EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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CMS Administrator Welcomes Providers to ICD-10 Compliance

CMS Administrator Welcomes Providers to ICD-10 Compliance | EHR and Health IT Consulting | Scoop.it

On October 1, the healthcare industry began ICD-10 compliance after countless months of preparation. In a CMS post, Deputy Administrator and Director of the Centers for Medicare & Medicaid Services (CMS) welcomed providers to ICD-10 and provided words of guidance to industry stakeholders on the transition day.

According to Cavanaugh, it may take a little while before CMS is able to assess how the transition to ICD-10 is proceeding. The reasons for this are twofold: first, most providers do not file claims on the same day as a service has been provided, and second, it takes a few weeks for CMS to process Medicare and Medicaid claims.


“Even after submission, Medicare claims take several days to be processed, and Medicare -- by law -- must wait two weeks before issuing  payment. Medicaid claims can take up to 30 days to be submitted and processed by states,” Cavanaugh wrote.


It is most likely that CMS will be able to assess ICD-10 progress following the first complete billing cycle. This is consistent with other CMS claims. In aconference call with industry stakeholders which took place a week before the October 1 deadline, CMS Principal Deputy Administrator Patrick H. Conway, MD, MSc, confirmed the same timeline for checking ICD-10 progress.

Until then, Cavanaugh explained, CMS plans to closely monitor the transition. Furthermore, CMS will be managing problems and questions that are submitted to the ICD-10 Coordination Center, which is staffed by several Medicare, Medicaid, billing, coding, and health IT experts to assist during the transition. In addition to the ICD-10 Coordination Center, Cavanaugh points providers toward other ICD-10 assistance resources, including William Rogers, MD, the ICD-10 ombudsman, and Medicare Administrative Contractors (MACs).


Cavanaugh also discussed the potential benefits of the ICD-10 transition, including the promise of more detailed health data reporting and and better healthcare delivery. By increasing the detail with which medical care is reported, policy changes can be more specific to the needs of populations.


“The change to ICD-10 allows you to capture more details about the health status of  your patients and sets the stage for improved patient care and public health surveillance across our country,” he wrote. “ICD-10 will help move the nation’s health care system to better, smarter care.”


These hopes for ICD-10 have been mirrored by many industry stakeholders, including AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA. Thomas Gordon recently stated howICD-10 will be of great benefit for patients because it will allow for better healthcare innovation due to the extensive detail of health records.

“As an active leader, supporter and advocate for ICD-10, AHIMA is pleased that the greater detail inherent in the code set will reverse the trend of deteriorating health data and tell a more complete and accurate patient story,” she said.


As providers continue with their transition to ICD-10, CMS is expected to report any major issues and provide guidance in fostering the smoothest transition possible.

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July ICD-10 Testing Shows CMS Readiness for Implementation

July ICD-10 Testing Shows CMS Readiness for Implementation | EHR and Health IT Consulting | Scoop.it

In preparation for the October 1 ICD-10 implementation deadline, the Centers for Medicare & Medicaid Services (CMS) have completed their third Medicare fee-for-service end-to-end testing with great success, according to a recent CMS report. This is the third successful CMS ICD-10 testing to occur in 2015.

The testing week, which occurred between July 20 and 24, included healthcare providers, clearinghouses, and billing agencies. These entities utilized the help of Medicare Administrative Contractors (MACs) and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange (CEDI) to file their claims. Participants from previous tests were invited to partake in the July tests, thus bringing a considerable amount of returners to this session.


The July test was a success, according to CMS, with an 87 percent acceptance rate of the 29,286 claims received. The rejection rate for ICD-10 errors was 1.8 percent, and the rejection rate for ICD-9 errors was 2.6 percent. However, majority of rejected claims were not ICD-10 related. Among others, these included invalid NPIs, claims outside of the covered date range, and invalid place of service. CMS confirms that many of these same errors occurred in previous test sessions.

