By Mary Mosquera

The Centers for Medicare and Medicaid Services will reimburse states for 100 percent of their payments to healthcare providers participating in the federal health IT stimulus program, according to a Sept. 1 letter from CMS to state Medicaid directors.

Moreover, state Medicaid agencies can immediately apply for 90 percent in federal matching funds to cover the initial planning that will be required to launch health IT incentive payment systems in their states, according to the letter from Cindy Mann, director of CMS’s Center for Medicaid and State Operations.

The letter and a package of supporting policy documents are the first formal direction CMS has provided state Medicaid agencies on how to manage the millions of dollars in incentive payments that will flow to healthcare practices under the federal stimulus law.

But federal financial support for state planning will not come without a hefty burden on state Medicaid agencies. According to the documents, CMS plans to keep a close eye on how states develop their incentive payment systems as well as how they mesh with other state health IT projects.

In order to receive the 90 percent administrative match, state Medicaid agencies must obtain from CMS an “HIT Advance Planning Document prior to initiating planning activities and expending funds.” States must receive prior approval of any initial planning eligible for the match, according to the letter.

CMS outlined a litany of state activities that could be eligible for 90 percent matching funds, including planning “for incentive payment delivery systems and audit tracking of payments to providers,” CMS said.

Work by states to set up “metrics and measures for providers to demonstrate meaningful use of electronic health records” would also be eligible for a match. So far, CMS has issued no guidance on how it plans to measure, account for, and verify payments that will be made to providers under the health IT stimulus plan.

States will also be on the hook for making payments to providers whose certified EHR software is incompatible with state and federal administrative management systems. “States risk making unallowable incentive payments prior to receiving guidance on how to make these systems compatible,” Mann said.

Although the letter focuses on Medicaid, it notes that Medicare provider health IT incentives are also called for under the stimulus plan. CMS said it will be a “priority for these incentives to be coordinated in order to reduce confusion, improve administration, and maximize the ability to advance HIT across the health system.”

CMS will provide states with more guidance about planning and administrative expenses and will work with the states to determine when each is ready to start making payments, the letter said. CMS will detail the information in a proposed rule by the end of the year.

CMS is especially keen that state Medicaid agencies’ incentive payment management systems be linked to the states’ overarching vision for health information exchange.

According to the letter, Medicaid offices will be required to submit a “State Medicaid HIT Plan,” or SMHP, describing “how it will integrate current and planned Medicaid HIT assets and fit within the larger State HIT/HIE roadmap,” the letter said.

“We expect the State to include in the SMHP their vision for Medicaid to become part of existing or planned Federal, regional, statewide, and/or local health information exchanges (HIE),” CMS said, “with projected dates for achieving objectives of the vision where appropriate.

“State plans should build off of existing efforts to advance regional and State level HIE, facilitate and expand the secure, electronic movement and use of health information according to nationally recognized standards, and move towards nationwide interoperability.”

The 90 percent matching funds are in addition to matching funds rates that states now receive under current law for using state Medicaid claims processing and automated retrieval systems, referred to as the Medicaid Management Information System (MMIS).

CMS expects that states to closely link their SMHP with these systems, as well as their work adhering to the Medicaid IT Architecture (MITA), an ongoing technology and business plan for Medicaid IT systems.

The MMIS contains a great deal of claims data and other information. “When combined with other systems and databases, [MMIS] can be of significant value in achieving the vision of using certified electronic health record technology to promote health information exchange, enhance quality and improve outcomes,” Mann said.

But CMS cautioned that states “should not begin implementation activities” related to their SHMP’s “until CMS issues future guidance on the Recovery Act HIT requirements or states risk not receiving (federal funding) for incentive payments due to non-compliance.”

CMS and the National Coordinator for Health IT will evaluate the states Medicaid health IT plans to make sure that planning activities are coordinated. CMS will publish more guidance in the near future on the review process, Mann said.

Above article published on

http://www.govhealthit.com/newsitem.aspx?nid=72050

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.

Above article published on

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

As the Obama administration works to garner support for healthcare reform, about $1.2 billion in grants were announced on Friday to help hospitals and healthcare providers implement and use electronic health records.

Announcing the grants in Chicago, US Vice President Joe Biden said the $1.2 billion would be funded by the $787 billion economic stimulus plan.

