HDM Breaking News

The Centers for Medicaid and Medicaid Services has sent a letter to all state Medicaid directors to provide initial guidance on upcoming Medicaid EHR incentive payments. Under the American Recovery and Reinvestment Act, hospitals and physicians that treat a qualifying number of Medicaid patients can apply for incentive payments based on their meaningful use of electronic health records.

The letter points out that states may immediately apply for federal funds to pay for 90% of administrative planning activities. It spells out criteria to receive the funding.

“This letter, including the enclosures, will provide preliminary guidance on state expenses related to activities in support of the administration of incentive payments to providers,” CMS states. “More information will be forthcoming through guidance and rulemaking regarding state administrative expenses and provider incentive payments. We intend to published proposed regulations to address the steps outlined in this letter by the end of the year.”

Other points of interest in the letter include:

• States should coordinate activities with their CMS regional office to reduce confusion of the Medicare and Medicaid incentive programs and maximize the ability to advance health I.T.;
• States should view Medicaid planning activities as part of larger evolving state health I.T. efforts; and
• States must settle a range of issues before they can begin making incentive payments. For instance, providers using certified EHRs are not eligible for Medicaid incentive payments unless the EHR is compatible with state or federal administrative management systems. “Therefore, states risk making unallowable incentive payments prior to receiving guidance on how to make these systems compatible.”

The letter and accompanying documents are available at cms.hhs.gov/Recovery/11_HealthIT.asp.

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http://www.healthdatamanagement.com/news/stimulus-38922-1.html

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By the Associated Press

President Barack Obama, faced with falling approval ratings and increasingly impatient with Senate negotiations over health care, is weighing a shift in strategy that would offer more details of his goals for overhauling the nation’s healthcare system.

The president is considering a speech in the next week or so in which he would be “more prescriptive” about what he feels Congress must include in a bill, top adviser David Axelrod said Tuesday in an interview. The speech might occur before the Sept. 15 deadline the White House gave to Senate negotiators to seek a bipartisan bill, Axelrod said. He suggested that two key Republicans have not bargained in good faith.

Congress reconvenes next Tuesday after an August recess in which critics of Obama’s health proposals dominated many public forums.

Some Obama allies, watching his approval ratings tumble in polls along with support for a healthcare overhaul, have urged the president to take a more hands-on approach. They feel he gave too much leeway to Congress, where one bill has passed three House committees, another has passed a Senate committee and a third has been bogged down in protracted negotiations in the Senate Finance Committee.

Axelrod indicated that Obama would not offer new proposals but would be more specific about his top priorities.

“The ideas are all there on the table,” Axelrod said. “Now we are in a new phase, and it’s time to pull the strands of these together.”

He said there is serious discussion in the White House of Obama “giving a speech that lays out in specific ways what he thinks” about the essential elements of a healthcare bill.

Axelrod said it was possible that the speech could occur before a planned Sept. 15 Obama address on healthcare in Pittsburgh.

Obama has called for innovations such as a public health insurance plan to compete with private insurers, but he has not insisted on it. It was not clear Tuesday the degree to which he might press for various proposals in a new speech.

Obama also plans to meet with Democratic congressional leaders on Tuesday.

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http://www.modernhealthcare.com/article/20090902/REG/309029973/-

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Two weeks ago, the Obama administration offered nearly $1.2 billion in stimulus-funded grants to set up state-run health information exchanges, and create 70 “health IT regional extension centers” to help physicians adapt to the digital era, a term officials defined in greater detail during a conference call late last week, Modern Healthcare reports. “As many as 1,250 participants logged- or dialed-in to hear and ask questions about the ground rules to apply” for the grant money “to be awarded over a four-year period to about 70 not-for-profit organizations that will run the regional extension centers.”

The centers will spend more than $500,000 a year, mostly on services for physicians; serve approximately 1,000 doctors each, mainly at smaller primary care offices; help doctors select an effective electronic record system; help them implement it and achieve “meaningful use,” the administration’s requirement for doctors hoping to get other stimulus payments; provide “in-depth” technical support on “a narrow list of vendor systems.” A caller pointed out that the government’s role in recommending and supporting individual, private vendors raised a potential conflict of interest for state officials choosing the potential grantees that will set up the centers.