Additionally, CMS states that many rejected claims may have been submitted with errors on purpose. This practice, referred to as “negative testing,” is intended to ensure that CMS’ rejection processes are functioning properly and will indeed reject a provider’s invalid claim.


CMS reports a larger cross-section of volunteers this test session, with about 1,200 organizations selected to participate in the test. There were 493 organizations returning for previous tests. Additionally, 1,400 National Provider Identifiers (NPIs) participated in the test, and approximately 12 percent of those were repeats from prior tests.


This test brought about similar results to previous tests performed in January and April. In January, CMS reported an 81 percent approval rating between January 26 and February 3. This test included 661 volunteers. Just like this most recent test, the January test boasts a high success rate, with a majority of rejected claims resulting from non-ICD-10 related errors.

Tests performed in April were likewise successful. With 875 participants, CMS reported an 88 percent acceptance rate, which is consistent with the July tests. The number of rejections due to ICD-10 and ICD-9 errors are also consistent with the July tests, with a majority of rejections being due to other provider-related issues.

As providers and payers alike continue to prepare for the impending October 1 ICD-10 deadline, these test results bring promise to CMS. Not only have CMS’ systems shown a proven capability for accuracy, but they have shown consistent accuracy, with only a seven percent difference between the best and worst test performances. Provided these positive results, CMS has shown that it is ready for this new coding system.

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CHIME and Fellow Industry Stakeholders Call on CMS to Expedite MU Modifications Rule

CHIME and Fellow Industry Stakeholders Call on CMS to Expedite MU Modifications Rule | EHR and Health IT Consulting | Scoop.it

The College of Healthcare Information Management Executives (CHIME) joined a diverse group 18 industry stakeholders urging the Centers for Medicare and Medicaid Services (CMS) to finalize the rule that sets meaningful use requirements for 2015 through 2017.


In May, the nation’s leading professional organization of chief information officers (CIOs) and senior IT executives in healthcare, submitted formal comments on the proposed changes to the EHR Incentive Program in which CHIME commended the agency for leading a series of changes to Meaningful Use, specifically the provision to shorten the EHR reporting period in 2015 from a full calendar year to 90 days.


“The additional time proposed by the modifications rule could help hundreds of thousands of providers meet meaningful use requirements in an effective and safe manner. However, we are just 61 days away from the end of the fiscal year, and the final quarter of 2015, yet hospitals and physicians are without the rules outlining the requirements for participation in the program this year,” said Leslie Krigstein, Interim Vice President of Public Policy for CHIME.


While, the efforts of CMS to simplify meaningful use in the 2015-2017 Modifications Rule are welcomed – and will be a key contributor to the ongoing success of the program – “providers and technology developers need to have the certainty now that comes with a Final Rule in order to be able to meet the reporting deadlines for 2015 and continue participation in the program,” stated the stakeholder group, which included provider and vendor representatives.


Unfortunately with the end of the fiscal year CIOs are finding themselves questioning their ability to successfully participate in the meaningful use program if the rules are not released quickly.


“CMS offered many beneficial changes in the proposed Modifications Rule, yet the delayed release may impede providers’ ability to not only take advantage of the proposed changes, but ultimately jeopardize their participation in the 2015 program year,” said Krigstein.


“Immediate clarity on the expectations for providers in 2015 is the best hope for enabling success in the meaningful use program this year.”


Citing the end of the fiscal year approaching, the letter states, “If providers do not receive the Final Rule shortly, it will be very difficult to make workflow adjustments in a timely manner to meet programmatic deadlines and facilitate Meaningful Use tracking and reporting.”

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ICD-10: CMS won't deny claims for first year

ICD-10: CMS won't deny claims for first year | EHR and Health IT Consulting | Scoop.it

In a surprise concession, the Centers for Medicare & Medicaid Services announced Monday that it would work with the American Medical Association on four steps designed to ease the transition to ICD-10.


Despite longtime disagreements on the topic, CMS will now adopt suggestions made by none other than the AMA with regard to the code set conversion. Those changes concern:


1. Claims denials. "While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family," CMS officials wrote in a guidance document.


