Security Steps

The three most important physical security steps to take to protect data centers, Weidenhamer says, are:

• Make sure that all critical servers are housed behind locked doors using auditable access control measures;


• Limit data center access to only those individuals who have a legitimate need;


• Ensure that visitors, contractors and others are always escorted within the secure area.

Montgomery County Memorial Hospital, a 25-bed critical access facility in Red Oak, Iowa, takes all these steps at its new data center in a recently opened addition to the hospital, says Ron Kloewer, CIO.

All hospital employees use RFID proximity badges that enable them to open doors to restricted areas, based on their roles. Only about eight staff members have access to the data center, he notes.

A camera at the door to the data center ensures that "every coming and going from the data center is recorded," he adds. And directory maps of the hospital don't display the location of the data center.

PCI, HIPAA Compliance

An often overlooked physical security measure involves making sure that vendors hired to handle offsite storage of backup media have demonstrated their compliance with all relevant federal regulations, including HIPAA and the Payment Card Industry Data Security Standard, or PCI DSS, Weidenhamer says.

He also urges healthcare organizations to encrypt backup tapes, as well as all media and devices that store protected health information. "Encryption is the single best way to protect sensitive data," he notes. "Healthcare organizations are going to be in a much better position in the event they are breached if the data is encrypted."

A recent major health information breach incident illustrates the value of encrypting backup tapes. New York City Health and Hospitals Corp. notified 1.7 million individuals of a breach that occurred when unencrypted backup tapes were stolen from a truck that was transporting them for offsite storage (See: New York Breach Affects 1.7 Million).

Montgomery County Memorial Hospital will implement encryption of its backup tapes stored offsite in the coming weeks, Kloewer notes. Plus, it's developing a strategy for encrypting drives on servers in its data center.

"Healthcare organizations need to perform a data flow analysis to determine where all sensitive data is located, classify these assets and data and then implement security controls," Weidenhamer stresses.

Business Continuity

A good business continuity plan also can help ensure the integrity, availability and security of information, Kloewer notes.

The Iowa hospital has a fiberoptic link to an offsite backup data center for use in an emergency, he notes. To hold down costs, the hospital didn't use a suspended ceiling in its new data center, keeping it open instead so that heat would not be trapped near equipment if redundant cooling systems failed.

For more information on Montgomery County Memorial Hospital's security strategies, see: Security Spending Up at Rural Hospital.

This article was originally posted at http://ping.fm/j2hC1


 

 

CMS says more docs opting for evidence of effectiveness in treatments

More physicians are participating in “pay for reporting” programs that focus on using quality measures and electronic prescribing, according to the Centers for Medicare and Medicaid Services.

Its data also shows that physicians are increasingly turning to treatments that offer the best evidence of effectiveness.

In a report covering the results of the 2009 Physician Quality Reporting System and the ePrescribing Incentive Program, the agency’s most up-to-date data, CMS said that 119,804 physicians and 12,647 practices who reported data on quality measures to Medicare received a total $234 million compared with $36 million paid out in 2007, the first year of the program.

Under the e-prescribing program, CMS paid $148 million to 48,354 physicians in 2009, the first payment year for the program.

The quality reporting and e-prescribing programs are part of a broad effort to encourage providers to adopt practices that improve patient care.

Earlier this year, CMS launched the Medicare and Medicaid EHR Incentive Program, through which providers can quality for incentive payments for becoming meaningful users of certified electronic health records EHRs).

Physicians will also see data on how well they perform compared with their peers on quality measures as CMS’ Physician Compare Web site expands to include quality information by 2013.

Many of the participants in the quality reporting program practice in office settings, according Dr. Donald Berwick, CMS administrator.

“This is the care setting for which we have the least amount of data about quality of care,” he said in announcing the results April 19. The quality reporting and e-prescribing programs offer a means through which to assess the quality of care that patients receive in ambulatory settings, he added.

Information from the quality reporting program demonstrate growing rates in how often providers report that they are using evidence-based care practices. By collecting data about care practices, CMS can identify improvements in care for Medicare beneficiaries, and ultimately all Americans, Berwick said.

[See also: CMS to fine-tune technical guidelines for standards in stage 2.]

Providers have increased the frequency of using the recommended care by 10.6 percent based on 99 quality measures, according to the report.

Physicians most frequently reported measures that they had adopted and used EHRs to help manage patient care; worked with patients with diabetes to control blood sugar to lessen potential complications of the disease; and performed electrocardiograms in the emergency department to help diagnose patients with chest pain for a potential heart attack.

In 2009, physicians showed improvement over 2007 rates in stopping post-surgical antibiotics to prevent overmedication and the formation of potentially drug-resistant "superbugs," communicating with patients with diabetes about potentially damaging eye-related complications; and recommending beta-blocker drugs to patients with a specific form of heart failure.

This article was originally posted at http://ping.fm/87V49

 

AAFP Calls for 'Robust Investment' in Primary Care Physician Workforce

Federal investment in health careis necessary to "transform health care to achieve optimal, cost-efficient health for everyone," said the AAFP in recent written testimony (4-page PDF; About PDFs) to the House Appropriations Committee. That is why the Academy is urging the committee to make a robust investment in the nation's primary care physician workforce by financially supporting programs critical to building and strengthening the nation's primary care physician pipeline.

