Posts Tagged EHR

HHS Proposes New Rules to Improve Interoperability of EHI

Posted by on
HHS Proposes New Rules to Improve Interoperability of EHI
Could new innovations in technology promote patient access and make no-cost health data exchange a reality for millions?

The U.S. Department of Health and Human Services (HHS) has proposed new rules to support seamless and secure access, exchange and use of electronic health information. The rules, issued by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), would increase choice and competition while fostering innovation that promotes patient access to and control over their health information. The proposed ONC rule would require patient electronic access to this electronic health information (EHI) be made available at no cost.

“These proposed rules strive to bring the nation’s health care system one step closer to a point where patients and clinicians have the access they need to all of a patient’s health information, helping them in making better choices about care and treatment,” said HHS Secretary Alex Azar. “By outlining specific requirements about electronic health information, we will be able to help patients, their caregivers, and providers securely access and share health information. These steps forward for health IT are essential to building a health care system that pays for value rather than procedures, especially through empowering patients as consumers.”

CMS’ proposed changes to the health care delivery system support the MyHealthEData initiative and would increase the seamless flow of health information, reduce burden on patients and providers, and foster innovation by unleashing data for researchers and innovators. In 2018, CMS finalized regulations that use potential payment reductions for hospitals and clinicians to encourage providers to improve patient access to their electronic health information. For the first time, CMS is now proposing requirements that Medicaid, the Children’s Health Insurance Program, Medicare Advantage plans and Qualified Health Plans in the Federally-facilitated Exchanges must provide enrollees with immediate electronic access to medical claims and other health information electronically by 2020.

In support of patient-centered health care, CMS would also require these health care providers and plans to implement open data sharing technologies to support transitions of care as patients move between these plan types. By ensuring patients have easy access to their information, and that information follows them on their health care journey, we can reduce burden, and eliminate redundant procedures and testing thus giving clinicians the time to focus on improving care coordination and, ultimately, health outcomes.

“Today’s announcement builds on CMS’ efforts to create a more interoperable healthcare system, which improves patient access, seamless data exchange, and enhanced care coordination,” said CMS Administrator Seema Verma. “By requiring health insurers to share their information in an accessible, format by 2020, 125 million patients will have access to their health claims information electronically. This unprecedented step toward a health care future where patients are able to obtain and share their health data, securely and privately, with just a few clicks, is just the beginning of a digital data revolution that truly empowers American patients.”

The CMS rule also proposes to publicly report providers or hospitals that participate in “information blocking,” practices that unreasonably limit the availability, disclosure, and use of electronic health information undermine efforts to improve interoperability. Making this information publicly available may incentivize providers and clinicians to refrain from such practices.

ONC’s proposed rule promotes secure and more immediate access to health information for patients and their health care providers and new tools allowing for more choice in care and treatment. Specifically, the proposed rule calls on the health care industry to adopt standardized application programming interfaces (APIs), which will help allow individuals to securely and easily access structured and unstructured EHI formats using smartphones and other mobile devices. It also implements the information blocking provisions of the 21st Century Cures Act, including identifying reasonable and necessary activities that do not constitute information blocking. The proposed rule helps ensure patients can electronically access their electronic health information at no cost. The proposed rule also asks for comments on pricing information that could be included as part of their EHI and would help the public see the prices they are paying for their health care.

“By supporting secure access of electronic health information and strongly discouraging information blocking, the proposed rule supports the bi-partisan 21st Century Cures Act. The rule would support patients accessing and sharing their electronic health information while giving them the tools to shop for and coordinate their own health care,” said Don Rucker, M.D., National Coordinator for Health IT. “We encourage everyone – patients, patient advocates, health care providers, health IT developers, health information networks, application innovators, and anyone else interested in the interoperability and transparency of health information – to share their comments on the proposed rule.”

Policies in the proposed CMS and ONC rules align to advance interoperability in several important ways. CMS proposes that entities must conform to the same advanced API standards as those proposed for certified health IT in the ONC proposed rule, as well as including an aligned set of content and vocabulary standards for clinical data classes through the United States Core Data for Interoperability standard (USCDI). Together, these proposed rules address both technical and health care industry factors that create barriers to the interoperability of health information and limit a patient’s ability to access essential health information. Aligning these requirements for payers, health care providers, and health IT developers will help to drive an interoperable health IT infrastructure across systems, ensuring providers and patients have access to health data when and where it is needed.

For a fact sheet on the CMS proposed rule (CMS-9115-P), please visit: https://www.cms.gov/newsroom/fact-sheets/cms-advances-interoperability-patient-access-health-data-through-new-proposals

For fact sheets on the ONC proposed rule, please visit: https://healthit.gov/nprm

To receive more information about CMS’s interoperability efforts, sign-up for listserv notifications, here: https://public.govdelivery.com/accounts/USCMS/subscriber/new?topic_id=USCMS_12443

To view the CMS proposed rule (CMS-9115-P), please visit: https://www.cms.gov/Center/Special-Topic/Interoperability-Center.html

Pin It

Tags: , , , , , , ,

Posted in: Technology

Leave a Comment (0) →

Speak Up! HHS Wants to Hear from YOU!

