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Health IT News: EMR Overhaul, Meaningful Use Reporting, & Patient EMR Access

Posted by Matthew Smith on Sep 18, 2014 9:08:00 AM

AMA Speaks Out In Favor of EMR Overhaul.

Health IT, HIT, EHR, EMR, Meaningful UseThe Wall Street Journal (9/16, Beck, Subscription Publication) reports, under the headline “AMA Urges Overhaul Of Electronic Medical Records,” that the AMA is backing physicians’ concerns that the current electronic medical records options are not user friendly and get in the way of patient care. AMA president-elect Steven J. Stack, MD, told the Journal that current EMR technology “is not supporting the quality of care we need it to.”

Dr. Stack criticized the Federal Meaningful User program, managed by HHS, and its requirements for the issues doctors have with EMR technology. Dr. Jacob Reider, currently the deputy national coordinator for health IT at HHS, said the agency welcomes the AMA’s feedback and noted that the agency is prioritizing usability. Dr. Reider was joined by other industry representatives in telling the Journal that usability was a priority for them but that improvement would be gradual and take a few years. 

Health IT Stakeholders Lobby for 90-day Meaningful Use Reporting Period in 2015

When CMS issued a final rule in early September granting providers the flexibility in meaningful use attestation the agency had originally proposed back in May and finalizing the extension of stage 2 through 2016 for providers that started attesting in 2011 or 2012.

The rule finalizes the proposed attestation flexibility for providers that were unable to implement 2014 CEHRT in time to successfully attest due to vendor delays. These providers will be able to use 2011 Edition CEHRT or a combination of 2011 and 2014 Edition to attest to either stage 1 or stage 2. They will also be able to attest to meaningful use under the 2013 reporting year definition and use 2013's clinical quality measures.

The rule was generally welcomed by provider organizations and other stakeholders, with one notable point of contention — the final rule keeps the 2015 reporting period at a full 365 days rather than the 90-day period industry members had urged.

This week, 17 industry organizations wrote a letter to HHS Secretary Sylvia Burwell to again request the reporting period be shortened to 90 days. The organizations' main concern is that many of the providers who weren't able to implement 2014 Edition CEHRT in time to attest this year won't be ready to do so in the next 15 days, when the 2015 reporting period starts.

"For roughly 3,800 hospitals, the final rule requires implementation of 2014 Edition CEHRT configured for stage 2 measures and objectives by Oct. 1, 2014," according to the letter. "More than 237,000 eligible professionals will need to be similarly positioned by Jan. 1, 2015. This is in addition to the 1,200 hospitals and 290,000 EPs who also must have 2014 Edition CEHRT implemented before the beginning of their reporting year at stage 1."

However, current meaningful use attestation numbers suggest the vast majority of these providers will not be ready. Just 143 hospitals have met stage 2 thus far, or about 4 percent of the hospitals that will be required to begin stage 2 reporting next month, according to the letter.

Reducing the attestation period to 90 days, and thereby giving hospitals until July 1, 2015 (and eligible professionals until Oct. 1, 2015) to start the reporting period, would "help hundreds of thousands of providers meet stage 2 requirements in an effective and safe manner," according to the letter. "This will reinforce investments made to date and it will ensure continued momentum towards the goals of stage 3, including enhanced care coordination and interoperability."

The letter's 17 signatory organizations include the American Academy of Family Physicians, American College of Physicians, the American College of Physician Executives, America's Essential Hospitals, American Hospital Association, American Medical Association, Association of American Medical Colleges, Association of Medical Directors of Information Systems, Catholic Health Association of the U.S., Children's Hospital Association, College of Healthcare Information Management Executives, Federation of American Hospitals, HIMSS, Medical Group Management Association, National Rural Health Association and Premier healthcare alliance.

ONC: Half of Patients Given Online EMR Access Use It

In 2013, about three in 10 patients were offered online access to their medical record. About half of those patients offered access logged on at least once, according to a news brief from the ONC.

The ONC surveyed 661 patients with online EMR access. Of those patients, 21 percent viewed their record once or twice, 15 percent viewed it three to five times and 10 percent viewed it more than six times. Fifty-four percent did not access their record at all.

Of those who accessed their medical record online, 60 percent said it was "very useful."

The brief comes at a time when hospitals and health systems are struggling to meet the view/download/transmit requirement of meaningful use stage 2, many worrying about low participation among their patient populations. This brief indicates patients may be more receptive to accessing their records online than providers think, according to an ONC blog post.

Topics: EHR, EMR, Meaningful Use, Health IT, AMA, Patient Access

ICD-10 Delay Approved By Senate; Deadline Moved to 10/1/2015

Posted by Matthew Smith on Apr 1, 2014 9:26:00 AM

ICD-10 DelayedBy a vote of 64 to 35, the U.S. Senate on March 31 approved legislation that includes a provision to delay the ICD-10 implementation deadline by one year to Oct. 1, 2015. The bill will be sent to President Obama for his expected signature.