“With electronic health records, we are making health care safer; we are making it more efficient; we are making you healthier; and we are saving money along the way. These are four necessities we need for healthcare in the 21st-century,” Biden said during an appearance at a hospital with Health and Human Services secretary Kathleen Sebelius.

Expanding the use of electronic health records is fundamental to reforming the country’s healthcare system, Sebelius said, adding that electronic health records would help reduce medical errors, make healthcare more efficient and improve the quality of medical care for all Americans.

“You are going to be able to save a lot more lives and save tens of billions of dollars,” Biden told about 100 medical professionals.

Of the total money, $598 million would be used to establish 70 health information technology regional extension centers, which would help hospitals select and implement electronic health record systems.

Grants totalling $564 million would go to States and Qualified State Designated Entities to support the development of mechanisms for information sharing within an emerging nationwide system of networks.

The grants would be awarded beginning fiscal year 2010. Biden also expressed confidence that the healthcare legislation would be passed.

“Soon we are all going to get much better health care at a more rationale price…We are not taking the system that works away from any American. We are making the stuff that doesnt work, work better,” he added.

Pointing out that the economic stimulus package is working to improve the economy, Biden said, “We stopped the free fall. Now we are beginning to ascend again”.

Above article published on

http://business.rediff.com/report/2009/aug/21/us-1-point-2-bn-dollar-grant-for-electronic-health-records.htm

Bernie Monegain, Editor

President Barack Obama told participants in an AARP tele-town hall Tuesday that electronic health records will help put an end to the inefficiencies they have experienced in healthcare.

“We’re also working to computerize medical records, because right now too many folks wind up taking the same tests over and over and over again because their providers can’t access previous results,” he said at the session at AARP headquarters. “Or they have to relay their entire medical history – every medication they’ve taken, every surgery they’ve gotten – every time they see a new provider. Electronic medical records will help to put an end to all that.”

Obama met at AARP headquarters in the nation’s capital with AARP CEO A. Barry Rand, AARP President Jenny Chin Hansen, moderator and AARP radio host Mike Cuthbert and an audience of about 60 retirees. He took questions from the audience, as well as from telephone calls and e-mails.

In a statement, Rand posted on the AARP site earlier this month, he said: “All Americans should have affordable healthcare choices. But our current healthcare system costs too much, wastes too much, makes too many mistakes and gives us back too little value for our money.”

He spoke about ending billion-dollar subsidies to insurance companies for Medicare Advantage, using nurse practitioners for home healthcare follow-up visits after hospitalizations, proving incentives for physicians to work as a team, creating a healthcare exchange for affordable coverage, including a public option and paying for improvements with greater efficiencies.

In response to a question about negative ads that emphasize the cost of healthcare reform and the high cost of automating the system, Obama acknowledged the upfront costs and mentioned his recent visit to the Cleveland Clinic.

“In order for us to save money, in some cases, we’ve got to spend some money up front,” he said. “Let me give you some very specific examples. Healthcare IT: Healthcare is the only area where you still have to fill out five different forms – when you go into a bank you don’t have to do that. You’ve got an ATM. If you use your credit card, they’ll find you real quick and the billing is real easy – right? But if for some reason you want healthcare, you fill out pencil and paper – I guess they Xerox it – they give it to somebody else. Sometimes you see their files and it’s all stuffed with papers, and nurses can’t read the doctor’s handwriting.”

“So for us to set up a system like they have at the Cleveland Clinic that I just visited in Ohio, where every medical record – your privacy is protected, but everything is digitalized,” he added. “Everything – the minute you take a test, it goes to all the doctors and all the specialists that you might end up dealing with. So you end up just having that one test instead of having to then go back to the doctor again and again and again and have a bunch of different tests. Well, that saves money, but you’ve got to get the computer equipment in the first place to do it. So in some cases we’ve got to spend some money on the front end.”

Above article published on

http://www.healthcareitnews.com/news/obamas-talk-retirees-
highlights-digital-health-records

by Foon Rhee, deputy national political editor

Could it be a reprise of the stimulus on healthcare?

There are certainly hints that moderate US senators of both parties could determine the fate of President Obama’s agenda yet again.

Obama is holding separate private meetings this morning to discuss healthcare overhaul with Senators Olympia Snowe, a Maine Republican, and Ben Nelson, a Nebraska Democrat. They are among the senators being targeted by new TV ads, launched by Obama’s grassroots organization, that say “it’s time” for healthcare reform.