Half of the grant money will go directly to states to help establish “a widespread and sustainable health information exchange,” American Medical News reports. “Legal, financial and technical support is necessary to enable secure exchange of sensitive patient data across health care systems, according to HHS. The program will help fund efforts at the state level to implement directories and technical services to enable interoperability within and across states. Some health IT experts say such assistance is vital in helping physician practices become meaningful users”.

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http://www.kaiserhealthnews.org/Daily-Reports/2009/August/31/Health-IT-Monday.aspx

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$1.2 Billion Slated for HITECH Priority Grant Programs

By News Staff

Nearly $1.2 billion soon will be available to help the nation’s hospitals, physicians and other health care professionals purchase and use electronic health records, or EHRs, according to an Aug. 20 announcement from Vice President Joe Biden. Money from the Health Information Technology for Economic and Clinical Health, or HITECH, Act priority grant programs, which are funded by the American Recovery and Reinvestment Act of 2009, will start flowing in 2010.

“With electronic health records, we are making health care safer, we’re making it more efficient, we’re making you healthier, and we’re saving money along the way,” said Biden in the announcement. “These are four necessities we need for health care in the 21st century.”

The money will be divided between two programs.

• $598 million has been set aside to establish the Health Information Technology Extension Program, which will allow about 70 health IT regional extension centers to offer technical assistance and guidance to support health care professionals using EHRs.
• $564 million will fund the State Health Information Exchange Cooperative Agreement Program, an initiative designed to help states and other entities establish health information exchange capacity among hospitals and health care professionals.

According to David Blumenthal, M.D., M.P.P., the national coordinator for health IT, the rollout of the programs “represents a critical step forward in laying the groundwork for meaningful use of EHRs.”

“Together, the grants will offer much-needed local and regional assistance and technical support to providers while enabling coordination and alignment within and among states, ultimately allowing information to follow patients anywhere within the health care system,” Blumenthal said in an Aug. 20 update e-mailed to health IT stakeholders and posted on the HHS Web site.

Information about the HITECH priority grants program and application requirements is available online from HHS

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By Anne Zieger

If the state’s governor gets his way, Kentucky will soon be home to a statewide electronic health records system. To foster that goal, State Gov. Steve Beshear (D) has created the Governor’s Office of Electronic Health Information.

The state is creating the office to make sure it gets its share of the Obama administration’s stimulus funding package for EHRs, which goes to states who adopt them by 2014.

To get those funds, states are required to create a department that oversees its EMR project. These state offices serve as single points-of-contact for federal and state agencies helping to get the EMR ball rolling. In this case, the office will also work with the state’s three regional health information organizations, healthcare providers, consumers, insurers and the whole kit and kaboodle involved in sharing health data.

It will be interesting to see if any of this comes to fruition. Despite some big talk, RHIOs aren’t going great guns, and getting a state’s worth of EMRs in place by 2014 sounds a tad optimistic at best. But hey, press releases wouldn’t exist if people weren’t optimistic!

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http://www.fierceemr.com/story/kentucky-launches-initiative-designed-foster-statewide-emr-system/2009-08-20

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By Joseph Conn

Another month, another matrix in the development of definitions of “meaningful use,” the key criteria providers must meet to unlock tens of billions of dollars of federal healthcare information technology subsidies under the American Recovery and Reinvestment Act of 2009.

The Health Information Technology Policy Committee, a creature of the stimulus law, received a third set of recommendations from its meaningful-use work group. The recommendations were again detailed, as were their predecessors handed over by the group in June and July, in a spreadsheet or “matrix” format.

The HIT Policy Committee accepted the recommendations, which under the order of events set out in the stimulus law the committee will forward to the Office of the National Coordinator for Health Information Technology at HHS, which will hand them over to the CMS for official rulemaking. All of these hand-offs will occur fairly seamlessly since David Blumenthal, the physician head of the ONC, is chairman of the HIT Policy Committee and Tony Trenkle, director of the Office of eHealth Standards and Services at the CMS, is a policy committee member. Both men attended Friday’s meeting.

