Obamacare | EMR and HIPAA

Keeping the “Health” in “Heathcare”

‘Tis the season for family gatherings, holiday parties, and a plethora of professional networking events – all of which give me ample opportunity to perfect my “elevator speech”, introducing my business. It seems like each time I discuss what I do for a living, the question that follows is, “So, how do you feel about Obamacare?”

I understand that the Affordable Care Act, AKA Obamacare, is a significant slice of the polarizing pie our nation is currently attempting to consume and digest. And I appreciate that now, for the first time in my career, more people than not take an interest in what I have to say about being “a healthcare data consultant.” In years past, eyes would glaze over as I explained the enormous potential of predictive analytics in wellness and disease management programs, or the power of unstructured data mining for clinical notes data. Mentioning the health insurance plans I worked with brought inquiries into individual versus group rates, and complaints about the latest round of premium increases. It’s been refreshing to experience keen interest and pointed questions as I talk, rather than have each person gulp the last sip of wine and excuse themselves to run for more as soon as they figured out I have nothing to do with how much out-of-pocket expense they’re incurring after each doctor visit.

But as much as I enjoy the sudden interest in healthcare policy and data management, there isn’t enough wine in the world to make me debate the politics of healthcare reform with my 6’5″ uncles, my friends, or my social media connections. I am not a lawyer or political pundit. I am not qualified to comment on the merits of the ACA legislation. I am not an economist. I am not qualified to comment on the fiscal impact of Obamacare. I am a technologist. I am qualified to comment on the translation of ACA’s many provisions into the infrastructure and applications supporting our healthcare system. I am also a healthcare system consumer. I AM qualified to comment on what I believe this historic legislation means to my health, the health of my family, and the health of future generations.

This is what ACA healthcare reform and its many facets – Health Information Exchange (HIE), Electronic Health Records (EHR), Electronic Medical Records (EMR), Meaningful Use (MU) – mean to me: more, better, faster healthcare data capture and communication between all the stakeholders involved in my health and wellness:

- More health data: Meaningful Use-certified EMR applications require that particular medical service activities and clinical data elements are captured and stored discretely, electronically, and made available for retrieval upon patient demand.

- Better health data: The majority of medical procedures, products, services, events, and outcomes are codified in order to meet regulatory standards. It may take longer for your provider to enter the information about a patient encounter into an EMR system than it did to scribble notes on a chart; however, because those detailed discrete data elements are now tied to compensation and incentives, there is a higher likelihood that more specific details will be captured individually per encounter, generating a more complete picture of a patient’s medical history than a manual review of their paper charts. No handwriting recognition required.

- Faster access to critical health data: With EHR applications and HIEs, providers can instantly access patient medical records from provider/facility sources and multiple insurance carriers. The difference between electronic transmission speeds and manual chart retrieval could be the difference between life and death.

How could a higher volume of increasingly accurate, integrated, and immediately available healthcare data result in adverse health outcomes?

To me, healthcare isn’t about politics. It is health care. It’s about me, caring for my health, and the health of my loved ones. I believe that technological advances can and will empower healthcare stakeholders of all ilks – provider, health insurance plan, pharmaceutical industry, patients – to increase the speed of condition diagnosis and treatment, and to assist in establishing and maintaining healthy habits for improved health over a lifetime.

This season, put the “health” back in “healthcare”.

88 New ACO Organizations – What Does That Mean?

Written by: John Lynn

It has been a really interesting couple months for those interested in ACO’s (Accountable Care Organizations) and healthcare. I love how Gregg Masters of ACO Watch called the ACO the “Child of the ACA (Accountable Care Act).” He even declares the SCOTUS supreme court ruling as a big battle won for the ACO. I certainly can’t disagree with him when it comes to the government ACO initiatives. The loss of ACA would definitely hamper much of the government’s work on ACOs. Although, he also acknowledges that ACA is still up in the air pending the Presidential election. ACA is directly in the republican cross hairs.