2. Quality reporting and other penalties. "For all quality reporting completed for program year 2015 Medicare clinical quality data review contractors will not subject physicians or other Eligible Professionals (EP) to the Physician Quality Reporting System (PQRS), Value Based Modifier (VBM), or Meaningful Use 2 (MU) penalty during primary source verification or auditing related to the additional specificity of the ICD-10 diagnosis code, as long as the physician/EP used a code from the correct family of codes," CMS explained. "Furthermore, an EP will not be subjected to a penalty if CMS experiences difficulty calculating the quality scores for PQRS, VBM, or MU due to the transition to ICD-10 codes."


3. Payment disruptions. “If Medicare contractors are unable to process claims as a result of problems with ICD-10, CMS will authorize advance payments to physicians,” AMA president Steven Stack, MD, noted in a viewpoint piece on the group’s website.


4. Navigating transition problems. CMS intends to create a communication center of sorts, including an ICD-10 Ombudsman, "to help receive and triage physician and provider issues." The center will also "identify and initiate"resolution of issues caused by the new code sets, officials added. 


"These provisions are a culmination of vigorous efforts to convince the agency of the need for a transition period to avoid financial disruptions during this time of tremendous change," wrote Stack.


While AMA played a pivotal role in bringing about these CMS concessions, it was not the only party calling for a smoother conversion to the new code set.


Some members of the U.S. Congress have publicly suggested a dual-coding conversion period wherein CMS would accept and process claims in both ICD-9 and ICD-10. Instead of dual coding, CMS indicated that "a valid ICD-10 code will be required on all claims starting Oct. 1, 2015."


So as things stand today, providers have to use ICD-10 come October – but CMS will be more flexible about denials and payments than it has previously suggested it would be.

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Three Steps to Follow Before ICD-10 Conversion Deadline

Three Steps to Follow Before ICD-10 Conversion Deadline | EHR and Health IT Consulting | Scoop.it

If any providers still think there will be another ICD-10 delay, they may be mistaken. The ICD-10 conversion is moving forward and a full implementation will take place on October 1, 2015. The Healthcare Information and Management Systems Society (HIMSS) reports that this major diagnosis coding change is coming in less than five months and providers need to be prepared for the ICD-10 conversion.


Providers will need to be ready to use ICD-10 codes on claims and other transactions with health insurers in order to be adequately reimbursed. The Centers for Medicare & Medicaid Services (CMS) will not be accepting any claims that used ICD-9 coding after October 1, which means providers that utilize old codes will not be paid.


While there are many healthcare providers that have taken the necessary steps to prepare for the ICD-10 conversion deadline, a WEDI survey and other reports illustrate that a significant number of healthcare organizations have not gone forward with preparing for the ICD-10 implementation.


HIMSS states that providers who haven’t taken the necessary steps need to devote as much time as possible over the next few months to prepare for the ICD-10 conversion and conduct testing, upgrading and training in the limited time before October. There are three steps that HIMSS suggests providers follow in order to prevent any major issues with their revenue cycle after the deadline passes.


Identify the Top Medical Conditions


Every healthcare organization has several common conditions that their patients are afflicted with. To prepare for the ICD-10 conversion, it’s vital to identify these diseases and find the corresponding coding set of each. The most common conditions are associated with the largest net of revenue for medical facilities, which is why understanding the documentation of these health problems is so vital.


Hospital coders and claim submitters need to know the key documentation information to ensure they select the right ICD-10 code. Processes surrounding data capture, documentation, and recording will need to be updated to correspond with the new coding set.


Upgrade Health IT Systems


In preparations for the ICD-10 conversion, one of the most important tasks to complete is to update all health IT systems within an organization for ICD-10 capability. If a vendor handles IT updates, be sure they have come to install and test the latest versions of their software, HIMSS explains.


If an internal team handles health IT updates, be sure they have gone forward with all relevant installations especially with coding, documentation, and billing systems. All staff affected by the ICD-10 conversion will also need to be trained before the deadline.