This latest batch also stuck to the original staging schedule first proposed by the work group in June of creating three sets of increasingly more complex meaningful-use criteria, which hospitals and office-based physicians must meet to qualify for the subsidy payments. The matrix includes a dozen broad goals, more specific objectives and proposed metrics by which compliance with the goals and objectives can be measured. The lowest bar is set for 2011, the first year electronic health-record subsidy payments can be made under the Medicare portion of the technology funding program.

For example, one care goal is to provide a patient healthcare team access to “comprehensive patient health data.” In 2011, one objective proposed for meeting that goal is a requirement that all hospitals use computerized physician order entry, or CPOE, systems for at least 10% of orders by doctors, nurses and physician assistants. By 2013, the work group proposed raising the bar, requiring that 100% of hospital orders be initiated using CPOE. In 2015, the objective switches from using a specific system, CPOE, to achieving “minimal levels of performance” that can be measured using clinical outcomes standards to be agreed upon sometime between now and then.

The other highlight of the meeting was the report and recommendations by the policy committee work group on EHR system certification and adoption. Under the stimulus law, only certified EHR systems qualify for federal subsidies, and only if they are used in a “meaningful manner.” In the past, the federal government deemed the certification of an EHR by the not-for-profit Certification Commission for Health Information Technology as good enough to meet its certification requirements for Stark and anti-kickback exceptions for EHR subsidies made by hospitals to office-based physicians. CCHIT took its cues on certification criteria from the American Health Information Community, the Bush administration’s counterpart to the HIT Policy Committee, and developed a program that tested vendors’ products on their ability to perform more than 300 functions.

But the stimulus act, which became law in February, did not specify that CCHIT would be even an acceptable certification body for EHRs for stimulus law subsidies, much less the only certification body with deeming authority as in the past.

To guide the new way forward, the certification and adoption work group made five recommendations, which were accepted by the policy committee.

First, the group recommended that certification under the stimulus law should focus solely on the functions needed to meet the meaningful-use standards. The statute provides eight specific areas that the HIT Policy Committee must consider in making its recommendations on meaningful use, plus 10 other areas that the policy committee might also consider.

Still, at least initially, the number of criteria against which systems will be tested under the stimulus law is likely to be far fewer than the 300 or so in the most recent CCHIT testing regime. In June, CCHIT announced its intention to continue to offer its comprehensive testing program, but also would add new testing and certification schemes tailored to the meaningful-use criteria as they are developed.

Second, according to the recommendations, progress needs to be made on testing and certifying systems that have the functionality to meet privacy, security and interoperability requirements called for in the stimulus act. Those include some amendments to the federal privacy law under the Health Insurance Portability and Accountability Act of 1996, such as the requirement that the systems be able to produce and report audit trails of where and when disclosures of patient information has been made, and to manage patient consents to release information, including a new authority that patients can block the release of their treatment information to their insurance company if they pay for treatment out-of-pocket.

Third, the work group recommended generally that the certification process be made more objective and transparent, with a specific recommendation that the federal National Institute of Standards and Technology, an agency of the Commerce Department, be tasked with helping the ONC develop a process to establish a separate and independent accreditation procedure for certification organizations such as CCHIT and any additional organizations that might join CCHIT in certifying EHRs to stimulus law criteria.

Fourth, the work group suggested that the certification process needs to be standardized so there is a level playing field for all seekers of EHR certification, whether they are commercial vendors of proprietary software systems, provider organizations that have developed home-grown systems, or communities or service providers of open-source EHR systems.

Finally, the work group recommended that the ONC and the CMS leverage as much as possible the work that has been done to date developing a certification program. Since an initial, official definition of meaningful use isn’t expected from the CMS until early next year, the work group recommended establishing a “preliminary certification process” so vendors can begin preparing their systems to what will be a likely set of criteria. CCHIT, for example, has prepared an analysis of its current testing and certification criteria and how they stack up against what might be expected to meet meaningful use under a new certification regime.

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http://www.modernhealthcare.com/article/20090817/DOSE/308179929

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Posted by John Moore

Despite the pending $36.3 billion that the U.S. government plans to spend over the next several years to drive physician adoption of electronic health record software, the market is at a standstill.

Why?

It’s really quite simple and logical. That $36.3 billion targeted for EHR adoption was part of the massive stimulus package signed by President Obama in early 2009. Within that package, was the $36.3 billion for the “meaningful use of certified EHRs.” Funny thing, though, no one was quite sure what “meaningful use” meant or what a “certified EHR” was. Defining those terms was left to the Department of Health and Human Services’ Office of the National Coordinator for Healthcare IT (ONC).