"We recognize the difficult decisions (that) our nation's budgetary pressures present," said the AAFP. However, the Academy urged the House Appropriations Subcommittee on Labor, Health and Human Services, and Education "to make a robust fiscal year 2012 investment in our nation's primary care physician workforce ... to ensure that it is adequate to provide efficient, effective health care delivery addressing access, quality and value."

Specifically, the Academy called on the committee to provide at least $449.5 million for training programs covered by Title VII of the Public Health Service Act and administered by the Health Resources and Services Administration, including at least

• $140 million for primary care training and enhancement as authorized by Title VII, Section 747 of the Public Health Service Act;


• $10 million for development grants for teaching health centers; and


• $4 million for rural physician training grants.

Failure to provide adequate funding for Title VII programs "would destabilize ongoing efforts to increase education and training support for family physicians, exacerbating primary care shortages and further straining the nation's health care system," said the AAFP."We urge the committee to increase the level of federal funding for primary care training to reinvigorate medical education (and) residency programs, as well as academic and faculty development in primary care to prepare physicians to support the patient-centered medical home."

The AAFP called for other funding increases, as well, including President Obama's requested funding of $418.5 million for the National Health Services Corps and at least $405 million for the Agency for Healthcare Research and Quality, or AHRQ.

"AHRQ's investment in patient-centered outcomes research will help Americans make the informed decisions we must make to focus on paying for quality rather than quantity," said the AAFP. "By determining what has limited efficacy or does not work, this important research can spare patients from tests and treatments of little value."

Among other programs that are critical to the primary care physician pipeline, according to the AAFP, is the teaching health center program, which provides resources to qualified, community-based, ambulatory care settings that operate as primary care residency programs. These settings include federally qualified health centers, rural health clinics, community mental health centers, health centers operated by the Indian Health Service and centers that receive Title X grants.

In addition, the Academy continues to call for reforms to graduate medical education programs that encourage training of primary care residents in nonhospital settings, which is where most primary care is delivered.

"We were pleased that the Patient Protection and Affordable Care Act authorized a mandatory appropriations trust fund of $230 million over five years to fund the operations of teaching health centers," the AAFP said. "However, if this program is to be effective, there must be funds for the planning grants to establish newly accredited or expanded primary care residency programs."

The Academy also addressed rural health needs in its testimony. For example, the Rural Physician Training Grants Program helps medical schools recruit students who are more likely to practice medicine in rural communities. "This modest program ... will help provide rural-focused training and experience and increase the number of recent medical school graduates who practice in underserved rural communities," the AAFP said.

This article was originally posted at http://ping.fm/1dcv1

Care for the Underserved, Interprofessional Learning Focus of Student-run Clinic

For more than two months, medical and nursing students from Case Western Reserve University, or CWRU, in Cleveland have been training together as they provide primary care at a student-run clinic for the city's underserved. Supervised primarily by family physicians, the interprofessional teams participating in this pilot manage all aspects of patient care, from preliminary intake and assessment of vitals to clinical evaluation and plan of care.


The CWRU Student-run Free Clinic, which is scheduled to open officially in October, is one component of an interprofessional learning initiative aimed at bringing together students from the CWRU School of Medicine and Frances Payne Bolton School of Nursing to learn to work as health care partners for patients. These future physicians and nurses have the opportunity to collaborate not only in clinical care but also in the daily management and administration of a community clinic.

Organized as part of a vision to increase access to care for the underserved in Cleveland, the clinic represents a collaboration with The Free Medical Clinic of Greater Cleveland, which has a nearly 40-year history of serving as a critical health safety net for patients in Cleveland. The clinic is designed to be self-sustaining, and participating students raise money themselves for operating expenses.

"There's a lot of energy among the students," said George Kikano, M.D., chairman of the family medicine department. "The idea is that the medical and nursing students learn together."

Collaboration Right From the Beginning

Tammy Wang, a third-year medical student and one of the four founders of the clinic, told AAFP News Now that the clinic's founders -- two medical students and two nursing students -- received encouragement from both the medical school and the nursing school. Working together for more than a year, the student founders set up the clinic's organizational structure.

For patient care, a medical student and a nursing student are paired as a team. The team performs patient histories and physical exams, presents findings to attending preceptors, usually family physicians, and discusses appropriate plans of care, including medications and connections to community resources.

The collaboration continues outside of the clinic sessions, with medical and nursing students working together to plan all logistics for the clinic. The clinic's board of directors, in fact, is made up of seven medical students and four nursing students.

It is anticipated that both CWRU medical and nursing students will acquire team-building skills as they voluntarily participate in the student-run free clinic, according to Wanda Cruz-Knight, M.D., who is an assistant professor in the medical school's family medicine department, director of the school's predoctoral program and faculty adviser to students in the clinic.

And, she added, the fact that the clinic is being managed by the medical and nursing students allows them to incorporate aspects of business, office practice and clinical models they've identified as being effective.

Mutual Respect and Effective Communication

"Working with nursing students has absolutely been a valuable experience," Wang said. "Though we have differences in our training, our skills can still complement one another to provide more comprehensive patient care.

