Healthcare Policy Getting Reimbursed: Its Complicated

Billing and Delivery for health services has become extremely complex. Although fee for service (volume-based care) is deemed to be on it's deathbed by proponents of payment for quality of care and outcomes, the complexity of obtaining a payment becomes more of a juggernaut. This is occuring in the face of  a system that is not ready to convert to accountable care organizations. The infrastructure for such a conversion is completely absent. The marketplace has abundant vendor offerings.  
Although the majority of health providers now are using electronic health records and are required to be certified for meaningful use, many providers are ignoring these standards.  Interoperability remains a major hindrance to  connecting all the systems of an accountable care organization

In order to address this issue and many others take this course.

You will learn about:

• The relationship between healthcare expenditures and provider compensation.
• Payment models under Medicare and the Affordable Care Act.
• The future distribution and cost of healthcare services

• Define the 3 types of provider payment schemes.
• Recite the types of national healthcare expenditures and the proportion that each contributes to the total spending.
• Compare the compensation for US and international physicians as a multiple of gross domestic product per capita.
• Describe the methods by which Medicare determines physician payments.
• List the provider components of a healthcare delivery system.

• Describe how healthcare services will be distributed in the future.
• List the types of costs associated with healthcare delivery.
• Describe bundled payments under the Affordable Care Act and how bundled payments are different from prior programs such as global surgical fees.
• Define the incentives to achieve Medicare bonus pay within a Pay-for-Value program.
• Review the concepts in the case studies.

Health Care Policy: Delivery and Payment

Habits of Physicians Posting for Professional Purposes

The following information is gleaned from

Kantar Media Healthcare Research Insights

Kantar Media is a pharma research company offering insights to drug manufacturers. The information also reflects directly back to MD usage of social media. 

Many physicians still are reticent to use social media. If you have not looked at social media in the past two years you would not know about the uptick for #hcsm. Users in all fields of medicine and health businesses, including device manufacturers, pharma, laboratories, and government. (FDA,HHS,CMS,WHO and more use social media for marketing and information purposes.

While most use Google to search for subjects you may notice that significant number of replies yield twitter, facebook, or Google + pages.  It is not at all unusual to see twitter handles and facebook page links on professional web sites.  If you want to remain strictly professional Linkedin has grown explosively in the last 12 months.  Building a profile on any of those sites or opening an about.me page will yield results.  About.me  is an eye catching site with creative graphics. It is much more interesting to read than a curriculum vita.

Kantar Media Healthcare Research Insights  

Uncovered some some specific insights about physicians and their professional social network usage. When it comes to posting on social media in a professional capacity, there are certain trends we can notice. We know that a doctor sharing an article is much more likely to be embracing new medical technology or drugs.

One of the trends we're noticing is that professional social networks are surpassing other platforms in terms of popularity and content shared. Our study results show that 58% of physicians that write/post on social networks for professional purposes choose to write/post on professional social networks vs. consumer or medical association social networks. What does this mean for advertisers? Well, potentially you as an advertiser should establish more of a presence on professional networks.

If you sell new pharmaceuticals to doctors, there's definitely some good news from the March 2015 edition of the Sources & Interactions™ Study. Physicians that write/post on social networks for professional purposes are more likely to be new drug adopters. Is social media advertising part of your media plan? It should be: 67% of respondents are saying they prefer to adopt drugs as soon as they are released or after a few others have tried it successfully. The fact is that medical professionals using professional social media are among the most receptive to new pharmaceuticals and you don't want to miss out on that group.

Sales teams should embrace these findings as well. Among this demographic using social media, 83% of them say they see sales reps—10 percentage points higher than the total physician population that see sales reps. It's clearly evident that social media needs to be a tool you utilize to reach the newest drug adopters. 