Physicians may receive as much as $48,000 in reimbursement under Medicare (hospitals may see up to $11 million) for meaningful use of certified EHRs. However, without a clear understanding of what was expected under meaningful use, let alone what a certified EHR really is, physicians and hospital CIOs have wisely waited for a clear signal from the administration and the ONC.

Aware that the market was at a standstill, ONC and its Meaningful Use Workgroup, worked feverishly to deliver recommendations. The first draft came out in mid-June and met much resistance. The workgroup was sent back to the drawing board, facing an extremely tight ten-day public comment period. On July 16th, it released a second draft, incorporating comments and concerns. This draft was adopted, and now, the Center for Medicare and Medicaid Services (CMS) will take these recommendations and turn them into rules and methods of verification.

In a nutshell, here are the five broad categories laid out by the workgroup that physicians and hospital CIOs will need to consider:

1. Improve quality, safety, efficiency and reduce health disparities.
2. Engage patients and families.
3. Improve care coordination.
4. Improve population and public health.
5. Insure adequate privacy and security protections for personal health information.

Within each category, the workgroup set specific objectives and measures in a matrix, ratcheting up requirements every two years. In 2011, which is adoption year one, the broad objective is to capture and share data. For 2013, adoption year two, meaningful use is to advance care processes with decision support. In 2015, adoption year three, meaningful use criteria focus on improving outcomes.

The use “adoption years” was one of the newest revisions. This approach lowers the burden for providers, letting them incrementally adopt an EHR and change process workflow overtime rather than having to jump in, say, in 2013 and be required to adopt all meaningful use criteria for the year.

At 10 pages, the meaningful use matrix sets some fairly high goals. Clearly, the federal government wants to ensure that it gets its money worth from the significant amount of tax dollars that will be pumped into the healthcare IT market. The real question, though, is have the goals been set too high?

As mentioned previously, the total amount of possible reimbursement for hospitals is roughly $11 million. Yes, that’s a lot, especially for a small hospital, but the potential future penalties are an even bigger issue for most hospitals. (CMS payment penalties, begin at 1% in 2016 and potentially ratcheting up to 5% five years later.) Thus, we’re likely to see virtually all hospitals attempt to meet the meaningful use criteria.

Small physician practices, where some 75% of all healthcare occurs, is another story. These practices are often family-run operations with modest IT skills. In such small practices, adoption of EHRs has been anemic (a recent New England Journal of Medicine article pegged adoption at some 4%). In these small practices, EHRs have yet to prove themselves as a benefit and are often seen as a serious detriment to delivering efficient care.

With EHRs already viewed as suspect by this sector, will adding on the burden of meeting meaningful use criteria and creating reports to verify compliance justify the upfront costs a physician will have to pay in expectation of future reimbursement from CMS? Not likely. Even the penalties with which CMS can threaten a small practice are likely to backfire, as many practices will simply stop seeing Medicare or Medicaid patients.

To drive EHR adoption among small practices, burdensome criteria tied to reimbursement won’t succeed. New incentives are necessary, and, more important, healthcare IT adoption can’t occur in a vacuum without broader payment reform. As long as physicians are paid by the visit, they’ll optimize their practices for higher patient throughput. Technology that hinders throughput won’t be adopted.

Maybe the trick to encouraging adoption of EHRs that will be meaningfully used by physicians in support of broader healthcare improvement goals rests within a policy framework that pays for healthy citizens. Or maybe EHR vendors need to simply create software that helps physicians be more profitable.

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http://www.informationweek.com/blog/main/archives/2009/08/has_government.html;jsessionid=FUP3WJ12DLKRHQE1GHRSKHWATMY32JVN

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By Mary Mosquera

The Obama administration is expected to announce as early as Friday plans to award a series of grants to assist healthcare providers acquire and use health IT properly as well as to help states set up health information exchanges.

National health IT coordinator Dr. David Blumenthal is scheduled to join Vice President Joe Biden and HHS Secretary Kathleen Sebelius Aug. 20 for a discussion with physicians, nurses and administrators from Chicago’s Mt. Sinai Hospital. They are expected to discuss health reform, including health IT infrastructure and preventative care, according to a White House statement.

