Healthcare Is Yet To Capitalize On Meaningful Use

The Medicare and Medicaid EHR Incentive Programs offer financial incentives for meaningful use of certified EHR technology to raise patient care. To get an EHR incentive payment, providers need to prove that they're meaningfully using their EHRs through fulfilling thresholds for a variety of goals. CMS has built the goals for “meaningful use” which eligible professionals, suitable hospitals, and critical access hospitals (CAHs) need to meet in order to have an incentive pay out. Dale Sanders, vice president for strategy at Health Catalyst stated in a post that, the program developed a very complex system which could go through the test of MU, but not generating meaningful outcomes for patients and clinicians. He mentioned that it's time to end the government MU program, get rid of the expensive administrative overhead of MU, get rid of the government subsidies which also produce perverse incentives, and allow 'survival of the fittest' play a greater part in the process. Sanders further stated that meaningful use Stage 1 created a false market for mediocre products.

It was discovered by the researchers of Mathematica Policy Research, there had been a "significant" rise in the percentage by 17.4% to 36.8% of hospitals getting incentive payments for obtaining Meaningful Use during 2011 and 2012. As per the research, the smaller and critical reach hospitals had been especially weak in falling behind in Meaningful Use of EHRs because of their lower patient volume, insufficient resources to get EHRs, difficulty in hiring certified IT people and getting a appropriate EHR vendor. Based on the CMS data, by March 2014, over 371,000 health care providers have received $22.9 billion on meaningful use incentive payments in taking part in the madicare and Medicaid Electronic Health Record (EHR) Incentive Programs. The data additionally reveals, above 470,000 eligible professionals, eligible hospitals, and also critical access hospitals are currently registered for the Medicare and Medicaid EHR Incentive Programs since March 2014.

In a recent research released in JAMA Internal Medicine , it seems to be “no association” between being a “meaningful user” of EHRs and also the quality of care offered to patients, even though one of the primary objectives of the Meaningful Use program should raise the quality of care. The researchers learned dealing with adult outpatients at Brigham and Women's Hospital and affiliated ambulatory methods during a 90-day reporting duration in the year 2012 to evaluate if there had been quality progress on seven measures for 5 chronic diseases: hypertension, diabetes mellitus, coronary artery disease, asthma, and depression. All the doctors taken the same advanced EHR. Based on a research published in last summer in Health Affairs, Meaningful Use attestation continues to be inconsistent with small and much remote hospitals are having a hard time to fulfill the incentive program's needed thresholds. During the 2014 HIMSS Annual Conference & Exhibition in Orlando, Florida, an opinion poll was conducted by Stoltenberg Consulting. It was discovered that 70% of participants don't believe their organizations are making the most of meaningful use.

Shane Pilcher, vice president, Stoltenberg Consulting, stated in a press conference, although many organizations might see meaningful use like an ought-to-do regulatory, but it happens to be a lot more, organizations have to see meaningful use like a strategy, discipline and procedure that helps healthcare transformation and helps reduce changes to initiatives like complete patient engagement value-based responsible care and population health management. Lots of officials have mentioned that MU Stage 1 is only the start, targeted to move hospitals and doctors to adopt these systems, and MU Stage 2 includes clinical quality enhancements. But Meaningful Use Stage 3 is exactly what lots of officials think will definitely pack the punch in the interest of enhancing clinical outcomes. Furthermore, a study revealed, MU Stage 2, what improves the thresholds many of the quality measures, has simply kicked off, and Meaningful Use Stage 3 is not ready to go live before 2017.

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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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How effective is mHealth In Treating the Elderly?

With more and more people accessing internet on their mobile devices, mobile health (mHealth) has emerged as a popular sub-segment of eHealth. The term mHealth is being used to refer the practice of medicine and public health supported by smartphones, tablets, phablets and mobile-enabled diagnostic devices. In addition to gathering clinical and community health data from various sources, the mHealth applications further enable the patients, clinicians, researchers and caregivers to access both healthcare information and health related services through their mobile devices. Many organizations, nowadays, invest in mHealth application development to improve and expand healthcare services, while reducing costs of care. A number of reports have also highlighted how mHealth applications can contribute hugely towards treating the elders more effectively.

Why mHealth Applications are Effective in Treating the Older Adults?

Chronic Disease Management

The cost of healthcare is hugely impacted by chronic diseases. As a person ages, his burden of chronic diseases grows. Further, the prevalence of multiple chronic conditions is much higher among older adults. The multiple chronic conditions also make the health care needs complex and expensive. For instance, an elder must avail effective care immediately to avoid frequent hospitalization, duplicative tests, adverse drug events and conflicting medical advices. The mHealth application will allow the elderly patients to support and manage their personal health efficiently by accessing the required health information and care.