Posted by on
Speak Up! HHS Wants to Hear from YOU!

The Department of Health and Human Services Office of Civil Rights wants to hear from health care providers, business associates and members of the public about how they can best modify HIPAA regulations. On Dec. 12, 2018, OCR issued a Request for Information, asking the public for comments on how the regulations can best facilitate continuity of care and decrease regulatory burdens.

“We are looking for candid feedback about how the existing HIPAA regulations are working in the real world and how we can improve them,” said OCR Director Roger Severino. “We are committed to pursuing the changes needed to improve quality of care and eliminate undue burdens on covered entities while maintaining robust privacy and security protections for individuals’ health information.”

They are looking for feedback in the following areas:

  • Promoting information sharing for treatment and care coordination and/or case management by amending the Privacy Rule to encourage, incentivize, or require covered entities to disclose PHI to other covered entities.
  • Encouraging covered entities, particularly providers, to share treatment information with parents, loved ones, and caregivers of adults facing health emergencies, with a particular focus on the opioid crisis.
  • Implementing the HITECH Act requirement to include, in an accounting of disclosures, disclosures for treatment, payment, and health care operations (TPO) from an electronic health record in a manner that provides helpful information to individuals, while minimizing regulatory burdens and disincentives to the adoption and use of interoperable EHRs.
  • Eliminating or modifying the requirement for covered health care providers to make a good faith effort to obtain individuals’ written acknowledgment of receipt of providers’ Notice of Privacy Practices, to reduce burden and free up resources for covered entities to devote to coordinated care without compromising transparency or an individual’s awareness of his or her rights.

Additionally, OCR is encouraging health care providers, business associates and members of the public to answer 54 questions that relate to their experiences working with health care data to determine which aspects of the regulations are necessary and which may be overly burdensome.

The RFI can be viewed by clicking on the following link: https://www.govinfo.gov/content/pkg/FR-2018-12-14/pdf/2018-27162.pdf

The deadline for comment is Feb. 12, 2019.  OCR has provided the following methods to submit comments:

  • Federal eRulemaking Portal. You may submit electronic comments at http://www.regulations.gov by searching for the Docket ID number HHS–OCR– 0945–AA00. Follow the instructions for sending comments.
  • Hand-Delivery or Regular, Express, or Overnight Mail: S. Department of Health and Human Services, Office for Civil Rights, Attention: RFI, RIN 0945– AA00, Hubert H. Humphrey Building, Room 509F, 200 Independence Avenue SW, Washington, DC 20201.

Instructions: All submissions received must include ‘‘Department of Health and Human Services, Office for Civil Rights RIN 0945–AA00’’ for this RFI. All comments received will be posted without change to http://www.regulations.gov, including any personal information provided.

As a compliance professional, I will be submitting comments on areas that impact my clients on Feb. 8, 2019.  If you have questions or concerns, feel free to contact me, and I’ll be happy to discuss your concerns or include your inquiry in my comments. I can be reached toll-free at 1-888-959-9501 or at Samarria@dunsongroup.com.

Article contributed by Samarria Dunson, J.D., CHC, CHPC, attorney/principal of The Dunson Group, LLC, a health care compliance consulting and law firm in Montgomery, Ala.  Attorney Dunson is also Of Counsel with the law firm of Balch & Bingham, LLP.  The Dunson Group, LLC, is an official partner with the Medical Association.

Pin It

Tags: , , , , , ,

Posted in: HIPAA

Leave a Comment (0) →

After EMR Implementation, Surgeons Spend Less Time Interacting with Patients

Posted by on
After EMR Implementation, Surgeons Spend Less Time Interacting with Patients

Implementing an electronic medical records (EMR) system at an orthopaedic clinic may have unanticipated effects on clinic efficiency and productivity – including a temporary increase in labor costs and a lasting reduction in time spent interacting with patients, reports a study in September 19, 2018, issue of The Journal of Bone & Joint Surgery. The journal is published in the Lippincott portfolio in partnership with Wolters Kluwer.

Even after an initial learning period, introducing a new EMR system may affect several aspects of clinic workflow, according to the paper by Daniel J. Scott, MD, MBA, of Duke University, Durham, N.C., and colleagues. They write, “Healthcare systems and policymakers should be aware that the length of the implementation period is approximately six months and that implementation may alter the time that providers spend with patients.”