Nelson and Snowe’s fellow moderate senator from Maine, Susan Collins, played a key role in negotiations to win Senate approval in February for the $787 billion economic recovery package championed by Obama. The stimulus bill passed the House without a single Republican vote, and the administration’s horse-trading focused on satisfying Nelson and Collins, who pushed for a smaller package.

After meeting with Obama, Snowe said the president repeated his wish for Congress to pass a bill before its August recess. “He’s determined to have that happen,” she said on MSNBC.

But Snowe said it’s more important to get bipartisan consensus in the Senate Finance Committee, especially on how to pay for the bill. Supporting a Senate vote in September, she also said she wants to give ample time for all senators and the public to review the bill.

“This deserves a thoughtful process,” she said.

Asked about Senate Finance Chairman Max Baucus saying today that Obama had hindered his efforts to reach a bipartisan deal by opposing a tax on some employer-provided health insurance benefits to help pay for the deal, Snowe said it would be helpful if Obama endorsed a financing approach.

The panel is “working mightily” to find “offsets” and other savings to reduce the cost of the bill. “It’s all part of building a consensus,” she said.

Asked to respond to Baucus, deputy White House press secretary Bill Burton told reporters on Air Force One today, “Nobody said it was going to be easy. And there are obviously bumps along the way to getting to final passage of legislation in both the House and the Senate. But we think that we’ve been able to make a lot of progress. And those comments notwithstanding, this week has been a very great week, if you consider that the House bill and the bill that passed through the HELP Committee are very, very similar. They’re about 80 percent exactly the same.”

Burton refused to say which version of the healthcare bills the president favors, and said Obama remains hopeful for a bipartisan compromise.

“We’re only about midway through this. But he feels very positive about the progress we’ve been able to make,” Burton said. ” And once we get something through the House and through the Senate, we’ll be able to go to conference and really put the rubber to the road and get something done.”

With the power equation in the Senate so tenuous — just last week Al Franken became the 60th Democratic vote, potentially enough to overcome Republican filibuster — Snowe and Collins play an outsized role.

Obama and Senator Edward M. Kennedy of Massachusetts are still holding out hope for a bipartisan deal this year on healthcare.

But those prospects appear to be dimming. The Senate health committee passed its $615 billion plan on a strictly party-line vote on Wednesday.

In the House, little, if any Republican support, is expected in votes planned today in the Education and Labor and the Ways and Means committees on a $1.5 trillion plan that House Democrats presented this week. It would be financed in large measure through a tax surcharge on the highest-income Americans.

“It is extraordinary, the breadth of the bill that is being pushed through and the cost associated with it,” Representative Eric Cantor, the No. 2 Republican in the House, told reporters this morning. “And ultimately, really, the cost is going to be borne by the people of this country — the middle class, the wealthy, those who can least afford it, all of us are going to be paying an astronomical cost at a time that we just cannot afford this ambitious grab.”

Obama, who during the campaign proposed paying for healthcare by limiting tax deduction for high earners, has not endorsed a specific financing plan. But on CBS’s “Early Show” this morning, he said, “Personally, I think the best way to fund it is for people like myself, who’ve been very lucky, to pay a little bit more.”

UPDATE: Today, the American Medical Association endorsed House Democrat’s bill, saying it “includes a broad range of provisions that are key to effective, comprehensive health system reform.”

“I am grateful that the doctors of the AMA have chosen to support health insurance reform that will lower costs, expand coverage, and assure choice and quality health care for all Americans. Along with the nation’s nurses, these doctors are joining the chorus of Americans who know that the time to reform what is broken about our health care system is now,” Obama said in a statement.

The insurance industry, however, said it opposes key elements of the bill, saying a government plan “will cause millions of patients to lose their current coverage.”

Above article published on http://www.boston.com/news/politics/politicalintelligence/2009/07/
fate_of_healthc.html

The AP reports President Obama “returned to campaign-style rhetoric on Thursday,” saying at two New Jersey events that “inaction is not an option” as he urged supporters “to push for his overhaul of the nation’s health care system.” ABC World News, which opened with the story, called the President “a man on a mission. Everywhere he goes these days, he’s pushing healthcare reform.” The AP reports Vice President Biden was also touting reform, joining Health and Human Services Secretary Kathleen Sebelius at a forum in Virginia.