Conduct Internal and External Partner Testing


After all systems are upgraded to the new coding set, it’s vital to conduct ICD-10 testing procedures both on the internal side and with external partners. Dual coding of incoming patients could be very useful information. Additionally, “dummy claims” in which false patient scenarios are incorporated can help test updated systems before the ICD-10 deadline. Any issues that may come up during testing should also be adjusted before October 1. It’s vital to follow these steps and prepare for the ICD-10 conversion before time runs out.


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EHR Incentive Programs Sparked Market to Reach $25 Billion

EHR Incentive Programs Sparked Market to Reach $25 Billion | EHR and Health IT Consulting | Scoop.it

The meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs have brought forth an era of electronic data access for the healthcare industry. The EHR market has never been stronger and recent findings illustrate that fact. A report from Kalorama Information called EMR 2015: The Market for Electronic Medical Records states that the EHR market reached nearly $25 billion in 2014.


Some of the stimulants that led to this increase for the EHR market come from the payment penalties promised by the Centers for Medicare & Medicaid Services (CMS), the financial boosts assured under the EHR Incentive Programs, vendors upgrading systems, and the search for greater efficiency throughout the healthcare industry.

“There’s still a healthy and competitive market for EMR,” Bruce Carlson, Publisher of Kalorama Information, said in a public statement. “Expect growth this year and next at seven to eight percent and stable growth until 2019. Eventually, there will be market saturation but this is a bit of a way off, especially in emerging markets.”


Between 2012 and 2014, the EHR market grew by 10 percent due to system upgrades and EHR adoption across the healthcare sector. Kalorama predicts that this market will hit $35.2 billion over the next four years.


As more providers and hospitals continue to attest to Stage 2 and Stage 3 Meaningful Use requirements under the EHR Incentive Programs, EHR adoption and upgrades will continue to rise over the coming years. Additionally, the payment reductions stemming from the meaningful use regulations will push more healthcare providers to continue updating their systems and spending more funds on certified EHR technology.


The latest results from CMS show that, last year, more than 80 percent of doctors across the country have utilized an EHR system as compared to 57 percent in 2011. At this point in time, the federal government has distributed more than $28 billion among providers who have successfully attested to meaningful use requirements under the EHR Incentive Programs.


The Kalorama report also found that EHR adoption varies among different parts of the US and different age groups with younger physicians more likely to implement and utilize certified EHR technology. One out of two doctors report having EHR platforms that meet the federal criteria for having a basic system.


The report from Kalorama discusses a variety of issues within the health IT sphere and the stimulants behind the EHR market. These factors include the historic market growth since 2012, regulatory trends, international market sizing, and profiles of various EHR vendors. Additionally, the report covers the status of meaningful use requirements, incentives under the EHR Incentive Programs, and vendor pricing.


Currently, the healthcare IT market is very complex with a wide variety of developments stimulating its growth. From mergers, acquisitions, security developments, and the ICD-10 transition to BYOD, big data, and the rise in electronic prescribing, the health IT market is likely to continue growing and transforming over the coming years.


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Future of Health IT: “It’s Time to Build Something Magnificent”

Future of Health IT: “It’s Time to Build Something Magnificent” | EHR and Health IT Consulting | Scoop.it

When it comes to health IT policy mandates, provider organizations have long questioned what’s behind the rulemaking process, with many showing further concern regarding federal leaders’ expertise levels and their lack of willingness to change based on public opinion. At the Centers for Medicare & Medicaid Services (CMS), senior technical director of Medicaid health IT Jason McNamara pays no attention these criticisms. “Those types of comments are tied to the old 1970s and 1980s way of thinking about the government, which was slow and hard to move, which sort of like a battleship in the ocean, took time to change. That’s not part of the government I’m with now,” McNamara says.  