Introducing EMRs Could Have ‘Negative Trade-Off’ for Patient Care

The researchers used time-driven activity-based costing methods to evaluate how a new EMR system affected costs and productivity at two outpatient orthopaedic arthroplasty (joint replacement) clinics. The analysis included detailed observations of 143 patient visits before implementation of the EMR system, and again at two months, six months, and two years after implementation.

At two months after EMR implementation, total labor costs had increased significantly, from $36.88 to $46.04 per patient visit. The cost increase was related to increases in the time that attending surgeons spent per patient, from 9.38 to 10.97 minutes, and in the time that certified medical assistants spent on patient assessment, from 3.4 to 9.1 minutes. For surgeons and medical assistants combined, the time spent documenting patient encounters more than doubled: from 3.3 to 7.6 minutes.

By six months after implementation of the EMR system, total labor costs were similar to costs in the pre-implementation period. From six months to two years, labor costs remained stable. Average weekly patient volume decreased for one of the surgeons studied, but remained stable for the other surgeon.

However, the increases in time spent on documentation persisted, even after the initial learning period. This was accompanied by a significant reduction in time spent interacting with patients, from 14.65 to 10.03 minutes.

Electronic medical records systems are rapidly being adopted throughout the US healthcare system, in part due to increased regulation. “EMR implementation can be costly and typically requires workflow redesign,” Dr. Scott and coauthors write. The study is the first to assess the impact of EMR systems in orthopaedic practice.

“This could suggest that providers ultimately were able to spend less time with patients as documentation requirements increased,” Dr. Scott and coauthors write. “If so, this could represent a negative trade-off for patient care and leave patients less satisfied, a trend worthy of further study.”

Pin It

Tags: ,

Posted in: Advocacy

Leave a Comment (0) →

Patients, Doctors Dissatisfied with Electronic Health Records

Posted by on
Patients, Doctors Dissatisfied with Electronic Health Records

Electronic Health Records are intended to streamline and improve access to information — and have been shown to improve quality of care — but a new study shows they also leave both doctors and patients unsatisfied, even after full implementation.

The study, by researchers at Lehigh University and the Lehigh Valley Health Network, surveyed physicians, mid-level providers and non-clinical staff at ob-gyn practices where EHRs were installed and analyzed survey answers given by patients. While there have been studies looking at how EHR implementation affects provider and patient satisfaction, this is the first study of how the integration of outpatient and hospital EHR systems affects provider and patient satisfaction.

Published in the August print issues Journal of the American Medical Informatics Association, the study tracked two ob-gyn practices and a regional hospital from 2009 to 2013, during the implementation of an EHR system and its subsequent integration with the hospital system. The EHR was installed in 2009 and information began flowing from the hospital to the ob-gyn practices in mid-2011. Full two-way exchange of clinical information was achieved a year later.

Ob-gyn practices posed a good opportunity for study because typically a woman will see physicians at her ob-gyn practice multiple times during the pregnancy before being admitted for labor (often seeing different doctors), and on average will have at least one pregnancy-related hospital visit prior to giving birth at a hospital, co-author Chad Meyerhoefer, professor of economics at Lehigh University, said.

Previous to the integrated EHR — digital versions of patient medical records were accessible through computers for some patients and paper records were sent by courier to the hospital for others — transmission of such records often was not made between hospitals and outpatient practices in a timely manner. This meant physicians at the practices might not know about visits to the hospital or test results ordered there and hospital doctors would not have access to the woman’s prior clinical data from outpatient OB-GYN appointments during visits to the hospital’s perinatal triage unit.

“We wanted to study how the EHR affected information flow between hospitals and practices and we chose pregnancy and obstetrics because it is a well-defined period — the prenatal care, birth and post-natal care all occur in a time frame we can capture,” said Meyerhoefer, who co-authored the paper with Susan A. Sherer, Mary E. Deily, Shin-Yi Chou and Jie Chen of Lehigh University and Michael Sheinberg and Donald Levick of Lehigh Valley Health Network. “In pregnancy, information is very important, having information about the patient’s prenatal experience can help to avert adverse events during the birth.”

Surprising Results

Researchers discovered both unsurprising and surprising results.

In theory, while it is understandable that implementation of an EHR would be seen as disruptive initially, by the time the EHR was in regular use, one would expect patients and doctors to report improvements in communication and coordination of care. However, the study showed that even after the EHR was established, both doctors and patients expressed dissatisfaction.

In the early stages, doctors and staff expressed frustration at learning a new system and the time it took to enter information. By the end of the study, staff appreciated ease with retrieving information and doctors felt communication and care were improved. Doctors, however, were also less satisfied by the system overall, citing the time it took to enter data, changes to workflow and decreased productivity.

“It was more of an adjustment for physicians, as it required them to do additional documentation they didn’t have to do before, and it had a bigger impact on their workflow,” Meyerhoefer said.