Medication Adherence
Along with facilitating chronic disease management, the mHealth application will further help the older adults to adhere to the relevant medication. As poor medical adherence affects the individuals and community negatively, each patient must adhere to the recommendations made by the healthcare provider. However, the medical adherence of a patient can be affected negatively by a number of factors including understanding the instructions, forgetting to take medication and remembering the medication-taking instructions. The mHealth applications make it easier for the older adults to understand and remember the medication regime. Further, they can receive regular notifications to obtain proper medication information on a regular basis.

Safety Monitoring
Many reports have highlighted that hip fractures, falls and similar injuries contribute hugely towards the death and disability of the older adults. So the mHealth applications come with special features to prevent injuries and promote safety among the elderly people. These features make it easier for the healthcare providers to monitor the patient in terms of his location, balance and gait. As most mobile devices support GPS tracking and accelerometers, the applications use fall detection technology to identify the location and nature of the fall, along with notifying others about the fall by sending alerts.

Access to Health Information
As the mHealth application specifically target mobile devices, it becomes easier for the user to access, share and coordinate his personal health information. In addition to facilitating communication and interaction between the elderly and the healthcare provider, the application further helps the older adult in improving self-management. At the same time, the user can further use the application to access his personal health records (PHRs). So he can constantly track his important health records, along with tracking his healthcare services. Most healthcare providers, nowadays, allow patients to control the PHR and share the information with others. Thus, it becomes easier for the elderly people to share crucial information like allergies, drug interactions and medication along with the narrative of their immunizations and diagnoses.

Facilitate General Wellness
The mHealth applications even contribute towards facilitating general wellness of older adults without any chronic conditions. The general wellness facilitated by the applications, however, can be divided into several categories including nutrition, fitness and overall quality of life. For instance, a user can use the mHealth application to access information related to weight loss, healthy eating, smoking cessation, exercise and yoga. He also has option to use different applications to facilitate fitness nutrition and quality of life. So each older adult can download the application according to his mobile device and operating system, and avail the benefits in a flexible way.

The older adults also have option to choose from a variety of mHealth applications according to their specific healthcare needs. So it becomes easier for a user to avail personalized and prompt care simply by using his mobile device, regardless of his current location.

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The issues around ICD-10 implementation

Physician practices are mostly running behind schedule in their quest for ICD-10 implementation. Surprisingly there also seems to be a strong positive vibe amongst most of them to achieve it before the switch deadline of Oct. 1, 2014. A survey done in this field has suggested that the industry is far behind milestones otherwise required by the ICD-10 implementation framework. The time available in their disposal is about nine months and given the devastating consequences predicted by various stakeholders, one is compelled to think whether it is not already time for providers to pull up the socks and get started with the act. In its current state, the coordination which is expected between practices and software vendors, health plans partners and clearinghouses is either missing or evidently not at a level which can foretell a seamless implementation. The one concern which seems to be common across all of these practices is something related to the fallout of the implementation and not how to achieve it. There is a strong apprehension that the switch will result in claims’ processing delay or denial which ultimately will have an effect on cash inflow.

Following various rounds of discussions between industry leaders, there seems to be 3 major recommendations which have come up for physician practices as they gear up for the deadline which is inevitable now. They include the following:

• Checking the accuracy of the mapping program: This will be possible by getting a demonstration from the vendor. Since the claim submissions eventually will be dependent on the accuracy of the mapping, it makes sense to check them beforehand. Infact getting the coders and health information professionals to be involved in understanding the possible changes in workflows is not a bad idea.
• Getting hands-on experience for the coding and billing staff members: Real life scenarios should be staged and the staff made to go through the process.
• Updations of EHR in order to remove the inactive problems from the problem list: All ICD-9 codes which have ever been used should not be blindly imported without checking on the incorrect and unresolved ones.

Productivity is expected to take a nosedive owing to this change. Providers are expected to have a permanent decrease in productivity in the range of 20 to 50 percent due to the granularity of ICD-10. The type of providers who are likely to be impacted the most with this change would be the ones dealing with a broad range of conditions like primary care, emergency orthopedics, cardio to name a few. Also, this impact will be felt irrespective of the size of the setups.

Pre-empting the roadblocks that the initiative will run into and the subsequent mess it is likely to result in, the Medical Group Management Association has appealed to the US department of Health and Human services to perform extensive testing of ICD-10 with immediate effect . They have also requested them to share the outcomes of the testing with vendors and providers. Primary reasons put forth in their defense include the following points:

• It will allow the software developers the time and the knowhow to configure the technology for physician practices
• Identified before the switch deadline, it will allow the relevant stakeholders to make the required adjustments to the workflows and systems
• Allow practices to understand fully well the effect of the implementation on reimbursement

All the above will go a long way in providing some level of assurance to physician practices pertaining to achieving seamless processing of their claims post the switch. Since any wide-scale interruption to the claim-processing system is likely to affect the running of healthcare providers, it is of high importance that required authorities take all necessary steps beforehand. A thorough end-to-end testing definitely qualifies as one.

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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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