"Working together at this point in our education builds mutual respect and effective communication skills for two disciplines that traditionally may have held some biases toward one another," Wang added.

Nicholas Kucher, a first-year medical student, leader of the campus family medicine interest group and volunteer coordinator of the clinic, agreed. "We're all learning as we go, but working with each other is key, because there is so much to coordinate and new issues are popping up," said.

"The key point that we want participants to take away is that medicine is no longer centered around someone with an M.D. It is centered around the patient, and different perspectives and training, such as with nurse practitioners, are important in providing the best possible treatment," Kucher added.

Alyssa Wagner, a first-year nursing student and a clinic director, told AAFP News Now that nursing students also gain special knowledge from the collaboration.

"The nursing students get to learn more about differential diagnoses, we both (medical and nursing students) get to work on our assessment skills, and the medical students get to participate in patient education. We get to use the strengths from each of our fields to provide the best care we can for our patients," she said.

After each of the clinic sessions during the recently completed pilot, the medical and nursing students met to discuss what went well, what didn't and what could be improved. They're using the results of this exercise to design a patient satisfaction and well-being survey that will set measures for future quality assessment and improvement activities.

Medical Education Benefits

CWRU's collaborative learning initiative offers a real-world model of recommendations in the Joint Principles for the Medical Education of Physicians as Preparation for Practice in the Patient-Centered Medical Home (12-page PDF; About PDFs) issued by the AAFP and other primary care groups last December.

Promulgated as a guide to the education of physicians in the context of a reformed health care environment that will rely heavily on primary care, the principles say, for example, that medical students should learn to work effectively with others as a member or leader of a health care team. Students also should be able to articulate the roles, functions and working relationships of all members of the team and apply knowledge of leadership development, quality improvement, change management and conflict management.

AAFP Vice President for Education Perry Pugno, M.D., M.P.H., who helped develop the joint principles, praised the CWRU initiative as embodying many of the concepts on which those principles were founded.

"This program is a prime example of what we hoped to accomplish in the creation of the new joint principles -- namely, an immersion experience for health professions students in actually delivering patient care in a highly functional interdisciplinary setting," Pugno told AAFP News Now. "This isn't just book learning; it's pragmatic hands-on learning."

And the learning continues.

Wang said the students presently are analyzing data from the four pilot clinic sessions, which provided care to more than 50 patients, and considering strategies to improve clinical care. Possible future directions include the incorporation of additional professional schools to provide patients with even more resources, she said. 

The latest challenge: adopting electronic medical records

For those of you who do not know me personally, I am an internist and have been in private practice in central Florida for more than 30 years. Like so many of you, I have had to make changes -- expensive changes -- over the years to keep my office up to date, my practice competitive, and to provide better service to my patients.

Right now, one of the biggest challenges small offices like mine are facing is the requirement to adopt health information technology -- health car IT -- such as electronic medical records and electronic prescribing systems. Both are good ideas. Both ultimately will improve efficiency and should allow physicians to do more of what we are trained to do, and that is spend time with our patients.

Many physicians, however, are seeing a very rough passage between the here and now and full adoption of electronic medical records.

As a voice for America's physicians, the AMA is involved both in Washington and on the ground to ease the transition.

In December, the AMA was one of several dozen professional associations that co-signed a letter to Health and Human Services Secretary Kathleen Sebelius about the inconsistencies in requirements between the federal e-prescribing and EMR incentive programs. We petitioned for relief until those inconsistencies are rectified. The most troubling thing about the inconsistencies is a policy in the electronic prescribing program that will penalize physicians in 2012 if they do not e-prescribe in the first six months of 2011.

The AMA believes the penalty policy is unreasonable in that it will force physicians to purchase stand-alone e-prescribing software just to avoid penalties -- software most of them will end up discarding when they transition to a complete EMR system.

Under law, physicians cannot receive incentives from both programs simultaneously, yet they will face a penalty if they decide to participate in one over the other.

A subsequent report by the Government Accountability Office echoed the AMA's concerns about inconsistencies within the two federal health IT incentive programs.

As AMA Secretary Steven J. Stack, MD, has stated, "We continue to urge immediate action by CMS to harmonize the conflicting e-prescribing and [electronic health record] incentive programs in order to support effective health IT adoption."

Since the inception of requirements for the federal EMR incentive program, the AMA has strongly advocated for greater flexibility in adopting the meaningful use requirements for EMRs so more physicians can successfully participate.

We submitted comments to HHS during the creation of the first stage of meaningful use criteria and more recently responded to the proposed stage 2 criteria to help ensure physicians are not overly burdened with requirements that would prevent them from successful participation in the incentive program.

A survey by the Markle Foundation in February showed that nearly half of physicians indicate they are "not too" or "not at all" familiar with meaningful use requirements.

Not surprisingly, a recent Black Book Rankings user survey found that fewer than 10% of EMR purchasers are on track to meet meaningful use requirements.

More than 90% said they lack substantive support from EMR vendors, and 89% have delayed implementation because of the cost of additional support from EMR vendors and/or consultants. Significant numbers of others said they lacked trained staff (or available staff) to properly implement an EMR system or are unprepared and underfunded to rectify the difficult system interfaces.

It's a difficult situation all the way around for many physicians, made worse by the feeling by many practices that they must move quickly to adopt a complete health IT solution.