The Sources & Interactions™ Source is a detailed examination of doctors’ online and mobile activities, e-detailing experience, and exposure to (and evaluation of) information sources including traditional and emerging media, pharma reps, CME, convention and more. The study is conducted every six months and targets more than 3,000 physicians annually across 22 specialties, exploring their media preferences and habits. Sources & Interactions was designed to help marketers and their agencies cost-effectively allocate resources to their overall promotional mix, and provide publishers with specific insight about where their offerings fit into physicians (and other healthcare professionals’) information inventory.tudy

Sources & Interactions, March 2015: Medical/Surgical Edition

Kantar Media’s Sources & Interactions™ Studies offer detailed research on healthcare professionals’ online and mobile activities, e-detailing experience, and exposure to (and evaluation of) information sources including traditional and emerging media, pharma reps, CME, conventions and more. Sources & Interactions helps marketers and their agencies cost-effectively allocate resources to their overall promotional mix, and provide publishers with specific insight about where their offerings fit into physicians’ (and other healthcare professionals’) information inventory.

The Medical/Surgical edition is conducted every six months,with brand new data available now!

Why the Government Prejudice regarding Specialty Electronic Medical Records

The past decade saw the development of electronic medical records, both in number and level of sophistication During this decade there was a steep learning curve by vendors with frequent and arbitrary regulations regarding EHRs.

Successfully Choosing Your EMR: 15 Crucial Decisions 

                                                                   Purchase on Amazon

EHR development has been overly influenced not by it's functionality but by parameters of HHS and CMS in regard to data structure and interoperability.

The regulations included a mandate for interoperability and items called 'meaningful use'.. The term 'meaningful use' is a misnomer.  Meaningful use in their terms only had to do with it's utility in garnering information from an EMR which may or may not be useful for it's designed purpose.

The following statement from Ophthalmology Management specifies some items:

"Switching electronic medical records (EMR) systems is a big decision, even if you feel like throwing your existing system against a wall. So don't ditch your EMR system before you download the paper that includes an eight-question assessment to help you decide - and to protect you from making the same mistake twice.  (this statement is from Ophthalmology Management and is a quote from EMA, a specialty EHR for ophthalmology.)"

In many specialties there are fields and specific information unique to that specialty. Clinical work flow must be considered, since a poorly designed software can radically alter efficiency and disrupt the clinic volume and income. Numerous studies have revealed that efficiency can be reduced for several months by a factor of 20-30%.

Medical practices chose to accept incentive payments for consenting to meet meaningful use criteria with their EHR.  This occured by an angst of 'not being left behind' despite serious reservations and advice for HHS and ONCHIT. Several deadlines have been delayed and doubts remain about the implementation of MU Stage III.

Many medical practices have invested in EHRs. Some installations were obsolete at the time of purchase.

Some medical practices decide to purchase a new system despite the added costs, preferring to write off an older system with accelerated depreciation. These decisions are supported by a record of decreased patient volume.  Most physicians report an additional hour of work each day and a reduction in patient volume.

Many physicians have expressed their extreme unhappiness with their electronic health records. Management surveys continuously confirm dissatisfaction. Despite this, EHR use has grown.  Imagine using a defective hammer to drive in a nail. Regulators have taken their eyes "off the ball" ignoring patient care, and equating paperwork with 'quality of care'.  This has become a fundamental failure of the entire American health care system.  Poor patient care can easily be disguised if all the information which is entered is designed to thwart the 'required entries' to proceed, or satisfy an algorithm for a complete medical record.

There are several certifying standards, the most onerous are those mandated by CMS and regulated by  

Adding to this frustration is that many large organizations will select a vendor whose reputation has been built upon usability for primary care and/or internal medicine/pediatrics.  Population Health has become a new 'buzzword" in the HIT workspace.  A large or medium sized multispecialty group may select a system which their specialists can not use.  Interoperability has become a deserved design requirement.

When designing or selecting an EHR, every department must have input on decision making. Some IPAs and loosely organized primary care groups have offered to 'give' an EHR to their specialists t
o encourage acceptance of a group EMR.  This in many instances has been disastrous.