Patients felt the disruption at the beginning, and continued to feel less satisfied with their experiences after the EHR was fully implemented and was being used.

“Our thought was after the system was implemented and some time had passed and all these new capabilities are added to the system, the patients would see the benefits of that and feel better about their visits,” Meyerhoefer said. “But that didn’t happen.”

Why? Researchers aren’t sure, but one aspect may be that patients would likely have been unaware of improvements to their care and outcomes as a result of the EHR and may not have considered that when describing satisfaction levels, Meyerhoefer said. A previous study by the researchers, which looked at data flow from outpatient ob-gyns to the hospital and back and which information mattered, showed that implementation of an EHR decreased adverse birth events and had a positive effect on birth outcomes.

Changes in administrative practices, documentation, staffing, staff work roles and stress, and doctors’ concerns about productivity goals related to the implementation may also have changed the patient experience, or a patient’s perception of the care experience, in ways patients didn’t like.

“It could also be the case that having the computer documentation be a bigger part of patient interactions may be a negative thing for patients,” Meyerhoefer said. “The need for documentation sometimes takes the focus away from having a personal relationship with the patient.”

Training for Doctors

“The takeaway message is that during these implementations or after you have the system in place, you have to really think about how this is going to affect patients and maybe do training on patient interactions with electronic medical records to head off some of these negative effects,” Meyerhoefer said. This might include training for doctors in how to maintain verbal and nonverbal communication with patients during visits while also collecting or inputting information into a computer.

Also, since the brunt of documentation impact falls to physicians and impacts productivity, adjustments should be made to productivity targets that take that into consideration, researchers said.

In addition to patient experiences, the impacts are important to study and consider because installation of an EHR generally changes the way doctors and staff record and report information, as well as work processes and staffing related to documentation. “It can be a big change, and can be very disruptive,” Meyerhoefer said. Acquiring EHR software is typically a large financial investment for a hospital or health system as well. And even after a system is acquired and used, replacing it with a new system would engender similar adoption issues.

“These findings are specific to OB-GYN patients, but I think these results on satisfaction would carry over to many other types of care, where physicians and other clinical providers will not really see the benefit of a system until the information flow is improved, and there can be persistent negative effects on patient satisfaction,” Meyerhoefer said.

###

The work was funded by a grant from the Agency for Healthcare Research and Quality, an agency of the U.S. Department of Health and Human Services, and by a Lehigh University Faculty Innovation Grant.

Pin It

Tags: , , , , , , , , , ,

Posted in: Research

Leave a Comment (0) →

STUDY: Independent Practice Declines Due Partially to EHRs

Posted by on
STUDY: Independent Practice Declines Due Partially to EHRs

A new study conducted by the Trump Administration suggests electronic health records are currently failing at reducing the cost of billing for medical facilities, especially for independent practices.

“Small physicians’ groups and solo providers could not afford to purchase and maintain electronic medical records and comply with government reporting requirements,” the White House report stated. “As a result, hospital mergers are booming, leading to horizontal integration, and large hospitals are buying up physicians’ practices and outpatient service providers to form large, vertically integrated health care networks.”

A study published in the Journal of the American Medical Association shows that billing costs consumed significant chunks of revenue even at a large academic center with a fully implemented EHR system. They represented about 14.5 percent of costs of primary care visits and 13.4 percent of costs for ambulatory surgical procedures. “These findings suggest that significant investments in certified health information technology have not reduced high billing costs in the United States,” the authors state in the report.

Independent physicians have also commented on the burdens of the EHR system. Three out of four physicians believe electronic health records (EHRs) increase practice costs, outweighing any efficiency savings, and seven out of 10 think EHRs reduce their productivity, according to a Deloitte’s recent 2016 Survey of U.S. Physicians.

The results of the survey also indicate physician satisfaction with EHRs varies by practice characteristics. About 70 percent of employed physicians are more likely to think that EHRs support the exchange of clinical information and help improve clinical outcomes compared to 50 percent of independent physicians. The results also revealed 72 percent of independent physicians are more likely to think that EHRs reduce productivity compared to 57 percent of employed physicians. Additionally, 80 percent of independent physicians think that EHRs increase practice costs, compared to 63 percent of employed physicians.

The federal government has financial interests in making it easier for physicians to cope with EHR requirements, according to President Trump’s 2018 Economic Report. As part of its 2018 economic report, released Feb. 21, the White House drew a direct connection between physicians’ struggles to purchase and operate EHR systems and the increase in consolidation among hospitals.