The so-called "Doc-Fix" bill also suspends Medicare's sustainable growth rate (SGR) formula that would have cut the physician reimbursement rate this year by nearly 24 percent. Congress had until today to pass the legislation that averts the payment cut and further delays Medicare cuts to physicians until April 1, 2015. In addition, the bill further delays enforcement of the Medicare two-midnight payment policy for hospitals until March 2015.

The Senate conducted a straight “up or down” roll call vote on the bill, which prevented senators from removing any sections of the bill, including the ICD-10 delay provision. Previously, in a March 27 voice vote, the House of Representatives approved the fast-track legislation that was based on a bipartisan deal struck between Senate Majority Leader Harry Reid and House Speaker John Boehner. 

In an opening statement earlier this afternoon to begin the Senate's consideration of H.R. 4302, the Protecting Access to Medicare Act of 2014, Reid acknowledged that the 12-month temporary SGR fix in the bill "is not perfect, not ideal" but it "ensures that Medicare patients will be able to see their doctors." The legislation is Congress’ 17th temporary Medicare patch. Sen. Ron Wyden (D-Ore.), recently installed as chairman of the Senate Finance Committee, tried but failed to get the Senate to consider a permanent Medicare SGR fix during debate on the bill.

Topics: CMS, AMA, ICD-10, AHIMA, HIMSS, Doc Fix

Senate to Vote Monday on ICD-10 Delay

Posted by Matthew Smith on Mar 28, 2014 2:13:00 PM
ICD-10, House Bill,Courtesy of HIMSS Government Relations

On Thursday, March 27th, the U.S. House of Representatives approved by voice vote HR 4302, a new bill that would create a one-year patch for the Sustainable Growth Rate (SGR) formula, further delaying action on replacing the current formula until April 2015. 

The bill would also delay the conversion to ICD-10 by one year to October 2015:

SEC. 212. DELAY IN TRANSITION FROM ICD–9 TO ICD–10 CODE SETS.

The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD–10 code sets as the standard for code sets under section 1173(c) of the Social Security Act (42 U.S.C. 1320d–2(c)) and section 14 162.1002 of title 45, Code of Federal Regulations.

The bill now awaits action in the Senate, which has announced plans to vote at 5:30 pm on Monday, March 31st, with 60 votes needed for passage.  The current short term SGR "doc fix" expires at midnight Monday.

“HIMSS is monitoring the developments in the House and Senate on ICD-10," said Tom Leary, HIMSS Vice President of Government Relations. "We continue to focus our efforts on supporting our stakeholders by providing education, resource and tools to help them make the conversion to ICD-10 in the most effective and efficient ways.”

HIMSS offers many resources for those making the transition from ICD-9 to ICD-10 in the ICD-10 Playbook

In February, Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner told HIMSS14 attendees that the October 1, 2014 start date for ICD-10 remained firm. 

Topics: CMS, AMA, ICD-10, AHIMA, HIMSS, Doc Fix

BREAKING: House Bill Would Delay ICD-10 Deadline Until at Least 2015

Posted by Matthew Smith on Mar 26, 2014 2:53:00 PM

ICD-10, House BillThe planned implementation of a nationwide conversion to the ICD-10 family of diagnostic and procedural codes would be extended at least a year by a House Ways and Means Committee bill aimed at providing the annual fix of the physician sustainable growth-rate formula.

“The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD-10 code sets as the standard,” states section 212 of the proposal. 

In late February, CMS Administrator Marilyn Tavenner told an industry conference, “There are no more delays and the system will go live on Oct. 1,” of this year, which was the original scheduled implementation date for ICD-10.

According to an announcement by the American Health Information Management Association (AHIMA), the bill is slated to be voted by the House of Representatives on March 27. “This bill was negotiated at the leadership level in the House and Senate, and it is expected that there will be no debate before calling the bill to vote,” the association revealed to its constituents.

Additionally, AHIMA has urged its members and other stakeholders to contact their representatives and senators not for the purpose of supporting the delay but instead of removing the ICD-10 provision from the SGR bill. The association has made the following script available to would-be callers:

Hello Representative XX/Senator XX, my name is XXX and I am a concerned member in your district, as well as a healthcare professional. I am calling to voice my opposition to the language in the SGR patch that would delay ICD-10 implementation until October, 2015. CMS estimates that a 1 year delay could cost between $1 billion to $6.6 billion. This is approximately 10-30% of what has already been invested by providers, payers, vendors and academic programs in your district. Without ICD-10, the return on investment in EHRs and health data exchange will be greatly diminished. I urge you, Representative XX/ Senator XX to oppose the ICD-10 delay and let Speaker Boehner and Senate Majority Leader Reid know that a delay in ICD-10 will substantially increase total implementation costs in your district as well as delay the positive impact for patient care.