The American Recovery and Reinvestment Act provided the Office of the National Coordinator $2 billion to promote the meaningful use of health IT. Up to $300 million was intended to help establish state HIEs; another share would fund regional training centers to help physicians and hospitals incorporate health IT into their practices.

In an e-mailed statement today, Blumenthal laid out the administration’s case for the importance of the health IT funding targets.

Nationwide electronic HIE “provides the best opportunity for each patient to receive optimal care,” Blumenthal said. The technology will make patients’ complete medical information securely available to their health care providers where and when it is needed, “when clinician and patient are together facing medical decisions that can make a lasting difference.”

“My personal belief in this transformation is not based on theory or conjecture,” said Blumenthal, who has been a primary care physician for 30 years.

“I spent the first 20 shuffling papers in search of missing studies and frequently hoping, during middle-of-the-night emergencies, that I knew enough about patients’ medical histories to make good decisions. All that changed when I began to have access to patients’ electronic medical records,” he said, adding that it made him a better doctor. He started using electronic records 10 years ago.

With the U.S. spending $2.5 trillion annually on healthcare, it is clear that change is necessary, he said. “Better, faster, more reliable and efficient care also ultimately reduces system-wide costs,” he said.

To realize the benefits of a nationwide health information system will also require that personal health information remain private and secure. “Putting into place safeguards for the privacy and security of this information, when it is in electronic form, will be an ongoing priority that influences and guides all of our efforts,” he said.

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Experts say electronic health records will slash health care costs, but hospitals wonder when — and how — they’ll be able to realize those savings.

By David Goldman, CNNMoney.com staff writer

The health care industry is poised to realize huge savings by implementing electronic health records systems, but who really benefits is up for debate.

Digitizing health records is a big part of the Obama administration’s health reform agenda, with the president arguing that EHR will save taxpayers from wasteful spending by making health care more efficient.

But huge upfront costs and a questionable return on investment for hospitals have some screaming for broader reforms.

A recent Congressional Budget Office report said the health reform bills wouldn’t sufficiently rein in costs nor would they trickle down savings to the average American with employee-sponsored insurance.

But a separate report from the CBO said the Recovery Act program that provides incentives to implement electronic health records in hospitals nationwide would save the government more than $12 billion in Medicare and Medicaid costs over the next 10 years.

Though that doesn’t sound like much, considering American consumers, businesses and governments spent approximately $2 trillion on health care last year, other studies show the savings are potentially ten times that amount for the entire health care industry.

Still, that’s just part of the story. Making hospitals more efficient could actually hurt their bottom line. Insurance companies are willing to pay more for longer and more complicated patient treatments, so cutting down on costs may only be part of the solution.

How digital health saves costs. The first, most obvious cost saving comes from the time EHRs save just from turning them on.

Since patient information lives in a database, an electronic health record system means patients don’t need to take the time to explain medical history to new doctors. EHRs help doctors diagnose faster, significantly cut down on the time it takes hospital staff to chart patients’ information and ultimately slash the length of an average patient visit.

A recent study at the Christiana Care emergency room in Wilmington, Del., showed that just having the ability to download and print out a file with a patient’s medical history saved the ER $545 per use, mostly on reduced waiting times.

With payroll generally serving as the single largest hospital expense, the creation of a digital system means hospitals can use their staff more efficiently.

“Doctors are paid by the minute, and they don’t have a clue who the patients are,” said David St. Clair, chief executive of health tech company MEDecision, which conducted the Christiana Care study. “Anything the system can tell them makes workflow easier and faster.”

Beyond the ER, St. Clair estimated that EHR will result in total cost savings of $100 per patient per year. Sudhakar Ram, CEO of health IT firm Mastek, put that figure as high as $200 per patient per year. Mastek recently won a contract to create a central depository for health records for the UK’s National Health Service.

Applied industry-wide, total savings could range up to $100 billion over the next 10 years, according to research group RAND.

Further out, as hospitals fully implement EHR and begin to cut back on duplications, misdoses and medical errors, cost reduction could total as much as $50 billion a year, said Ram.