Make no mistake: The AMA is committed to widespread health IT adoption that can help streamline the clinical and business functions of a practice, but this takes time. We are working hard to help physicians understand the requirements of the federal incentive programs and how they can qualify for them. Even more important, we want to advise physicians to take the time to find the right solution for their practice.

While federal incentives for demonstrated meaningful use of electronic medical records begin this year, physicians don't have to rush into adopting a system today. If a practice reports on just the last 90 days of the year, that will qualify for meaningful use incentives, and practices even can wait to adopt a solution until 2012 and be eligible for full payment under the meaningful use program. Physicians should take the time to explore their practice needs, assess their practice's readiness to adopt health IT and select the right system for the practice -- and its patients.

Recognize that there are alternatives to implementing more complex systems, such as adopting a certified patient registry and certified e-prescribing application that also can qualify a doctor for stage 1 of meaningful use incentives and may be sufficient alone, or in conjunction with other modules, to qualify for subsequent stages as well. Such an approach can cost less, be easier to implement and be far less disruptive to work flow. But no matter the decision, it should be made with care and deliberation. In the Black Book Rankings survey, 82% of those who adopted health IT programs reported that a hurried selection of an EMR vendor produced negative consequences.

Dr. Thomas Fuller, a 17th-century British physician, noted, "All things are difficult before they are easy." That is certainly the case with EMRs.

In addition to advocating on behalf of physicians in Washington, the AMA is on the ground with support for physicians' offices that are moving forward in adopting health IT.

To this end, the AMA has many free resources available to help physicians with successful selection, purchase and implementation of health IT. We have information and tools to help physicians better understand the federal incentive program requirements and a wealth of additional health IT resources. You will find it all online (www.ama-assn.org/go/hit).

Today and always, the AMA is committed to supporting the physician community as we try to find a way through these murky waters.

This article was originally posted at http://www.ama-assn.org/amednews/2011/04/04/edca0404.htm

Obama deficit plan includes strengthened Medicare pay board

President Obama on April 13 rebutted a House Republican plan to trim $4 trillion worth of federal deficits over a decade with his own proposal that he said would protect guaranteed benefits in Medicare and Medicaid.

Obama also proposed that the Medicare Independent Payment Advisory Board be directed to enact even deeper reductions than outlined. The 15-member board was created by the health system reform law to improve Medicare quality and cut costs when the program's per capita growth rate exceeds specific targets. The IPAB, which is set to begin its work Jan. 15, 2014, could call for pay cuts to physicians and others that could be overridden only by substantial majorities in both houses.

GOP leaders have vowed to repeal the IPAB and the rest of the health reform law. A bill by Rep. Phil Roe, MD (R, Tenn.), that would accomplish the former had 83 co-sponsors, including four Democrats, at this article's deadline.

The American Medical Association also opposes the IPAB as structured, noting that physicians already are subject to deep pay cuts under Medicare's sustainable growth rate formula that lawmakers have had to override.

"We have strong concerns about the potential for automatic, across-the-board Medicare spending cuts because they are not consistent with meeting the medical needs of patients, which is our primary focus," said Ardis Dee Hoven, MD, chair of the AMA Board of Trustees.

Obama, however, proposed using the strengthened authority for the IPAB and other health care savings in his proposal to pay for a reform of the SGR formula, estimated to cost $300 billion over a decade.

The other health care proposals in the Obama deficit plan include limiting states' ability to draw higher Medicaid payments through funding loopholes and establishing tighter limits on prescription drug spending in Medicare and Medicaid. The president also proposed establishing a single rate for federal Medicaid payments that would increase automatically during recessions.

Obama said he would oppose any reform that fundamentally alters the commitments the nation has made -- in the form of Medicare and Medicaid -- to health care for seniors, the poor and the disabled. The GOP's budget plan would limit federal health spending by changing Medicare into a voucher program that would help seniors buy private coverage. It also would reduce federal Medicaid payments to states and allow states more flexibility on how they run their Medicaid programs.

Obama criticized the House Republican plan -- known as the Path to Prosperity -- for including $1 trillion in tax cuts to wealthier Americans while asking middle- and lower-income people to pay more for health care and college.

"In the last decade, the average income of the bottom 90% of all working Americans actually declined," Obama said. "Meanwhile, the top 1% saw their income rise by an average of more than a quarter of a million dollars each. That's who needs to pay less taxes?" Obama also said he would not approve further extension of the Bush tax cuts to wealthier people.

The House adopted the GOP's fiscal 2012 budget plan by a vote of 235-193 on April 15, with no Democratic support and only four Republicans voting against it. The budget resolution would set fiscal 2012 spending limits for Congress, but it faces strong opposition from Democratic leaders in the Senate.

2011 cuts affect reform

Congress and Obama avoided a partial government shutdown on April 8 by agreeing to about $38 billion in reductions over the previous year in a fiscal year 2011 spending measure that will fund the federal government until Oct. 1. In doing so, Obama and congressional Democrats agreed to cut or repeal three programs in the health reform law, including:

• Ending the Consumer Operated and Oriented Plan, created to foster the development of nonprofit health plans in individual and small group markets.