The Politico reports, “On the defensive over the economy and health care, the White House is shooting back with a double-barreled message for its critics and skeptics. To Republicans who say the stimulus isn’t working: Back off. To moderate Democrats wary of health care reform: We’re watching you.” Bloomberg News, however, reports Senate Finance Chairman Max Baucus “complained…Obama is ‘making it difficult’” to create a bipartisan compromise in the Senate. Baucus said Obama’s “opposition to the idea of taxing health-care benefits is ‘not helping us.’” The Hill reports Baucus and other senators emerged from “another intense day of closed-door negotiations” to “admit they had not reached the finish line.” Baucus said, “We’re very close to reaching agreement. By close, I mean it’s a matter of couple, three or four days, maybe.”

Sen. John McCain said on Fox News’ Your World, “The President has reiterated time and again his commitment to getting through before the recess. This thing is like a fish in the sun. If you leave it out there very long, it’s going to begin to smell very, very badly to the American people. That is why they are in such a rush to fundamentally affect one-sixth of our gross national product.”

USA Today reports that three tax increases “proposed by President Obama and House Democrats on the richest Americans could produce the highest tax rates in a quarter-century.” About 500,000 taxpayers earning $1 million or more would pay a full 5.4 surtax under one plan; surtaxes at lower rates would impact anyone earning more than $350,000 per year. Obama’s February budget “calls for letting tax cuts for top earners enacted at the beginning of the decade expire in 2011,” and during the presidential campaign, Obama “favored bolstering Social Security by subjecting family income above $250,000 to the 12.4% payroll tax.”

The New York Times reports Congressional Budget Office Director Douglas Elmendorf told the Senate that healthcare legislation proposed so far “would not curb the federal government’s runaway spending on medical care, and that lawmakers would need to take more forceful action to meet President Obama’s goal of controlling costs.” His testimony “drew criticism from Democratic leaders” and “provided ammunition to Republican critics.” The Wall Street Journal reports Senate Majority Leader Harry Reid “quipped that Mr. Elmendorf should consider running for Congress,” while Senate Majority Whip Richard Durbin “admitted that Senate Democrats were frustrated with the CBO’s various pronouncements over their efforts to push through health-care overhaul.”

Above article published on

http://www.usnews.com/usnews/politics/bulletin/bulletin_090717.htm

Molly Merrill, Associate Editor

ANNANDALE, VA – President Obama called for fixing the broken healthcare system by building upon investments made in electronic medical records in a town hall meeting held Wednesday.

The town hall was held at Northern Virginia Community College in Annandale, Va., where the president took questions the public submitted online regarding healthcare reform.

“I know that people say the costs of fixing our problems are great - and in some cases, they are,” Obama said. “The costs of inaction, of not doing anything, are even greater. They’re unacceptable. And that’s why this town hall and this debate that we’re having around healthcare is so important.”

The president highlighted the continued use of electronic medical records as one way to help drive down costs.

“We already made those investments in the Recovery Act - because when everything is digitalized, all your records - your privacy is protected, but all your records on a digital form - that reduces medical errors. It means that nurses don’t have to read the scrawl of doctors when they are trying to figure out what treatments to apply. That saves lives; that saves money; and it will still ensure privacy,” the president said.

Obama said the government has already identified $950 billion over 10 years that will be used to pay for healthcare reform. He said this “doesn’t even include the savings that we’re going to get from prevention, or the savings that we’re going to get from health IT - because in using congressional jargon, which I’m never supposed to do because nobody understands it - it’s not scorable.”

“And what that means is, is that the Congressional Budget Office can’t identify exactly how much you would save - even though everybody believes that it will end up saving a lot of money, we can’t put a hard number on it,” Obama said.

The president ended his speech by calling for the American people to “stand up and say now is the time.”

“We can create a healthcare system that gives you choice, allows you to keep your doctor, drives down costs, makes sure that every American doesn’t have to worry if they lose or change their jobs. That’s our aim. That’s our goal. We’re going to make it happen this year.”

Above article published on

http://www.healthcareitnews.com/news/obama-highlights-it-tool-fix-healthcare

WASHINGTON – President Barack Obama’s expanded fiscal year 2010 budget signals continued commitment to advancing healthcare IT as a way to cut healthcare costs and save lives.

