Saturday, January 2, 2016

2016 What are the New Rules For Our Health’s Digital Future |

2016 is now well underway.No matter what your political proclivities may be the ride will be fraught with potholes.

Big Data and Analytics.  Some of my sources reveal that some developers are feasting on the big hype using unproven metrics.  Barbara Duck

Technology promises to transform health care. It’s redefining how we interact with, and act on, our health data, and reshaping how care is delivered and coordinated. But uptake so far has been limited, particularly among the elderly, those with chronic conditions and others who could benefit most from a better, smarter health care system.

On the other side of the new rules, providers are adopting and adapting to new HIT tools, for better or worse. Pandora's box is open and the horse has left the barn. It is like the conversion from horse carriages to motor vehicles, less manure, higher speeds, and more pollution. That's the way it is will all disruptive technology.  Sometimes in order to go faster, we must go slower at first.

Time will refine HIT offerings, just as motor vehicles evolved....larger engines, power steering. automatic transmissions, cruise control, electronic add ons, computerized engine control and more.

Just as old motor vehicle are barely recognizable as what we use today for motor vehicles, so too will health care evolve into something unrecognizable from what is today.

 Featured Image: Bloomua/Shutterstock

Payment rules shape access to technology

" Every year, CMS (the Centers for Medicare and Medicaid Services) develops regulations governing the payment of treatments and services provided to the one in three Americans covered by Medicare or Medicaid. They determine not only which technologies will be funded, but also how, when and at what level they will be reimbursed.

"Payment matters. So to lack reimbursement is, effectively, to not exist at all. "Although difficult to quantify, the downstream effects may go further than access alone. These policies also shape how entrepreneurs and
investors size up market opportunities and form views on product strategy. By erecting barriers to adoption of technology, CMS could inadvertently subvert its very development.

Modernize reimbursement to promote innovation

"Earlier this year, Medicare committed to moving 50 percent of total spending in the coming years to new payment models that reward value rather than volume. While it hasn’t attracted
as much attention, we also urgently need new health technology to help providers, payers and patients make the transition. And CMS ought to make its payment rules more flexible to spur innovation.

"A first step in this direction came with CMS’ recent rule for its bundled payment program for hip and knee replacements. Starting in April 2016, hospitals in 67 geographic areas across the country
including New York City, Miami and San Francisco) will be accountable for the costs and qualityperformance associated with the entire episode of care — spanning the initial hospitalization for joint replacement surgery to the 90 days following the patient’s discharge.

     Technology promises to transform health care.

" The final rule grants new found flexibility for providers to leverage
technology more directly to improve patient care. One notable change:
For program participants, Medicare has agreed to lift many of its
restrictions on telemedicine. Telemedicine can now be used to provide
remote care in the patient’s home. And gone are the agency’s usual
geographic restrictions: Patients in urban areas will qualify for
telehealth services, too.

"Participating hospitals will also be allowed to provide incentives,
worth up to a thousand dollars per beneficiary per episode, directly to
patients to improve engagement and treatment adherence. The agency
singles out weight and vital-sign trackers, but providers will have the
authority to decide which incentives would work best for their patients.

"Equally important, the rule is likely to trigger demand for entirely
new classes of technology. The most immediate need will be for
administrative platforms to build episodes and monitor clinical and
financial performance.

"Providers will also need new tools to facilitate the sharing of
health information, including electronic health records, to support care
coordination. While hospitals have benefited from federal stimulus
dollars to incentivize health IT adoption, post-acute care providers
have generally been slower to adopt health IT systems.

"More so than ever, health IT will be a “critical capability,” as the agency itself notes, for the success of all stakeholders in patient care.

Looking forward

"For now, these tech-friendly provisions are limited to the joint
replacement program. CMS can and should apply this flexibility to its
other value-linked payment programs.

"It would be difficult to overstate the long-term impact of this
change. Because Medicare is the single largest payer in the country, its
rules set the de facto standard for other insurers. In fact,
commercial payers, including Aetna, United Health and Blue Cross Blue
Shield plans, are already stepping up to meet or exceed Medicare’s
targets for expanding value-based care. And many of the new technologies
that are being developed will be broadly applicable across the care
spectrum, regardless of payer or provider.

"It’s the start of a new chapter, one that will hopefully feature
better technology and better care. But to get there, we’ll first need to
modernize our payment rules. Our health depends on it. "

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