• Ending the Free Choice Voucher program to allow certain workers in 2014 to use their employers' contribution on health coverage to pay premiums for a health insurance exchange plan or a private health plan.


• Reducing the State Health Access Grants program, which awards money to states to help them expand affordable health care coverage to the uninsured.

In addition, the deal repeals $3.5 billion in performance bonus payments to states that meet certain enrollment goals in Medicaid and the Children's Health Insurance Program. The 2009 CHIP reauthorization created the program.

House Republican support for the 2011 spending bill wavered before the House adopted the package on April 14 on a 260-167 vote. In part, GOP reluctance came from the fact that the Congressional Budget Office concluded that only $352 million of the cuts actually would affect spending in fiscal 2011, which ends on Oct. 1. The CBO also said the measure would cut spending by up to only $25 billion between 2012 and 2016, with the rest of the cuts only reducing dollars Congress is authorized to spend, not dollars Congress is likely to spend.

Fifty-nine House Republicans joined the majority of Democrats to vote against the 2011 spending package on April 14, but 81 Democrats crossed the aisle to help adopt it. The Senate approved the measure 81-19, and Obama signed it into law on April 15.

The CBO did not detail which cuts it deemed part of the $25 billion of real cuts. However, a House Appropriations Committee summary of the $38 billion package outlined about $1.5 billion in cuts to health programs, including $600 million in reduced funding to community health centers.

"This cut is especially perplexing at a time when our nation and the Congress are focused on reducing health care costs," said Tom Van Coverden, president and CEO of the National Assn. of Community Health Centers.

This article was originally posted at http://www.ama-assn.org/amednews/2011/04/25/gvsa0425.htm

 

 

Homeland Security plans EHR for detainees

The Homeland Security Department plans to acquire an electronic health record system to improve the quality and efficiency of its health care for illegal aliens and other foreign fugitives detained by the Immigration and Customs Enforcement agency.

DHS clinicians and staff at 22 locations will use the electronic health record (EHR) to replace the current manual and stand-alone automated systems.

[See also: VA, citing taxpayer savings, seeks open source EHR.]

DHS is gauging vendor expertise to deploy a comprehensive system for patient operations, reporting and statistical analysis within a correctional environment, according to a request for information announcement in Federal Business Opportunities.

The agency anticipates awarding a contract in September to deploy the EHR system in fiscal 2012 as part of a five-year contract.

The potential vendor’s system must be certified by an organization authorized by the Office of the National Coordinator for Health IT as meeting the functions for meaningful use requirements. Those features include being able to exchange patient records using standard summary care and message formats when detainees move between facilities.

[Related: ONC's draft Federal Health IT Plan: Realistic in a reasonable timeframe?]

The system should also be able to perform detainee intake screening, scheduling, master medication list management and clinical decision support, according to the notice.

Last year, DHS published an announcement for such a system but ran into delays in the solicitation process, so it released another request for information, April 6 with responses due April 25.

This article was originally posted at http://ping.fm/RJLFY

 

HHS releases 2012 justification for funding requests

"OCR’s requested budget will support our ability to protect the public’s right to equal access and opportunity to participate in and receive services from all the Department of Health and Human Services’ (HHS) programs without facing unlawful discrimination, and to protect the privacy and security of individuals with respect to their personal health information.

 

OCR’s performance objectives are in line with HHS’ objectives for transforming the healthcare system, increasing access to high quality, effective healthcare; promoting the economic self-sufficiency and well-being of vulnerable families, children and individuals; and reducing disparities in ethnic and racial health outcomes.

Lastly, a 

recent program assessment demonstrated our continued commitment to use our human capital effectively and efficiently to achieve results in support of our nondiscrimination and privacy compliance mission. OCR has made progress in achieving results to support HHS-wide initiatives to improve the health and well-being of the public. To ensure continued results, individual performance plans at all levels of OCR’s leadership and staff are focused on achieving the goals and objectives set out in our organizational performance plan. In this way, all OCR staff are working together to achieve our shared objectives in protecting civil rights and the privacy and security of health information."

Read the Full Report Here.

Survey Names EHRs Most Likely to Help Physicians Earn Bonus

Clinicians with electronic health record (EHR) systems from Epic Systems and Greenway Medical Technologies may be best prepared to qualify for federal incentive payments for using the technology in a "meaningful" way, according to KLAS, a firm that researches medical software and services.

The 2 products also were customer favorites in a KLAS ranking of EHRs for medical practices published in December. Greenway's software took top honors among medical practices of 6 to 25 physicians, while the Epic program was number one among groups with more than 100 physicians.

The economic stimulus legislation of 2009 — known as the American Recovery and Reinvestment Act — authorized up to $44,000 under Medicare and almost $64,000 under Medicaid to physicians who demonstrate "meaningful use" of an EHR system as defined by the US Department of Health and Human Services. In so many words, meaningful use amounts to improving and streamlining patient care with the digital technology.

To qualify for the incentive cash, clinicians must satisfy 15 meaningful-use criteria considered "core" along with any 5 from a menu of 10 additional criteria. They can begin to report, or attest, to CMS on Monday, April 18, that they are meeting the requirements this year, the first year for the incentives to be paid out. For more information on registering for the incentive program and how to attest to meaningful use, visit the CMS Web site.