Obama’s $3.4 trillion federal budget, released May 8, expanded the outline he presented to Congress at the end of February. It includes $879 billion for the Department of Health and Human Services, an estimated $63 billion increase over fiscal year 2009.

The Agency for Healthcare Research and Quality (AHRQ) is expected to receive $372 million to conduct research on comparative effectiveness, prevention and care management, value research, health information technology and patient safety. In addition, the AHRQ will use the funding to support research it conducts with other agencies.
The president’s budget for AHRQ will be in addition to the $1.1 billion allotted for comparative effectiveness research under the stimulus package.

Obama’s plan calls for $635 billion over 10 years as a “down payment” toward health reform. Health and Human Services Secretary Kathleen Sebelius called it “a smart investment.”

“No one should underestimate President Obama’s commitment to getting healthcare reform this year,” she said. “This budget sends a clear message that we can’t afford to wait any longer if we want to get healthcare costs under control and improve our fiscal outlook,” she added. The president has made it clear that he considers health IT as a major aspect of containing costs into the future.

David Blumenthal, MD, National Coordinator for Health Information Technology, said his office is “totally focused” on President Obama’s initiatives to establish healthcare IT. He called health IT “a critical pillar” in the plan to build more quality into American healthcare. Obama’s goal calls for every American to have electronic health records by 2014.

Though Obama clearly has much support, some are not sold. At a Senate Finance Committee hearing May 11, Ranking Member Chuck Grassley (R-Iowa) was skeptical about spending a lot on health reform, including health IT.

“It will be some time before this fairy dust turns to gold,” he said. Grassley did say that President Obama’s leadership would be “essential” in figuring out how to pay for health reform.

Above article published on

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HITECH Act entices physicians into future with incentives

By Jill Coley

The federal government has put aside nearly $20 billion to convince doctors to ditch their manila files for electronic medical records. But look at any physician’s walls of patient records, and the enormousness of that task becomes apparent.

In the Lowcountry, opinions are mixed. Most agree the move would reduce unnecessary testing, administrative overhead and medical errors. Yet with so many systems to choose from, patient privacy concerns and the time it takes to learn new software, money might not be enough.

Dr. Christos Maltezos, a Mount Pleasant endodontist, is ahead of the curve and already paperless. “That’s where the future is going,” he said. Patients can fill out forms at home and enter their medical and pain histories online.

In addition to streamlining administrative work, going digital also reduces forgery since doctors can send prescriptions to pharmacies digitally, said Maltezos, who can access patients’ records on his BlackBerry no matter where he is. “I don’t think I could do it any other way now,” he said.

Starting out digital is easier than changing over. The older internist may imagine scanning in 300-page medical records. But after a few patient visits, most of the information would be contained in an electronic file.

The Health Information Technology for Economic and Clinical Health Act, or HITECH, became federal law in February and created payment incentives in Medicare and Medicaid to encourage providers to go digital. It wasn’t long before electronic medical record vendors began using the promise of stimulus money to entice physicians.

Chris Hughes, founder of Advanced TeleHealth in Mount Pleasant, consults physicians before they adopt an electronic medical records system to make sure their practice is ready for the technological leap and is compliant with the Health Insurance Portability and Accountability Act, or HIPAA.

The economics of the situation is going to drive electronic medical records forward, Hughes said.

Dr. Dave Albenberg is passionate about electronic medical records but worries the government’s lofty goal may not be feasible.

Albenberg invested about $150,000 in a digital system for his concierge practice, Access Healthcare, in Charleston and Mount Pleasant.

Every doctor thinks it needs to be done differently, and getting all of them on the same platform is impossible, Albenberg said. “This is something you can’t throw money at,” he said.

Dave Terry, former administrator of James Island Medical Care, knows firsthand the pitfalls of electronic medical records. The 6,000-patient practice tried to go electronic about six years ago, and although hardware and software has improved since, the experience is still fresh in his mind.

Doctors use so many categories of codes, Terry said, that when physicians got in a room with a patient, the program went “six ways to Sunday.”

“You feel quite often like a deer in headlights in the middle of a patient encounter,” he said. Training was a problem because doctors couldn’t stop seeing patients long enough to learn the system. And if a staff member was sick or on vacation, their replacement had to be schooled in the software.

“We yanked it out and went back to paper,” Terry said.

Above article published on http://www.postandcourier.com/news/2009/may/04/doctors_look_into_digital_age80979/