McNamara has a wide variety of skills and projects he works on at CMS, ranging from Medicaid electronic health record (EHR) incentive programs to meaningful use rule development to health information exchange (HIE) strategies to consulting on state health IT development under the state innovation model (SIM) grants. McNamara, who focuses on the Medicaid side at CMS, recently spoke with HCI Associate Editor Rajiv Leventhal further about the perception of the government in the health IT landscape, as well as current trends and challenges he’s seeing in the industry from a policy perspective. Below are excerpts from that interview.


Tell me about how you got involved with CMS and what your current role there is?


I work in the data systems group, and if you think about the data systems group, in the context of Medicaid, we essentially work on anything IT related as long as it touches the administration of a Medicaid program or Medicaid beneficiaries. So I like to loosely interpret that as the IT arm of Medicaid. I am a technologist by trade; I spent five years in the Marine Corps, and have trained in communications and technology. I set myself up for a public safety IT focus, which evolved into health IT over the years,  and 15 years later, here I am. I also did work as a consultant implementing EHRs, building proprietary systems for large hospital systems, eventually moving over to the Department of Defense (DoD) and Veterans Administration (VA), having worked on their clinical applications as well. I was clinical operations director for ALTA, the DoD EHR system. Then in 2012 with HITECH legislation coming down, I have been managing EHR incentive programs ever since.


What are your insider thoughts on the DoD EHR contract bid?

Well it’s needed, it’s time to modernize that infrastructure. If you look at the infrastructure that’s in place, it’s antiquated. Some of those legacy systems were developed in the 1970s and 80s. Clearly it’s time to change the way they’re deploying their clinical technologies. This proposal will give us an opportunity to modernize a much needed environment. I have to maintain vendor neutrality here, but folks know some of the largest vendors that have partnered to help develop interoperable solutions, and it’s good that they have come to the table here.


What are the biggest priorities right now for you at CMS?


We have been very focused on Affordable Care Act work; we spent a lot of time deploying that, and now we’re breathing easier and are more focused on modernizing our systems on the Medicaid side, moving them into a real-time, progressive, shared-service model across Medicaid states. We are also heavily focused on data, deploying systems both at the state and federal levels to help analyze the massive amounts of Medicaid data we have. That is huge for us over the next 12 months.  And then we are of course continuing to work on health IT an HIE, an area that has lot of area for growth both from a policy and deployment perspective.


Ideally, in a perfect world, what would be the role of the government in this industry?


It depends on the topic. If you look at the National Health Information Network (NHIN), that was an Office of the National Coordinator for Health Information Technology (ONC) program,  and they managed it 100 percent at the federal level. As time progressed, they changed that and it got run over to a non-profit, Healtheway, who has since taken it over. In that regard, the government was widely used as a kickstarter to deploy that program, which is now self-sustaining in the private market. So I think it was important to push that forward. We took a step back and let the market drive that, and it’s been successful.


 Standards are an interesting topic as to what role the government plays, and we’re still trying to figure that part out. There has been a lot of conversation around open source products, as we have been playing with this idea in the Medicaid space. But how do we administer those open source products? What is our role? We have started to dabble in that market, but how do we translate that back into the community and let them market-ize the platform?


Basically, there isn’t one answer to this question. Everyone would agree that government has an important role, and we have to figure out what that looks like in each separate scenario.


How would you respond to the criticism that federal leaders aren’t appropriately apt to make such impactful health IT policy decisions?

In our government, these are folks who are industry experts who gave up lucrative positions and high paying jobs to help do good. They come from the smartest universities such as Harvard and Johns Hopkins, they were CIOs in large hospitals, and data geeks form get go with three or four computer degrees. So I don’t see this in the world I live in. It is true that it’s difficult for policy makers to keep in touch with where the rubber meets the road. We have to understand the impacts of the policy decisions and how it translates, and we’re getting better at it. We are receptive to public reception and very perceptive into how folks see the program. I’m a technologist, I started by implementing EHRs, so when someone tells me I don’t know what I’m talking about with EHRs, it is offensive. The government is made up of people who want to do good and are here for good reasons. They are underpaid and overworked. I know colleagues that haven’t had a day off in two or three months. So I can’t really associate with those types of comments.