Associations such as the American Medical Association (AMA) have asked their members to convince Congress of the need for a timely SGR repeal, with the failure to do by March 31 leading to a 24-percent cut in payments to physicians. But this advocacy does include any mention of the recent inclusion of an ICD-10 delay into the debate over the SGR.

Topics: CMS, AMA, ICD-10, AHIMA

Affordable Care Act: Beyond the Initial Reactions

Posted by Matthew Smith on Aug 8, 2012 10:56:00 AM

Affordable Care ActIt's been nearly six weeks since the Supreme Court's Patient Protection and Affordable Care Act (ACA) ruling, and some physician-based organizations have had time to digest the intricacies of the resulting information that was released.

As a refresher, the new law will require most Americans to carry health insurance or pay a penalty beginning in 2014. The law also guarantees that health insurance will be available to those who are already ill or need expensive care, ultimately helping many poor and middle-class people afford coverage. All totalled, it is believed that hospitals can expect an influx of approximately 32 million newly insured patients. So the issue that has developed is, "How are physicians reacting to these changes?" To answer this question, the following are opinions delivered by the Presidents of three, large, physician-minded associations.

John R. Tongue, MD
President
American Academy of Orthopaedic Surgeons

Although the American Association of Orthopaedic Surgeons (AAOS) opposed much of PPACA, we recognize that there are provisions in the law that aim to help providers deliver high-value healthcare services, including the development and implementation of Accountable Care Organizations and other quality improvement efforts, and assistance for pediatric specialists serving underserved communities. In addition, there are valuable patient protection provisions within the law, such as enabling young adults to remain on their parents’ insurance policies, outlawing coverage denials based on pre-existing conditions, enforcing medical loss ratio requirements, and doing away with maximum coverage limits on insurance policies.

However, PPACA also contains some provisions that could greatly hinder providers’ ability to deliver patient care, thereby threatening patients’ access to the healthcare services they need. The AAOS, along with its more than 18,000 members, stands ready to work with Congress to address these detrimental provisions in the law, such as continuing efforts to repeal the Independent Payment Advisory Board (IPAB) and other administrative burdens that infringe upon providers’ ability to deliver safe and effective patient care. 

 

Jeremy A. Lazarus, MD
President 
American Medical Association

While the law is not perfect, the AMA, the nation's largest physician organization, supported it because it makes necessary improvements to our health care system. We are pleased the law expands coverage to millions of uninsured who live sicker and die younger than those with insurance. It allows physicians to see patients earlier before care is more expensive, provides funding for research on drugs and treatments, increases Medicare and Medicaid payments for primary care physicians and includes Medicare bonus payments for general surgeons in underserved areas.

The AMA is working during implementation of the law to make changes like eliminating the Independent Payment Advisory Board. Lawmakers also must address two problems that predate the law, the broken Medicare physician payment formula and the flawed medical liability system.


Glen Stream, MD, MBI
President 
American Academy of Family Physicians

The Patient Protection and Affordable Care Act has been a divisive issue not only in our country but also amongst our own membership. Clearly, it is far from perfect legislation. But now that the Supreme Court finally has issued its long-awaited rulingwe can move forward with needed health system reforms.

The Academy will continue to work to implement the best pieces of the ACA, advocate for change in provisions of the law that are flawed and address the law's two key deficiencies -- meaningful medical liability reform and a replacement for the sustainable growth rate (SGR) formula.

The ACA, even with its flaws, provides a pathway to reach the AAFP's vision of health care for all, a policy goal the Academy has been pursuing for more than two decades. By extending health coverage to roughly 30 million more people, the law will improve the health of the nation by ensuring access to basic primary care, including preventive services and chronic disease management.

The court's decision helps our patients by preserving provisions of the ACA that:

  • eliminate annual and lifetime coverage limits;
  • eliminate cost sharing for preventive services;
  • prevent payers from denying coverage based on pre-existing conditions; and
  • allow young adults to stay on their parents' insurance up to age 26.

For primary care physicians, the court's decision preserved provisions of the ACA that:

  • create Medicare primary care payment incentives; and
  • boost Medicaid payments for primary care services to Medicare levels.

For our workforce, the decision means investment in primary care education and training will continue through:

  • funding for teaching health centers;
  • scholarship and loan repayment programs in the National Health Service Corps;
  • support for the health professions grants for family medicine; and
  • establishment of the Health Care Workforce Commission.

The ruling also means that projects intended to align payment to support medical home transformation will continue. 