Many Providers Naively Optimistic About Receiving Bonus

KLAS surveyed 597 healthcare providers about 8 areas of EHR meaningful use, some of which include more than 1 criterion:

• Using computerized provider order entry for medication;


• Transmitting prescriptions electronically;


• Implementing drug-drug and drug-allergy alerts;


• Giving patients electronic access to their health information;


• Reporting clinical quality measures to CMS or state Medicaid programs (an example of data mining);


• Maintaining active medication, problem, and medication-allergy lists;


• Charting progress notes; and


• Implementing 1 clinical decision-support rule — in other words, a clinical alert — and tracking compliance to it (an example of a clinical alert might be a reminder to order an eye exam each year for a patient with diabetes; drug-drug and drug-allergy alerts do not count for this requirement)

According to KLAS, 80% of respondents say they are confident that they will satisfy meaningful-use requirements by year's end. However, KLAS states that this optimism is largely naive because most respondents are struggling to make the grade in 2 areas. Less than 35% are giving patients electronic access to their health information, and only about half have implemented a clinical alert. On a scale of 1 to 9, respondents scored the ability of their EHRs to provide these functions at 6.7.

KLAS notes that although EHRs must be certified by testing organizations as capable of meeting meaningful-use requirements, "not every vendor is successful in delivering those capabilities to their customers."

Epic EHR users reported the deepest adoption of all key meaningful-use functions, and its system scored highest in giving patients digital access to their record, thanks to the success of the company's patient portal, called MyChart. Greenway customers — 96% of them — are the most confident about receiving a bonus in 2011, and they are heavily implementing most of the meaningful-use functions of their software.

KLAS calls Epic and Greenway the "safest bests" for meaningful-use success. The riskiest bets for EHRs, according to KLAS, are from 3 vendors: Praxis, SRSsoft, and simplifyMD.

The KLAS report is available for purchase on the company's Web site. The price for physicians is $980. Physicians can look up survey data on individual vendors free of charge if they first complete an online questionnaire about the medical software, equipment, or computer services used in their practices.

This article was originally posted at http://www.medscape.com/viewarticle/740769

New study estimates cost to implement EHR systems

The American Recovery and Reinvestment Act of 2009 made a significant investment to encourage the adoption of electronic health records (EHRs) by healthcare providers and the chiropractic industry.

Under the new program, due to begin in 2011, physicians — including DCs — are eligible for incentive payments totaling more than $40,000 for meeting EHR standards developed by the U.S. Department of Health and Human Services.

Conversely, healthcare providers who have not implemented EHR technology by 2014 will face Medicare fee schedule reductions.

According to a new study, total cost to purchase and implement electronic health record systems averages $46,000 for a primary care practice staffing five

physicians. Researchers in Texas studied 26 practices of various sizes that were a part of HealthTexas Provider Network.

Because of variables in practices, the average cost per physician might not convey exactly to smaller, independent practices. Researchers found that the average cost to develop an EHR infrastructure included approximately:

• $25,000 per practice for cables and wireless Internet


• $7,000 per physician for personal computers, printers and scanners


• $17,100 in maintenance costs per physician for the first year, which included software licensing fees, domain hosting, technical support and networking costs.

To read more about the study, click here.

 

 

Rural Texas Hospitals Eye EHRs

Seven rural hospitals in Texas will implement certified electronic health records software from two Texas-based vendors to go after meaningful use incentive payments.

Cameron-based Central Texas Hospital, with six facilities totaling 305 beds, will do a fast-track deployment of integrated and Web-hosted clinical/financial management software from eCareSoft, Austin. The new vendor is a subsidiary of Expert Sistemas Computacionales, which has a 40 percent market share in Mexico and now is targeting small and mid-sized hospitals in the United States.

Eastland (Texas) Memorial Hospital on March 1 started implementing the ChartAccess Comprehensive EHR from Prognosis Health Information Systems, Houston. The 52-bed hospital expects to start its 90-day attestation period on May 31.

The EHR will integrate with billing, laboratory, pharmacy, radiology and other ancillary systems, and will serve as the centralized data repository. Eastland Memorial also will join the Texas Regional Health Information Organization.

--Joseph Goedert

This article was originally posted at http://ping.fm/yhCOF

Top 10 issues for health plans in 2011

The Managed Care Executive Group, a national organization of U.S. senior health plan executives, met last week in Arizona to discuss the top issues that health plans face in 2011.

The 22nd Annual Forum, lead by industry thought leaders such as Dr. David Brailer, Thomas Main, Dr. Karen Bell, Jeff Margolis and 14 other invited healthcare experts, focused heavily on the forward progression of healthcare retail, enabling innovation and technology, payment reform, and the rising role of consumers via social media and individual markets including Medicaid and Medicare.

Each year The Managed Care Executive Group polls health plan executives and industry thought leaders across the country via surveys, webinars and other events to compile a list of issues impacting health insurance organizations. At their yearly forum the executives voted their "Top 10" issues, as represented below.

This year's list changed quite significantly from a year ago when the list was dominated by the role of government. "In such a rapidly changing environment, MCEG members and nationally recognized executives offered additional clarification and guidance on how health plan priorities continue to evolve and what they can do to address them," said Alan Abramson, the outgoing chairperson of MCEG, SVP and CIO of HealthPartners, and Emeritus MCEG board member. "The discussions were invaluable for our members to survive and thrive in 2011 and beyond."

