Majority of Healthcare Organizations disappointed by ICD-10 Delay

The recent decision on delay of the ICD-10 deadline, a large number of healthcare organizations being reported unhappy and very disappointed. Right after the news which ICD-10 will likely be delayed, many healthcare organizations seems to be unhappy. This is surprising to some, because lot of the previous polls found providers were not prepared for the transition. Not more than 10% providers were ready as per the MGMA report in February.

An opinion poll conducted by the Deloitte Center for the Health Solutions, inquiring providers about the way they considered the latest ICD-10 delay. Only 11% stated that they are happy, 21% stated they are not concerned with the delay but the majority over 50% (58%) stated to be unhappy with the delay. Further it inquired about the right time for the implementation, 49% stated October 2015, 30% needed the 2014 date to be reinstated, and simply 6% stated they will prefer the date to get moved ahead of October 2015. According to the Healthcare Informatics, 59% of providers say that they assume a lack of momentum because of the delay and 58% believe that there will be a great impact on their resources and funding. Whereas, 14% said that the delay will provide them time to compensate on testing for the latest coding system. What exactly the providers are planning to do since ICD-10 isn't due till 2015 the following year? 30% say that they will stick to their initial strategy and keep going with their testing schedule. According to 26%, the delay will provide a chance to stop and allow them to reevaluate their plans. While 20% will make use of the extra time to slow down and choose their time while moving towards the implementation.

In the meantime, the Coalition for ICD-10 has sent a letter to HHS encouraging the department to reconsider the decision about the October 2015 deadline. Lynne Thomas Gordon, CEO at AHIMA and a Coalition member said in a statement that, as the transition to ICD-10 continues to be unavoidable, it is extremely challenging for organizations to make appropriate preparations and investments with no knowledge of the execution date and the announcement for the new implementation date would give the industry the understanding required to prepare within the mos economical, wise and also strategically.

A senior Vice President and CIO of children's Medical Center Dallas, Pamela Arora stated that the delays of ICD-10 are concerning. She also said, ultimately both the delays might cost over $1 million to the hospital. With the use of this money, for an instance, they could manage to buy approximately 170 physiological monitoring devices and could have provided more tools into the hands of their physicians, she stated. Further, she said a majority of these kinds purchases will now be postpone if the funds are restricted. Overrun of 2 years of cost and missed deadlines will be called an effective project within the private industry concerned with profits, she added. Ralph Johnson, CIO at Franklin Community Health Network based in Maine and President at New England HIMSS, stated that he is certainly disappointed with the delay on the whole and also disappointed particularly the way it had been passed from the House and Senate. Further he said, nobody could glow light regarding the delay during the debates and was buried in the large legislation.

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Ethical considerations for Physicians?

The desire and need to have a better healthcare delivery system has necessitated implementation of a number of regulatory mandates and adoption of healthcare IT. This requires physicians to make considerable amount of investment in their clinical setups to obtain the required level operational efficiency and subsequently to avoid the risk of punitive actions by the government in the event of failure in compliance. All this has resulted in making the existence of independent medical setups very tough. The jobs of physicians now go beyond just patient care and involve understanding the implications of regulatory norms and changing their working styles so as to abide by them. In order to avoid the pain of dealing with so many factors, which are generally looked upon as nothing by hindrance to their core work of providing care, and risk profitability, physicians are actively getting into agreements with larger provider setups and picking up a payment method with suits their deal. It helps them avoid to a large extent the headache of keeping their clinical setups updated with evolving regulatory norms and making sizable investment in healthcare IT. All this is automatically taken care of by the larger organization they enter into a contract with. Physicians thus have all their energies to focus on their primary area of work and draw financial benefits based on the agreement they hold. This is where there is a need for them to be proactive and take into account ethical concerns around those financials incentives, offered as a part of financial arrangements, which influence their clinical decision making.

Capitation is a popular payment arrangement model, comes in different variants and can potentially result in offering cost effective and efficient care. However, there is a lot of scope for conflict in such systems too. The onus lies on physicians to guard against those. It starts right from the time they are about to get into one such agreement. Two factors which they should never compromise on are the quality of care and the range of services they offer. While arriving at a rate-of-capitation the existing conditions of enrolled patients should also be taken into account. While evaluating plans, they should look at the size of the plan and the duration; both of which should be large to bring in more predictability. Physicians generally get concerned when treatment expenses go beyond predictable limits. It has a possibility of influencing their behavior since outcome generally results in a financial loss for them. Stop-loss provides a good option to handle such situations. Finally, the sanctity of a physician-patient relationship needs to be kept intact. Although it is an obligation on the part of the physicians to consider and meet the broader needs of a patient population, in order to achieve it, they have to focus their energies into every one-to-one relationship that they share with their patients. Any financial reimbursement system which acts as an impediment to this has to be avoided or worked around at any cost.