Politics aside, the ACO program is going forward. CMS recently named 88 new Accountable Care Organizations (ACOs) that will take part in the Medicare Shared Saving Program (Originally it was 89 ACOs, but one organization dropped out).

You can see the full list of ACOs on the press release linked above, but I really like this image that The Advisory Board Company put together that shows the location of the various ACOs across the US (click image twice for full size):

I think this represents a pretty good distribution across the country. However, there are a few things that I find a bit disturbing about the organizations participating in the government ACO programs. The first is that many healthcare organizations that you think would be perfect fit for an ACO aren’t participating. Kaiser and IHC come to mind. I’ve heard that both organizations are very interested in ACOs, but not the government ACO programs. I think this is a bad sign for the government sponsored ACO programs.

The second is that only five of the ACOs applied for the version of the Medicare Shared Savings Program where they have a chance to earn a higher share of any savings, but they’ll also be accountable for any losses if the cost o the care increases. You might take a look back at my ACO Risks and Reward post. These five organizations have gone all in with the ACO program. With that said, I wonder why only five of them chose to participate in it? Shouldn’t we want more organizations to have some accountability and responsibility if they don’t improve care and lower costs?

As I have pointed out before, the ACO movement is happening and is not likely to slow down. Even if ACA or other government legislation is repealed, the move to ACOs is going to happen. With that knowledge and some of the comments above, it makes me wonder if the government should be the one funding an ACO initiative. Will their involvement help or hurt the overall ACO movement?

I’ll be interested to see how it goes for these new ACOs. As we’ve seen with EHR and meaningful use, we’ll have to be careful to filter through the messages coming out of CMS about the success or failure of the ACOs. As they progress we’re going to have to reach out to the ACOs and hear the first hand stories. If you’re an organization that’s participating, we’d love to hear your thoughts in the comments.

SCOTUS Decision and Healthcare IT

Written by: John Lynn

For those living in a hole that haven’t read about the SCOTUS supreme court decision that was issued today, here’s a good one paragraph summary of their decision from a post by The Atlantic:

In Plain English: The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding.

There have been a lot of interesting reactions to the SCOTUS decision. Many of them revolve around the politics of the decision. We’ll obviously avoid the political side of the discussion for the most part. I did find HIMSS response to the ACA Supreme Court decision quite interesting. They are mostly grateful that some of the uncertainty is gone so we can move forward in healthcare. Plus, they remind people that health IT has had bipartisan support in Washington despite Obamacare’s obviously partisan issues.

Personally, I think that this decision (regardless of which way it went) will not have a major effect on the healthcare IT and EHR world. Most of the major happenings in healthcare IT and EHR aren’t related to Obamacare. There are a few places that impact it, but most are relatively innocuous.

My biggest concern with the SCOTUS decision is how it will impact healthcare reimbursement in general. Plus, the ACA uncertainty is still there since if the Republicans take control in Washington, then you can be sure that they’re going to repeal ACA as one of the first things they do. This uncertainty could affect the health IT decision making by many institutions.

I’d be interested to hear what other impacts people think the SCOTUS ruling will have on healthcare IT. I do agree with HIMSS that I’m glad we have a decision and can at least move forward with that knowledge.

Accountable Care Organizations and SCOTUS

Written by: John Lynn

The Supreme Court ruling on SCOTUS is likely to come sometime this month. There are all sorts of opinions out there about what’s going to happen to the ruling, but a recent tweet caused me to stop and think about the real impact of SCOTUS. The tweet (which sadly I can’t find again) said something about the Supreme Court’s ruling on Obamacare and SCOTUS really doesn’t matter to healthcare since the change in care model has already been started.

I take one slight exception to this comment. I agree that the ACO (Accountable Care Organization) movement and all that it embodies is already upon us and won’t be affected by the Supreme Court’s decision on SCOTUS. However, I think the SCOTUS legal decision does matter and will still have an impact on healthcare. Not to mention the politics related to the decision. Although, I’ll leave both of those topics for a different blog.