Their are other choices.

1. Utilize a specialty specific EHR based upon:

     User testimonials
     Site visits
     Demonstrated user functionality and efficiency in actual operations.

2. The requirement for interoperability are clearly defined by ONCHIT which should make disparate systems interoperable.

3. The realities however are quite different from a vendor point of view, leaving users holding the proverbial 'bag'.

Does your EHR need a tweak or a trashing?

How to tell if your system is already in need of a major goose.

BY ROBERT N. MITCHELL

Need an EHR plan?

Whether it’s your practice’s first foray into EHRs or your practice is upgrading to a new version of the software or a new system, the HealthIT.govwebsite provides ophthalmology practices valuable insight. This includes these six steps:

1. Assess your practice readiness
2. Plan your approach
3. Select or upgrade to a certified EHR
4. Conduct training and implement an EHR system
5. Achieve Meaningful Use
6. Continue quality improvement

On the www.HealthIT.gov website, each step is a link that users may click on for a detailed explanation.

Health Reform to 2014 and Beyond or Back to the Future

The More You Understand About the 2014 Changes,  The Better.

If you had not noticed.

I am retired from clinical practice, and  admit I miss seeing patients.  My career goals have changed as some of you have noticed.

During the last decade I became interested in health information technology and set out to communicate with fellow professionals.  Readers of Health Train Express and it's predecessor will see an evolution, beginning with electronic medical records, health information exchange, health reform, mobile health applications, remote monitoring, and telehealth. They all serve to integrate our health communications for providers and patients.

During the last 12 months I was diverted by the Affordable Care Act and  the promises of Accountable Care Act. The potential for these new paradigms are great, however the day to day activities of providers and hospitals will  increase their load, and without additonal reimbursements. Providers have been expected to make huge capital outlays for health IT, design,implement and use these new systems.  They are directed at reductions in reimbursements to allow the large growth in patient access.  i doubt whether there will ber an actual decrease in the gross outlays for health care.  However during the past two years there have been reports of a decrease in the rate of growth.

There are some key actions to implement changes:  These webinars are designed to address specific areas that will require action.

Understanding Payment Reform - Beyond Fee For Service 

In the past decade there were some pre-paid and capitated models. The new paradigm is to approach payments connected to outcomes.  How they will be measured is open to great debate, and the subject should be addressed actively and with transparency before changes are made to avoid a catastophe such as the Health.gov benefit exchanges.  Some of these issues may be addressed by a 'global fee to hospitals and providers and/or medical groups as part and parcel of integrated medical systems.

Understanding The 2014 EHR Incentive Program 

The webinar addresses objective information for non-acute providers,practice and clinics on how to prepare for 2014 changes to the CMS EHR Incentiviei Programs.

An ICD-10 GEMS Crosswalk Overview

GEMS is a term which most providers are not familiar. CMS on it's web site offers these white papers. 

• 2013 General Equivalence Mappings - Diagnosis Codes and Guide [ZIP, 583KB]
• 
  

     The compressed zip files contain 3 white papers.

     The Dxgem file addresses specifics of conversion from ICD9 to ICD10.

MDs Everywhere's Vice-President of Development, Doug Salas explains the impact of 14,000 ICD codes expanding to 70,000 will have on documenting

Understanding HIPAA Requirements and Safety Measures 

HIPAA has been around since the mid 1990'. Providers have always known the standards of ehtical private confidentiality.  HIPAA was designed for others, institutions who deal with large amounts of patient health and financial data.  Penalties and fines are impressively high and the law has been enforced agains several large hospitals and other custodians of health records.

Recording and Archived:  (In case  you cannot attend the webinar at it's schedule time) At the time of registration you will receive a link and a date, which can be downloaded to an Outlook  .ics file.

All of the webinars will be archived for later viewing