Health plans generally tend to set expectations for physicians which are not always easy to meet. For e.g. it could be in the form of a steep utilization rate which is difficult to achieve or making physician payment dependent on so many factors that it is next to impossible to get a good deal without affecting clinical behavior. All health plans have financial incentives. Physicians should keep a few things in mind before entering into a contract with any plan:

• large incentives generally make it difficult for physicians to turn down but more often than not require them to make commensurate compromises on clinical standards
• show more preference towards those types of incentives which are applied across broad physician groups
• advocate increase in the time-duration over which incentives get determined. It helps in negating the impact of fluctuations in utilization
• prefer those plans which have a large pool of patients
• avoid agreeing to a tiered system of incentive/penalty payout
• advocate for a stop-loss provision as a solution to handle outliers
• ensure that patients are informed about financial incentives which could affect the level-of-care that they receive.

Physicians should always urge for incentive programs which do not just primarily focus on utilization, efficiency and cost reduction. On the contrary, they should emphasize on those which lay importance to quality-of-care and patient satisfaction as well. Physicians ought to be given flexibility to accommodate the varying needs of patients. No incentive plans should tempt them towards selectively treating healthier people and avoiding the high-risk ones in order to improve their own and their groups’ chances of gaining financially. Creating custom solutions for your healthcare practice can help you immensely. Healthcare software development companies can assist you in this.

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The future of Health Information Exchanges

Health Information Exchanges (HIEs) are expected to bring about a huge difference in the healthcare industry because of the nimbleness they are to suppose bring to data availability. This will also mean healthcare software testing will also pick up steam. There are some EHR vendors who currently offer the provision to physicians to exchange data with other practices which are registered to them. Some even go to the extent of offering all other features as are found in standard HIEs to them. But they are restricted in size and scale since it is only those physicians which are registered with the vendors which get entitled to draw the benefits.

HIEs go much beyond. These can be privately or publicly held and help in the transmission of clinical information from EHRs to participating physicians and providers. Most of the information is very holistic and helps in reducing the operational costs and improving the efficiency of practices. EHRs on the contrary hold a lot of information apart from the clinical data like demographics, allergies, laboratory reports etc. The potential benefits made available to group practices and physicians are many. By receiving and sending information, these entities benefit in a number of ways like

• Automation of their administrative tasks
• Availability of real time information at the point of care
• Transparency of processes
• Availability of Decision Support Tools
• Reduction in operational costs
• Qualification for Meaningful Use Incentives
• Increased Competitive advantage
• Improved quality of services

There are many other benefits offered by HIEs in addition to the ones listed above. However, it is not mandatory to find all of these offerings at a single HIE. It is left to the physicians to exercise their judgment before deciding to join one such organization. There are many reasons for the buzz around creation of HIEs. Needlessly to say that they enhance the degree of safety, quality and cost reduction otherwise possible without their usage. But one of the major driving factors has been the push provided by the Federal Funding.

Through the HITECH ACT, which stands for Health Information Technology for Economic and Clinical Health, an amount of 2 billion dollars has been put aside by the federal reserve for creation and expansion of HIE infrastructure. HIEs fall under the purview of both the State, as well as the Federal government laws for finalizing the regulations of its operations esp. related to the privacy and security concerns of handling patient information. With the broad guidelines made available by the Federal government, the state laws determine the rules to be followed to set up the infrastructure, get the required certification to operate and specific ones for patient information protection. HIEs as such do not directly fall under the HIPAA act. But since it has to deal with entities which are covered by HIPAA e.g. providers, clearing houses etc. HIEs are expected to exercise and follow all the rules so as to comply with the privacy and security provisions as per the Act.

HIEs can act both as repositories and conduits for health information based entirely on the model that they want to follow. In the centralized model, data is stored in a central repository and is made available to members based on need. The advantage of doing this is that it leads to standardization of data. There are policies defined for ensuring this. In the federated model, the data stays at the source with HIEs providing pointers to them. This makes it possible for providers and physicians to get more control over the data unlike the previous one.

Overall, the involvement required by physicians in HIE governance is critical to their fraternity. From knowing how the model is developing in their states to how their data will be used, all this is important for physicians they decide to join one. There is one school of thought which is kind of making the physicians slightly apprehensive about their participation in HIEs. According to them, the data which is available with HIEs could be used to evaluate physicians or for profiling purpose. Thus all the more reason for physicians to know who has what access to the data available with HIEs and how is it supposed to be used.

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