Pin It

Tags: , , , , , , , , ,

Posted in: Advocacy

Leave a Comment (0) →

Bipartisan Budget Act Boosts Health Programs

Posted by on
Bipartisan Budget Act Boosts Health Programs

In a rare show of bipartisanship for the mostly polarized 115th Congress, the Bipartisan Budget Act of 2018 is officially one for the record books. The week leading up to the final vote was far from smooth with Sen. Nancy Pelosi impressively filibustering on the floor of the U.S. Senate for eight hours to Rep. Rand Paul blocking the final vote late Thursday night/early Friday morning and forcing a six-hour government shutdown before allowing the final vote to be taken.

Now that President Trump has signed the Bipartisan Budget Act of 2018 here’s what you need to know:

Technical Amendments to MACRA. Makes several changes to the Medicare Access and CHIP Reauthorization Act (MACRA) that the medical community has been strongly advocating for, including:

  • Excludes Medicare Part B drug costs from MIPS payment adjustments and from the low-volume threshold determination;
  • Eliminates improvement scoring for the cost performance category for the third, fourth and fifth years of MIPS;
  • Allows CMS to reweight the cost performance category to not less than 10 percent for the third, fourth, and fifth years of MIPS;
  • Requires CMS to update on CMS’ website by Dec. 31 of each year, information on resource use measures including measures under development, the time-frame for such development, potential future resource use measure topics, a description of stakeholder engagement and the percent of expenditures under Medicare Part A and B that are covered by resource use measures.
  • Allows CMS flexibility in setting the performance threshold for years three through five to ensure a gradual and incremental transition to the performance threshold set at the mean or median for the sixth year;
  • Allows the Physician Focused Payment Model Technical Advisory Committee (PTAC) to provide initial feedback regarding the extent to which models meet criteria and an explanation of the basis for the feedback.

Physician fee schedule update (in lieu of Misvalued Codes). Reduces the Physician Fee Schedule conversion factor for 2019 from 0.5 percent to 0.25 percent. This is more favorable language than, and is in lieu of, the language in the House bill that would extend the “misvalued codes” provision for one additional year. The AMA estimated, based on the recommendations of the AMA / Specialty Society Relative Value Scale Update Committee (RUC), that the misvalued code provision in the House bill would have reduced the statutory 0.5 percent payment update in 2019 by 0.45 percent. Rejection of the misvalued code policy is an important outcome for future budget saving exercises. On a bipartisan basis, policymakers have recognized that the misvalued code “budget dial” is tapped out and should be shelved.

IPAB. Permanently repeals the Independent Payment Advisory Board. IPAB was a 15-member government agency created in 2010 by the Affordable Care Act for achieving specified savings in Medicare without affecting coverage or quality.

Children’s Health Insurance Program (CHIP). CHIP is extended for an additional four years beyond the previous Continuing Resolution’s six-year extension, with appropriations made through 2027.

Community Health Centers. Funding for community health centers is reauthorized for two years at a level of $3.8 billion for FY 2018 and $4 billion for FY 2019.

Medicare payment cap for therapy services. Permanently repeals the outpatient therapy caps beginning on Jan. 1, 2018.

National Health Service Corps. Funding for the National Health Service Corps is extended at the FY 2015 – 2017 annual level of $310 million for two additional years.

Teaching Health Center Graduate Medical Education. Funding for Teaching Health Center Graduate Medical Education is extended for two years at an annual level of $126.5 million, more than doubling annual funding for this program.

Geographic Practice Cost Indices (GPCI) floor. Extends the work GPCI floor for two additional years through Jan. 1, 2020.

Reducing EHR Significant Hardship. Removes the current mandate that meaningful use standards become more stringent over time. This eases the burden on physicians as they would no longer have to submit and receive a hardship exception from HHS.

Closing the Donut Hole for Seniors. Closes the Medicare Part D prescription drug “donut hole” sooner than under current law by increasing the discounted price manufacturers provide from 50 percent to 70 percent.

Emergency Medicaid Funds for Puerto Rico and the U.S. Virgin Islands. Puerto Rico’s Medicaid caps for 2018 – 2019 are increased by an additional $4.8 billion. The Virgin Islands’ caps are increased over the same time period by $142.5 million. Also, 100 percent federal cost sharing for Medicaid is provided for both territories through Sept. 30, 2019.

Prevention and Public Health Fund (PPHF). The Senate bill reduces funding for the PPHF by $1.35 billion between FY 2018 – 2027.

Other Select Budget Agreement Provisions:

Note: there is an agreement to include these funds in the Omnibus before the March 23 deadline.

  • $6 billion in funding for the opioid crisis and for mental health
  • $4 billion to rebuild and improve VA Hospitals and clinics
  • $2 billion for NIH research (above CURES Act increases)

Click here if you would like to see how Alabama’s Congressional Delegation voted.