Voted as the Top 10 issues in 2011 for health plans:

1. Administrative Mandates (Compliance HIPAA 5010, ICD-10, etc.).


2. Care Management, Data Analytics, and Informatics.


3. Health Insurance Exchanges and Individual Markets.


4. New Provider Payment & Delivery Systems (ACOs, PCMHs, etc.).


5. Bend the Cost Trend.


6. Medicare and Medicaid.


7. Health Information Exchanges and EMRs.


8. Consumer's Role in the Modernization of Healthcare.


9. Reform Uncertainties.


10. Payer/Provider Interoperability.

"These issues, and others that become critical, will continue to be the topics of additional webinars, white papers and discussions over the next year within MCEG," said Vince Ferri, VP & CIO of AvMed Health Plans, and the newly elected chairperson of MCEG. "We invite all health plan executives to join us in addressing these priority issues with a focus on enhancing collaboration and working on affordability."

Click here to read full descriptions of the top ten issues.

Bill would post every physician's Medicare billing data on Internet

A Senate bill aimed at curtailing Medicare fraud would publish physician billing data online, letting viewers determine how much individual doctors earn annually from the program.

The release of the data has been prohibited by a court ruling for more than 30 years. But some lawmakers recently stepped up their efforts to lift the ban and bring Medicare billing data to light to prevent fraud.

Sen. Charles Grassley (R, Iowa) introduced a program integrity measure before a Senate Finance Committee hearing on Medicare and Medicaid fraud on March 2. The bill in part would require the Dept. of Health and Human Services by the end of 2012 to start publishing Medicare claims and payment data on the website USAspending.gov.

In making the information public, the government could help prevent billions of dollars each year from going to those defrauding the program, Grassley said. Sen. Ron Wyden (D, Ore.) said he was drafting his own legislation that would make Medicare claims data publicly available.

"More transparency about billing and payments increases public understanding of where tax dollars go," Grassley said. "The bad actors might be dissuaded if they knew their actions were subject to the light of day."

But the American Medical Association, along with HHS, has opposed challenges to the decades-old ban on publicizing the information. Physician organizations have said allowing public access effectively could permit anyone to determine how much an individual doctor makes in a year, especially if that doctor has a patient population that is mostly Medicare. Publicizing raw claims data without any necessary context would be of dubious anti-fraud value, they said.

"Releasing Medicare claims data to the public does not further the goal of combating fraud, as those tasked with this responsibility already have access to the data," said Ardis Dee Hoven, MD, chair of the AMA Board of Trustees.

However, Grassley said the government is not the only entity trying to smoke out Medicare fraud. During the Finance hearing, he cited a recent series of Wall Street Journal articles that examined Medicare claims from 1999, 2001 and 2003-08. Under a special arrangement, the journal, working with the Center for Public Integrity in Washington, D.C., paid the Centers for Medicare & Medicaid Services $12,000 for a 5% sample of the Medicare carrier payment file for those years. The newspaper reported that it was able to identify tens of thousands of physicians and other health professionals who could be considered outliers based on the relatively large amounts they billed Medicare in those years.

However, the journal could not name the physicians based on its data usage agreement with CMS. That policy stems from the federal court decision that protects the privacy of the physician data.

"I think it's time to revisit this decision and make some transparency of payment physicians receive from Medicare," said Grassley, a long-time farmer. "Pretty much like you will see Chuck Grassley's name in the newspaper sometimes that I've gotten a farm subsidy through the U.S. Dept. of Agriculture."

Reviving an old court fight

In 1978, the Florida Medical Assn. and six physicians filed a class-action lawsuit to prevent the predecessor department to HHS from disclosing a list of all medical professionals who received Medicare payments the previous year. The AMA joined the lawsuit as a plaintiff in June 1978.

In October 1979, the judge in the case ruled that individual billing data were exempt from public disclosure laws and barred the department "from disclosing any list of annual Medicare reimbursement amounts, for any years, which would personally and individually identify those providers of services under the Medicare program." The ruling protects AMA members and doctors in Florida, but HHS has applied the prohibition to all physician billing data.

Several recent challenges to the 1979 ruling have failed. In 2009, an appeals court decided that the government was not required to release claims information to the marketing firm Real Time Medical Data based in Birmingham, Ala. The same year, another appeals court denied a similar request from Consumers' Checkbook/Center for the Study of Services, a nonprofit consumer organization based in Washington, D.C. In that case, the court said release of the data was an "unwarranted invasion of personal privacy."

In the latest legal challenge, The Wall Street Journal's parent company, Dow Jones & Co., filed motions on Jan. 25 to reopen the 1979 case and intervene as a defendant. A federal judge is scheduled to hear arguments on these motions on April 14.

The paper said the original decision prevented reporters from naming physicians they believed were defrauding the Medicare program.

In a series of articles, titled "Secrets of the System," the newspaper cited doctors with questionable billing records. For instance, one New York family physician took in more than $2 million in 2008 from Medicare, the journal reported.