There is plenty to like, and dislike, about the ACA. The bottom line is that our Academy will work to maximize the provisions of the law that benefit family physicians and our patients while also addressing issues where the law is lacking or deficient.

 ----------------------------------------------------------

So how about the rest of the country's physicians? In a survey conducted by Kantar Health and Sermo, Inc. following the Supreme Court’s decision to uphold the Affordable Care Act:

  • 71% of U.S. physicians want major changes to the law
  • 57% percent of the 1,500 respondents said they would like to see the law repealed altogether
  • 14% would keep the law but undertake major bipartisan revisions
  • 26% favor keeping the law and “fine tuning” it over time.

With the jury still out on the ACA, only time will tell if the ACA will deliver improvments and changes that the US health system needs.

Topics: ACA, Affordable Care, SCOTUS, AMA, AAOS, AAFP, Medical Association, Physicians

Early Reactions to Supreme Court's Affordable Care Act Decision

Posted by Matthew Smith on Jun 28, 2012 10:16:00 AM

Supreme Court Ruling, ACAAmerican Medical Association:

The American Medical Association has long supported health insurance coverage for all, and we are pleased that this decision means millions of Americans can look forward to the coverage they need to get healthy and stay healthy.

The AMA remains committed to working on behalf of America's physicians and patients to ensure the law continues to be implemented in ways that support and incentivize better health outcomes and improve the nation's health care system.

This decision protects important improvements, such as ending coverage denials due to pre-existing conditions and lifetime caps on insurance, and allowing the 2.5 million young adults up to age 26 who gained coverage under the law to stay on their parents' health insurance policies. The expanded health care coverage upheld by the Supreme Court will allow patients to see their doctors earlier rather than waiting for treatment until they are sicker and care is more expensive. The decision upholds funding for important research on the effectiveness of drugs and treatments and protects expanded coverage for prevention and wellness care, which has already benefited about 54 million Americans. 

The health reform law upheld by the Supreme Court simplifies administrative burdens, including streamlining insurance claims, so physicians and their staff can spend more time with patients and less time on paperwork. It protects those in the Medicare ‘donut hole,’ including the 5.1 million Medicare patients who saved significantly on prescription drugs in 2010 and 2011. These important changes have been made while maintaining our American system with both private and public insurers.

Ohio Hospital Association:

This ruling provides clarity to allow welcome and much-needed health reform efforts already underway to move forward. Ohio hospitals are committed to leading the evolution to value-based health care delivery. While the ruling is expected to increase demand for medical care, Ohio’s hospitals are pleased it will allow nearly one million uninsured Ohioans to obtain better access to essential care in the most appropriate setting. While some provisions of the ACA merit further debate and amendment, Ohio hospitals believe leaving such refinement to future legislative action is a wise decision,” said OHA President and CEO Mike Abrams.

American Academy of Orthopaedic Surgeons:

"The AAOS recognizes that there are provisions within PPACA that help providers deliver high-value health care services and offer musculoskeletal patients protections against insurance company abuse and educational tools to make better health care choices.

However, we cannot overlook provisions like the IPAB that threaten the doctor-patient relationship and the administrative burdens within the law that could greatly hinder providers’ ability to deliver quality care by infringing upon exam room time.

The AAOS will continue its efforts to achieve a patient-centered solution to health reform by working with Congress to best implement the beneficial provisions of PPACA; repeal the detrimental provisions that still exist, and; to solve critical issues, like achieving a permanent solution to the flawed Sustainable Growth Rate formula and addressing federal medical liability reform, that the law failed to address.”

Texas Medical Association:

“One thing today’s ruling has not, and cannot, change is Texas physicians’ deep commitment to care for our patients. The well-being of our patients comes first.

The Texas Medical Association has said since day one that we need to find what’s missing, keep what works, and fix what’s broken in the new law. We absolutely must reduce the law’s red tape and bureaucracy that interfere with patient care. Today’s health care system is riddled with hundreds of regulations imposed by federal health law that do little to improve patient care, but instead divert our time and energy away from our patients.

The court gave the states flexibility on Medicaid expansion. We desperately need a better system of caring for Texas’ large uninsured population. We need a local/state/federal partnership to design a fair and sustainable system. Top-down mandates are not the answer.

American Academy of Family Physicians:

  • The AAFP is praising a Supreme Court decision upholding all provisions of the Patient Protection and Affordable Care Act.

  • In a prepared statement, AAFP President Glen Stream, M.D., M.B. I., said that "as a result of this decision, more Americans will have access to meaningful insurance coverage and to the primary care physicians who are key to high-quality health services."

  • Stream cited various provisions in the Affordable Care Act that will strengthen the nation's primary care and family physician workforce and infrastructure.

     

Topics: ACA, Affordable Care, SCOTUS, AMA, AAOS, TMA, AAFP

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