Pin It

Tags: , , , , , , , , , ,

Posted in: Advocacy

Leave a Comment (0) →

MACRA: Rolled Out and Still Rolling

Posted by on
MACRA: Rolled Out and Still Rolling

Most physicians have, by this point, gained some familiarity with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The name of this law has appeared frequently in commentary over the past several years, and the changes it imposes are well on their way. However, many of the details concerning MACRA’s implementation—how it affects physicians on the ground and what they need to do on a practical and technical level in order to comply with its requirements—deserve additional attention. It is, after all, a law that changes much about the Medicare payment landscape, and new guidance from the government continues to appear.

This article will discuss three recent releases from the Centers for Medicare & Medicaid Services (CMS) that concern MACRA, dating from the end of 2017 through the beginning of 2018. There is obviously much more that physicians should note about MACRA as we head further into 2018, but hopefully, this very brief article can serve as a springboard into the many features of this multifaceted new legal scheme.

  1. Starting with the most recent news release, on Jan. 3, 2018, of this year CMS announced that it had launched a new system for clinicians in the Quality Payment Program to submit their 2017 performance data. This system is located on the Quality Payment Program website, and because it replaces an array of former systems on multiple websites, it should make such data submission easier. For most clinicians, the 2017 submission period runs from Jan. 2, 2018, to March 31, 2018. Therefore, exploring this website’s new system for submission — including developing familiarity with the log-in and submission procedures — sooner rather than later is advisable. There are multiple data submission options embedded in the website, and thus having some advance knowledge of the preferred method should benefit a clinician. Eligible clinicians will see in real time the initial scoring, which may later change, for each of the Merit-based Incentive Payment System (MIPS) performance categories as they submit their data. CMS’ news release included a link to a fact sheet on this new system, which can be accessed here.
  2. On Dec. 19, 2017, CMS published the “2018 Medicare Electronic Health Record (EHR) Incentive Program Payment Adjustment Fact Sheet for Eligible Clinicians.” The referenced Payment Adjustment relates to the reduced Medicare payments for clinicians who do not demonstrate that they are meaningful users of Certified Electronic Health Record (EHR) Technology. This year is the final year of meaningful-use payment adjustments under the Medicare EHR Incentive Program, but the need to meet EHR standards is not going away: MACRA combines certain aspects of this Medicare EHR Incentive Program with other programs into MIPS, and the basic requirements that established meaningful use will still factor in as a percentage of a clinician’s MIPS score. The MIPS payment adjustments will be applied to Medicare Part B payments in 2019 for the 2017 performance period. CMS’ news release containing additional details can be accessed here.
  3. On Nov. 2, 2017, CMS issued a rule containing updates to the payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule for this year. This is not a MACRA-specific rule; instead, it demonstrates how MACRA has already become incorporated into the Medicare payment landscape as a whole. For example, MACRA helped determine the overall update to payments under the Fee Schedule, which is +0.41 percent for this year; the rule discusses the replacement of the Physician Quality Reporting System by MIPS; the rule also discusses the patient relationship code categories required under MACRA. In short, MACRA’s impact on the payment landscape is varied and pervasive. The time for getting up to speed on the practical implementation of this law has certainly arrived.

As noted above, MACRA is here among us, and it touches upon many facets of a physician’s practice. In order to avoid the various causes of decreased reimbursement, it benefits physicians to proactively seek to understand the ongoing requirements ushered in by the law.

Article contributed by Chris Thompson, an attorney at Burr & Forman LLP practicing within the firm’s Health Care Industry Group. Burr & Forman LLP is an official partner with the Medical Association.

Pin It

Tags: , , , , , ,

Posted in: Legal Watch

Leave a Comment (0) →

Physicians Spend More Than Half of Work Day on Electronic Health Records

Posted by on
Physicians Spend More Than Half of Work Day on Electronic Health Records

Primary-care physicians spend more than half of their workday on electronic health records during and after clinic hours, a University of Wisconsin School of Medicine and Public Health and American Medical Association study has found. The study, published online in the Annals of Family Medicine, shows physicians spent 5.9 hours of an 11.4 hour work day on electronic health records.

“While physician burnout happens for a number of reasons, spending a good deal of the work day and beyond on electronic health records is one of the things that leads to burnout,” said Dr. Brian Arndt, associate professor of family medicine and community health.

Arndt said 142 family-medicine physicians in the UW Health system were part of the study and all EHR interactions were tracked over a three-year period from 2013 to 2016 for both direct patient care and non-face-to-face activities.

He found that clinicians spent 4.5 hours during clinic each day on electronic health records. Another 1.4 hours before or after clinic were used for electronic health records documentation for a total of 5.9 hours each day.

That means that primary-care physicians spent nearly two hours on electronic health records per hour of direct patient care.

“When you factor in the non-electronic health records duties, it adds up to a workday of 11.4 hours, representing a significant intrusion on physicians’ personal and family lives,” said Arndt.