The AMA, meanwhile, "intends to vigorously defend the current injunction, which protects the privacy of physician data while allowing it to be seen by the agencies working to identify fraud," Dr. Hoven said.

"Medicare fraud threatens our entire health care system, and the AMA supports targeted efforts by the Dept. of Justice, [HHS] Office of Inspector General and others to identify perpetrators of fraud -- the vast majority of whom are not physicians," she said.

There's little doubt that the vast majority of physicians are billing the Medicare program appropriately, said Jason Conti, an attorney for Dow Jones in New York. However, restrictions on access to the claims data prevent further investigation of true outliers in the program.

"If the data is released, more fraud will be exposed," he said.

As it has since 1979, HHS is opposing reopening the case. The restrictions placed on the newspaper in the data usage agreement are based on a statutory exception to the Privacy Act of 1974 and not the 1979 court decision, HHS said in court papers.

This article was originally posted at http://www.ama-assn.org/amednews/2011/04/04/gvl10404.htm

AARP Under Attack In GOP Efforts Against Health Law

House Republicans issued a report Wednesday and plan to hold a hearing Friday to investigate AARP's support for the health law as well as the organization's business interests.

The Washington Post: In Campaign Against Health Care Law, Republicans Take On AARP
House Republicans, who are continuing their efforts to chip away at President Obama's health care law, have now set their sights on a powerful group that strongly supported the legislation: the AARP seniors lobby (Eggen, 3/30).

The Hill: GOP Report Questions AARP's Motivations For Supporting Health Care Reform
"Over and over during the health care debate, questions arose about why AARP was appearing to lobby in opposition to its members," said [Wally] Herger (R-Calif.), who chairs the panel's health subcommittee. "We couldn't understand why AARP would support a health care reform bill that would threaten access to doctors (and) hospitals and could force seniors out of the plan they know and like …" The report looked at AARP's public tax filings and concluded that the group stands to gain $1 billion from the health care reform law. That's because AARP makes considerably more from royalties (46 percent of revenues in 2009) than from membership dues (17 percent) (Pecquet, 3/30).

Bloomberg: AARP May Get $1 Billion on Health Law, House Republicans Say
A group of House Republicans said seniors lobby AARP will gain as much $1 billion over the next decade from the 2010 health care overhaul it supported and should have its tax-exempt status investigated. AARP represents 37 million people ages 50 and over in the U.S. Its gains will come from insurance products it endorses and that will attract customers under the health law, a group of Republicans on the House Ways and Means committee said in a report released today (Armstrong, 3/30).

The Fiscal Times: Republicans Continue Attack On AARP For Conflict of Interest
AARP's structure is not unique. Many non-profits run for-profit subsidiaries to generate revenue for their charitable and lobbying activities. The Smithsonian's or National Geographic's television deals come to mind, or every museum's gift shop. Yet the scale of AARP's insurance subsidiary's dealings (it runs its own firm as well as forms partnerships with UnitedHealth Group and other insurers) is breathtaking. The Ways and Means report, based on publicly available documents, found that insurance royalties paid to the non-profit side of the 40 milllion-member AARP nearly tripled to $657 million between 2002 and 2009, which constituted 46 percent of its $1.4 billion in revenue (Goozner, 3/30).

Modern Healthcare: GOP Lawmakers See AARP Profiting From Reform Law, Question Group's Tax Status
A new federal report concludes AARP could make $1 billion in profits (PDF) in the next 10 years as a result of the health care reform law and it questions the tax-exempt status of the organization representing America's seniors. Reps. Charles Boustany (R-La.,), Wally Herger (R-Calif.) and Dave Reichert (R-Wash.) — all members of the House Ways and Means Health Subcommittee — released the report, which cited Richard Foster, chief actuary at the CMS, as saying that about 6 million to 7 million Medicare Advantage beneficiaries will leave those plans and will want auxiliary coverage, and Medigap will be the most straightforward way to get it. A Medigap policy is private health insurance intended to supplement Medicare as it helps pay some of the health care costs that Medicare doesn't, according to HHS (Zigmond, 3/30).

The Seattle Times: Reichert Claims AARP Had Hidden Motive To Back Health Care Overhaul
Did AARP, the nation's leading advocacy group for older Americans, fight for last year's federal health care law to the detriment of its members? Guilty, according to U.S. Rep. Dave Reichert and his fellow House Republicans — and they contend AARP had a motive. On Wednesday, three members of the House Committee on Ways and Means released a report detailing what they called troubling conflicts over the nonprofit group's multimillion-dollar foray into for-profit insurance businesses. Titled "Behind the Veil: The AARP America Doesn't Know," the report takes aim at possibly stripping AARP of tax-exempt status. The organization was one of the most vocal supporters of the Affordable Care Act, which Republicans are attempting to repeal (Song, 3/30).

Roll Call: AARP Is Next On GOP Target List
House Republicans on the Ways and Means Committee on Wednesday released a report that accuses the influential senior citizens organization of having a conflict of interest because it will financially benefit from the health care overhaul that the group heavily lobbied for last year. AARP collects royalties from endorsing health insurance policies and other products (Roth, 3/31).

This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from more than 300 news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

This article was originally posted at http://ping.fm/QuNnWDaily-Reports/2011/March/31/aarp.aspx