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Remembering Mike

December 21, 1954-
August 9, 2012

 

New Blog Post

Four Themes to Successfully Navigating the Supreme Court Decision

The decision by the U.S. Supreme Court to uphold the controversial Patient Protection and Affordable Care Act confirms the direction of healthcare reform that had already begun a few years ago.  Many payers and providers, responding to the slowly emerging regulatory architecture of the law, have embarked on large scale transformational initiatives which will fundamentally change their business models forever.

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New Article

Payers and Providers: The Pressure On Payers Is Relentless

No matter the outcome of the Affordable Care Act, the long-term picture for payers remains uncertain. Even if all the ACA provisions are enforced by the Supreme Court, there are still many issues to sort out. If some of the provisions are struck down, then other issues will be encountered. In an unpredictable business environment, Blue Cross Blue Shield Montana decided to give itself a physical and make process improvements to control what we could control.

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Meaningful Use - Decoder Ring

Source: Processor Magazine – May 11, 2011
By: Holly Dolezalek

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Sift Through The Requirements To Learn How They May Affect Your Organization

Health IT is abuzz with the words “meaningful use” these days, but to many, it’s a nebulous term that’s difficult to define. To help clear up confusion, here is a look at meaningful use, its requirements, and what it means for IT workers in the healthcare industry.

Meaningful Use, Defined
Meaningful use is a health initiative that came out of the American Reinvestment and Recovery Act of 2009. It’s an attempt to modernize the way healthcare providers share information with each other and the patients they treat. It’s also an attempt to improve healthcare outcomes by improving and expanding that sharing in targeted ways.
From an IT perspective, a lot of the meaningful use criteria, incentives, and penalties are centered on EHR (electronic health record) systems. Generally, the meaningful use standards relate to what an EHR can do and what healthcare providers do with their EHRs.

There are three stages of meaningful use, and the timeline for implementation is as follows: In order to get the incentives for meaningful use, providers or hospitals must have reached Stage 1 by 2011-2012. They must reach Stage 2 by 2013, and if they haven’t reached Stage 3 by 2015, the penalties for noncompliance will begin. The meaningful use standards only apply to providers and hospitals that are treating Medicare and Medicaid patients; any providers or hospitals that do not take these kinds of patients will only have to comply with private insurers’ requirements for EHR use.

Meaningful Use Stages
So what do the stages require? Stage 1 is the only stage that has been finalized, and that’s where most healthcare professionals are focusing at present. Stages 2 and 3 are still being finalized, although Erica Drazen, managing partner for emerging practices at consultancy and healthcare IT provider CSC (www.csc.com), believes that Stage 2’s proposed parameters are relatively certain. “Stage 2 is only proposed at this point, but based on prior experience with Stage 1, it isn’t likely to be radically different in the final version,” Drazen says.

Stage 1, Drazen explains, involves having an EHR system that is certified to meet all the requirements of meaningful use. “Stage 1 is about having the basic data in electronic form,” she says. “Stage 2 is about expanding the set of information that’s available electronically and starting to engage patients more with their health information, and Stage 3 means demonstrating improvements in healthcare outcomes by using that information.”

According to Michelle Layton, regulatory compliance specialist at myCatalyst (www.mycatalyst.com), what happens in one stage will often be expanded in the next. “The way that CMS [the Centers for Medicare and Medicaid Services] has structured this is that later stages are extensions of earlier stages,” she says. “So in Stage 1, that requirement is 40%; in Stage 2, it’s 50%; and in Stage 3, it’s 80%.”

There are more than 20 of these requirements, and required compliance with them starts in different stages and at different levels. The full description of each is beyond the scope of this article, but you can expect the following if your company is pursuing the meaningful use incentives.

Reporting. Whether you have an EHR system already or are in the process of installing one, your main focus has likely been on getting that EHR up and running and getting the records into the system. But with the advent of meaningful use, the functions for reporting on how that system is used will become more and more important. “Quality reporting is going to be a big challenge,” Drazen says. “Physicians in practice will have to report on six quality measures. There has been voluntary reporting in the past, but this is mandatory, and that means a change in practice that’s pretty dramatic.” It will also likely mean more demands on your staff to help with those reports.

Help desk. This is an area where you are likely to need more resources than ever before. It’s one thing to add a new system for users who are already accustomed to similar systems, but it’s quite another to add one for physicians who have not been working that way at all. “Information technology is not embedded in the way we practice medicine, and we’re on the very early edge of how it impacts the user side,” says Ron Wince, CEO of Guidon Performance Solutions. “When you bring in something new, there’s a huge volume of calls to the help desk. Plus, if help isn’t readily available to access quickly, [users are] likely to go back and put information in after the fact and you won’t meet some of the requirements of meaningful use.”

Additionally, he says, there are technological challenges even for those populations that are used to technology in practice. The use of tablets and iPhones has been increasing in some healthcare providers, and that may make adoption or further implementation of an EHR system easier. But that doesn’t mean those two systems will play nicely together. “Most tablets in use today are Apple products, but most EHRs aren’t Apple-based,” Wince says. That kind of challenge may also lead to increased help desk calls.

Privacy and security. Any certified EHR is going to comply technologically with the meaningful use requirements for privacy and security. But in order for that technology to work, you’ll need to put policies in place to take advantage of it. Drazen explains that most privacy or security breaches take place inside organizations, rather than externally by the efforts of hackers. “It might be malevolent things, like someone who steals patients’ credit card information, or privacy violations like looking up the records for someone famous who comes into the clinic for treatment,” she says. “It’s a balance of technology and policy: The more information is electronic, the more that information is accessible in this way. But if you make it so secure that nobody can get it, it’s useless for providing care.”

All contents © 2011 Processor Magazine. All Rights Reserved.

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