Order entry, billing and coding, and system security accounted for nearly half of the total electronic health records time (2.6 hours). Clerical duties like medication refills, interpretation of lab and imaging results, letters to patients, responding by e-mail to questions about medications and incoming and outgoing phone calls accounted for another 1.4 hours of every work day.

“It is imperative to find ways to reduce documentation burden on physicians,” said Arndt. “There are a couple of things to consider. Having clinical staff enter verbal or handwritten notes (based on a standardized checklist) could save time and allow physicians to focus more on the patient. In addition, documentation support by staff and additional training in documentation optimization should be available for interested physicians.”

Arndt said the electronic health records event logs used in the study can identify areas of electronic health records-related work that could be delegated to reduce workload, improve professional satisfaction and reduce burnout.

UW Health Chief Medical Information Officer and Senior Vice President Dr. Shannon Dean said the health system leadership supports and appreciates the work of Dr. Arndt and his colleagues in identifying areas of concern and supports reducing any undue burdens on physicians by proactively looking for ways to make the electronic health records system more efficient and distributing appropriate work amongst the clinical care team. Electronic health records systems do offer major benefits to patient care, so preserving their value is also a key goal.

Dean said initiatives include the recent deployment of single sign-on technology that addresses the time spent simply logging in and out of the system and the rollout of advanced voice-recognition software to allow providers to “dictate” directly into the system rather than type.

“UW Health acknowledges that the electronic health records and increased documentation requirements are contributing factors to physician burnout and has invested significant resources in education, optimization and support teams to ensure providers have ‘at the elbow’ support for doing their work,” said Dean. “Our support teams are currently meeting one-on-one with every provider to review their use of the electronic health records and provide them with tips and tricks to improve efficiency.”

Pin It

Tags: , , , , , , ,

Posted in: Management

Leave a Comment (0) →

Report: EMR Industry Must Reckon with Physician User Frustration

Posted by on
Report: EMR Industry Must Reckon with Physician User Frustration

ROCKVILLE, MD – A new study by health care market researcher Kalorama Information has found that physician frustration over the use of EMR systems will be a trend for vendors to deal with. Previously, incentives paid to providers to buy and use electronic medical records were enough for a market boost, but now user frustration is driving vendor switches and contributing to implementation costs. Kalorama has covered EMR for a decade and has issued a new report: EMR Market 2017: Electronic Medical Records in an Era of Disruption.

Kalorama based its findings on attendance at the 2017 HIMSS conference, and from vendor and end-user consults.

“During the HIMSS 2017 conference, discussions revolved around physician dissatisfaction with EMRs,” said Mary Ann Crandall, author of the report. “Physicians still feel that vendors are missing the mark when addressing the needs of physicians.”

Physicians have repeatedly complained that EHRs are difficult to use. Many EHR interfaces are awkward and non-intuitive creating more problems than solutions. Physicians are not convinced that EMRs will cut costs or help to provide better and safer care. One of the reasons for this may be that vendors do not seem to be in touch with what physicians need in their individual practices. Furthermore, EHRs often get in the way and slow users down because of the way they are configured or are not convenient to use. Most EHRs are not designed to help physicians juggle the simultaneous tasks they all face, like answering a question about one patient while in the middle of writing a prescription for another. In addition, because most of the programs that are on the market were developed many years ago before today’s sophisticated interface tools were developed, it compounds the problems.

“Furthermore, physicians get tired of having to sign into multiple hospital systems to locate data on their patients. Smartphones, iPads and the Internet are so intuitive and well integrated that they make EHRs look even worse,” said Crandall in the report.

A survey of nearly 3,000 physicians reported that most physicians do not like the Affordable Care Act and many of them do not like EMRs. Only 30 percent of the physicians surveyed think that EMRs will have a positive effect on the quality of care. One big reason for the sour feeling it that  Medicaid and Medicare reimbursement continues to fall, and Medicaid will cover many of the 32 million uninsured individuals targeted to be insured under the law. The survey also did not show a lot of support for accountable care organizations, which is an emerging payment model authorized in the reform bill.

Crandall said physicians feel that there needs to be a concentrated effort to focus on evidence, accuracy, how it is integrated with the physician’s EMR and how it is integrated within the practice. According to Michael Hodgkins, AMA CMIO, physicians are spending twice the amount of time on deskwork and EHR maintenance, including 38 hours a month spent on EHRs after work hours. This is creating dissatisfaction and contributing to burnout for physicians. Michael Hodgkins further stated that physicians just want to provide high-quality care, but EHR work seems to get in the way. At the same time, practice sustainability and changing reimbursement models that favor scale and shift risk to the providers is leading many practices to merge or sell out altogether.  Simply, physicians are overwhelmed with platforms, apps, regulations and computer work.

Several vendors are listening to the physician complaints and are attempting to make changes. Kalorama reported in April that Allscripts is developing separate workflows for mobile devices and desktop computers, and will focus on touch speech recognition and other non-keyboard interfacing techniques that will help to improve physician perception.