I do think it’s worth exploring ACOs and why SCOTUS or NO-SCOTUS, ACOs are here to stay in healthcare.

Dave Chase recently said in a Forbes article that “More than 80% of the newly formed ACOs are driven solely by private sector efforts.”

I believe that Dave Chase got these numbers from an ACO Watch article about a Leavitt Partners study on ACO growth and dispersion. It’s a powerful number to consider that despite all the efforts by government to move to accountable care organizations that only 20% of the newly formed ACOs came from the government. What a healthy thing and a great illustration of why SCOTUS won’t impact ACOs in any major way.

Dave Chase in the above linked article adds this additional quote from Philip Betbeze:

As Philip Betbeze stated, “In their day-to-day-lives, it [the SCOTUS decision] largely won’t affect the 180-degree shift they’re making in reimbursement philosophy. For most systems, those changes are taking place largely at the behest of commercial plans and local employers.” The fee-for-value train has left the station. Woe is the health system that hasn’t made aggressive moves to reinvent themselves.

We’re still early in the reimbursement philosophy switch, but the winds of change are upon us. Personally I’m excited to see how health systems reinvent themselves. I think this reinvention will be around these key pillars:

*Communication – ACO’s will drive better communication. This will include patient to doctor, doctor to doctor, and even patient to patient. The beauty is that in an ACO, the goal will be for the patient not to come to the office instead of the de facto, come to the office answer most practices give today.

*Data – Practices better be preparing for the tsunami of healthcare data on the horizon. How an ACO takes that data and uses it to improve patient care is going to be key.

If you look at these pillars of an ACO, are they even possible to deal with without technology?

No EMR Mandate in HITECH or ACA – Meaningful Use Monday

Written by: John Lynn

I’m going to veer off a little bit from the regular Meaningful Use Monday topics to cover something that I think needs to get more coverage and is related to the EHR incentive money and meaningful use. Let me start by making something extremely clear:

There is NO EMR mandate. There is NO EHR mandate.

For those of you who want a broader post on the subject, you should read my post from a little over a year ago about the 2014 EHR Mandate. The key is that there’s no EHR mandate and no one is going to put an EHR mandate in place. Certainly there are incentives to use EHR and penalties if you don’t use EHR, but that’s not a mandate.

For those that don’t want to click to the full post above, in it I give five other reasons to implement EHR and an explanation of each. These reasons together could feel like a mandate. Here they are:
* Ability to Sale Practice
* Government Mandated Reporting
* Reimbursement Requirements
* Patients
* ROI for Your Practice

I’m sure that people are still confused on this subject. In just the past 7 days, this website has gotten 250+ people searching terms related to EHR mandate. A lot of people are starting to get concerned about what they’re hearing on the street about EHR. Will this fear of an “EHR Mandate” push many into EHR adoption?

HITECH and Obamacare (ACA)
Related to this mandate for EHR, many people are also confused by the EHR incentive money and the supreme court case for Obamacare. Many people confuse Obamacare, otherwise known as ACA, with the HITECH act (which was part of the ARRA legislation).

What you need to know is that when 99% of people talk about EHR incentive money, meaningful use, EHR mandates, EHR penalties, etc, they are talking about ARRA and more specifically the HITECH act. ARRA and the HITECH act aren’t going before the supreme court and so they’re not at risk. ARRA and HITECH could be affected if the republicans win the Presidency, Congress and the House, but most people argue that HITECH is pretty bipartisan. Although, that’s a topic for another post.

ACA is what’s gone before the supreme court and we’re awaiting a ruling. If ACA is declared unconstitutional, then there will be some affect on healthcare IT programs in general but most EMR programs won’t be affected.

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88 New ACO Organizations – What Does That Mean?

SCOTUS Decision and Healthcare IT

Accountable Care Organizations and SCOTUS

No EMR Mandate in HITECH or ACA – Meaningful Use Monday

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