Cost savings don’t always mean more money. Those same cost reductions ultimately mean hospitals are getting less money.

The health-care system, as currently devised, allows savings for the health insurers, but not for those providing and receiving the care, said David Brailer, chairman of Health Evolution Partners and former health tech czar under President George W. Bush.

“We can influence care in a way that saves money, but we cannot tell you we’ll have a robust return on investment,” said Gail Donovan, chief operating officer for Continuum Health Partners, a New York network of 12 hospitals. Donovan said the network’s 10-year cost for health information technology is $100 million.

Electronic health records cost tens of millions of dollars upfront for a typical hospital to implement. They also take years to set up and hours to train physicians.

“I’m still shocked that there is a business argument for electronic medical records because it kills the very thing that makes hospitals money,” said Brailer. “The way we pay for health care penalizes efficiency.”

Solutions: charge more. St. Clair argues that hospitals that can prove they are saving money and time — and seeing more patients as a result — will be able to convince the insurance industry to pay more for hospitals’ services.

“If hospitals are able to demonstrate savings, they’ve got to charge more money to commercial insurers,” said St. Clair. “The insurers would be happy to do that, because they’re willing to improve the quality of care and don’t want to screw over the hospital in the process. That’s how hospitals will get more profits.”

But Brailer said that’s wishful thinking. He instead advocates for a “pay for performance” system, in which insurers pay hospitals a lot for a job well done and nothing for a bad job. That puts the burden on the hospitals to treat patients well and efficiently, rather than the current system in which hospitals can make more when patients stay sick.

“If we had that system, we wouldn’t need a stimulus plan for EHR, because every hospital would already have one to improve their results,” Brailer said. “Hospitals should be accountable for their results.”

Above article published on http://money.cnn.com/2009/08/21/technology/electronic_health_record_cost_savings/?postversion=2009082103

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President Obama held a town hall meeting in New Hampshire today, Tuesday, August 11, in an effort to calm fears over the Democrats’ legislative initiatives to reform healthcare in this country. The meeting was structured, and no visible emotional outbursts were seen as in other meetings with lawmakers across the country.

Obama answered questions posed by attendees, emphatically telling the audience that the current healthcare system solely benefits the insurance industry. With 46 million in the country without health insurance, he tried to reassure his audience that they would be able to keep their current coverage and doctor and that the government would not be “in charge”. Obama hammered on the fact that the government and insurance bureaucrats should not be meddling, that pre-existing conditions will be covered and that insurance companies would not be able to drop or deny coverage or water down coverage. Many of the questions on voter’s minds that were expected to be answered, especially with respect to employers and small businesses, were not addressed.

Numerous recent polls show support for healthcare reform is eroding, and the President’s numbers are dropping as well over fears that a government takeover of our healthcare system in the U.S. will lead to a Canadian style system with long waits for treatments and referrals.

The President’s message today was supposed to address people who already have insurance through their employers and highlight how his proposals would affect them. HAI monitored the town hall meeting and didn’t find the retool of the White House message to have answered those questions. Another town hall meeting with Obama is scheduled for Bozeman, Montana on Friday, and on Saturday, Obama will be in Grand Junction, Colorado.

Meanwhile, the White House has opened a Reality Check website with a viral tool aimed at online healthcare combat on everything from rationing to euthanasia. The website incorporates lessons learned from the Obama presidential campaign, and shows the White House is becoming more aggressive in dispelling what they call misinformation in the healthcare debates.

The August Congressional Recess is not even half over, and Democratic lawmakers are very much at risk of losing control of the public debate over healthcare reform, facing wary constituents and facing a barrage of accusations and criticism over their writing of the legislation prior to leaving Washington. Powerful groups on both sides of the debate are using the August recess to hammer home to lawmakers that there are very serious political consequences to the healthcare issue.

Senators working on a yet to be released draft bill said earlier this week that President Obama would like to get something passed for healthcare reform and then start negotiating in a House-Senate conference committee. Some Democrats support the public option, but it will be a tough sell for Republicans if they want to get a bill through the Senate. The flashpoint in the debate has become the question of whether a healthcare overhaul should include a public option. As the debate rolls on, Americans are questioning what the shape and size of the government’s role in the economy should be, especially on the heels of Congress passing three massive economic stimulus bills.

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