Kalorama notes that while there are a few leaders in the EMR market, there isn’t much brand and mind share and few favorites among physician users. Greater detail on these trends are included in Kalorama Information’s report, EMR 2017: Electronic Medical Records in an Era of Disruption.

Pin It

Tags: , ,

Posted in: Management

Leave a Comment (0) →

Meaningful Use and the Costs of Noncompliance

Posted by on
Meaningful Use and the Costs of Noncompliance

It is something of an understatement to note that the U.S. health care legal landscape is currently experiencing a degree of transition and uncertainty. There is no shortage of changes to discuss, debate, and, perhaps, grow apprehensive about. One development that has been the radar of many physicians for several years now – and brought into new relief by more recent changes such as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) – is the Meaningful Use concept introduced by the Health Information Technology for Economic and Clinical Health (HITECH) Act.

“Meaningful Use” relates to physicians’ use of certified electronic health records (EHR) technology in the interest of interoperability and efficient electronic exchange of health information. The Centers for Medicare & Medicaid Services (CMS) offers an incentive program which offers incentive payments to eligible professionals and eligible hospitals who join and comply. Participation involves making “Meaningful Use Attestations” regarding compliance. Both compliance and noncompliance with Meaningful Use goals can represent a significant cost to physicians: compliance, as bringing a practice’s technological infrastructure up to the appropriate standards does not come cheaply; noncompliance, as those who choose not participate in CMS’s incentive program, face reductions in their Medicare and Medicaid payments. These reductions equal a 3 percent decrease in 2017.

It appears that noncompliance with Meaningful Use standards carries more of a bite than some observers may have thought. In June of 2017, the Office of the Inspector General (OIG) released a report that Medicare made hundreds of millions of dollars’ worth of incentive payments to Meaningful Use attesters who failed to meet the necessary requirements. The OIG estimated a total of approximately $730 million dollars in inappropriate payments – more than ten percent of the total payments. CMS’s blunder largely resulted from its failure to conduct adequate documentation review, thus rendering the self-attestations of professionals prone to abuse. Note, too, that CMS is not the only authority to make inappropriate EHR incentive payments: the OIG faulted Texas in August 2015 for making such wrongful payments in an amount over $15 million through its Medicaid program.

This does not, of course, amount to a windfall for the physicians who received the wrongful payments. The OIG’s recommendation to CMS includes directing CMS to recover the wrongful payments it has identified (a small sample of the total), and to seek to identify, and then recover, the rest of the inappropriately directed federal funds. As is characteristically the case, government overpayments cannot be retained by the recipient. Thus, the takeaway from CMS’s improper Meaningful Use largesse should not be an observation that the government has, up till now, not been adequately reviewing Meaningful Use documentation. Instead, it should be that one can, of course, expect such mistakes to be corrected when discovered and that it is even more important to get Meaningful Use compliance correct now. What has been done in the past by a physician may not actually have sufficed. Additionally, part of OIG’s recommendation to CMS was to educate eligible clinicians on proper Meaningful Use documentation requirements. Physicians should look for and take advantage of such education.

This need to double down on one’s Meaningful Use efforts comes at a time when the reimbursement system is shifting to MACRA. The Medicare EHR Incentive Program is no longer a standalone program –it has been combined through MACRA with the Physician Quality Reporting System and the Physician Value-based Payment Modifier into a single program, the Merit-based Incentive Payment System (MIPS) under the Quality Payment Program (QPP). Although hospital and Medicaid Meaningful Use programs are unaffected by MACRA, clinicians will make their Medicare Meaningful Use attestations through the QPP. This program still focuses on the use of Certified EHR Technology to support interoperability and healthcare quality objectives. The meaningful use measures are calculated and compensated somewhat differently under MIPS; one significant change is that a hybrid scoring system has replaced the previous all-or-nothing approach.

Although the manner of reporting Meaningful Use has changed somewhat, it has not become either less important or markedly simpler. Getting up to speed on the technological, administrative, and reporting features of establishing Meaningful Use now – when there is some clemency as far as timing goes worked into the transition period – is certainly advisable. The need to establish the goals of interoperability, efficiency, and care coordination that Meaningful Use seeks to advance is a need that is unlikely to diminish. The fact that CMS is now beginning to seek hundreds of millions of dollars in wrongful incentive payments only highlights that Meaningful Use compliance is an issue worth following in the always changing health care landscape.

Chris Thompson is an attorney with Burr & Forman LLP. Chris practices exclusively in the firm’s Health Care Practice Group. Burr & Forman, LLP, is an official Bronze Partner with the Medical Association.

Pin It

Tags: , , , , , , , ,

Posted in: MACRA

Leave a Comment (0) →
Page 1 of 2 12