What did you think about the news that Karen DeSalvo is likely out at ONC, and what would you like to see from the next National Coordinator?


I think it's a logical step for her career and her success.  Karen is a dear friend and colleague and she is one who can just get things done. There's value in that mindset no matter where you are in the health system. I think the next coordinator will have to continue to push the community with health IT adoption and interoperability. More importantly, push agencies towards modernizing their various policies that have a direct or indirect impact in the use of technology.  In short, the last five years have been spent laying the foundation. It's time to build something magnificent. 


What are your biggest challenges and pain points right now at CMS?

The way we have done business in the last 30 years is significantly changing; helping become a change agent is a very sensitive thing around everything related to Medicaid. We are not your grandmother’s Medicaid program anymore—it’s a different environment and building that trust is something we’re very focused on. It will become more complicated and important as we liberate data and start to tell stories about our beneficiaries. We have begun to publish a lot of data, and then folks get access to it, analyze, and make connections. We need to make sure communications across systems is continual, that’s a big focal point for us.


With respect to EHRs, we are very mindful of providers who have never had technology in practice. They are a minority but they do exist, as a specific percent are struggling with that. So it’s a challenge considering that from a policy perspective. Also, from a federal perspective, figuring out what’s the value in what we pay for? The data systems group has a $5 billion IT portfolio across states, but what does that mean and how do we create an environment where we make taxpayers dollars most effective installing systems? That’s very complicated, especially when working with legacy systems.  


You help write the EHR certification criteria for the meaningful use program. Can you get into detail about what’s behind that?

We create an advisory group, which comes from the private sector—doctors and CIOs—not public servants.  That committee looks at the program, takes public comment, and has very intimate conversations about how it will look from a clinical and systems perspective, and how it will be deployed. So we take in recommendations, and sometimes the idea starts with a simple Word document. We’ll toss around ideas and end up with some direction. The committee acts as an objective filter for that. So once we do that, we make a notice for proposal.  


For the meaningful use program, we put that on the street and take public comment. We are required to respond back—most people don’t even know that. If there’s a policy objective or measure we use and there’s a lot of comment, we can go back, change it and finalize it. We take our process from the Hill, we interpret what we think they’re trying to achieve for regulation, and then we finalize that with our rulemaking process. Then we go forward and deploy the program. When we start to hear questions from provider groups or associations, we create a sub-regulatory guidance, which provides clarity to what we intended when people have difficulty interpreting things. And we can use riders to modify and make amendments as well.  


What has the Stage 3 feedback been like so far?


I think we are at a place where Stage 3 was an aggregate of comments that we have heard over the years. We have learned lot of lessons with Stage 1 and 2, and we are now seeing a much more simplified version. How is this connecting to other programs? It aims to simplify the administration process. Folks have been generally favorable—there have been some concerns about the details of the regulation, and we will publicize those as we start to finalize it. Stage 3 is a much needed policy change, generally speaking.


You have worked with a ton of EMR vendors in the past. How would you rate their willingness to be more open systems?


I think at the end of day, vendors are there for their customers. That means a few things: customers have to hold the vendors accountable, customers have to be knowledgeable, they have to know what they want, and they have to know what’s happening. Too often we see providers pointing fingers at vendors, but are you asking them the right questions and holding them to those standards? Chances are if you hold someone to a standard, he or she would like to perform to that standard.


I think vendors want to support their customers, do good by them, stay in business, and grow revenue, and the way to do that is to solve problems of customers. You can’t get answers to those problems unless you ask questions, though. The vendors are trying, some have built infrastructure around housing their data in an effort to move data within the context of their own systems. I think that’s okay for now. But when folks talk about restricting and closing access, that’s a problem for me. We meet with vendors regularly, people don’t realize that. If we’re hearing problems from providers over and over again we can go right to the executive leaders of those vendors to work those out.

If you had to give a message to the industry as they move forward in a challenging time, what would it be?


We have to keep asking questions and challenge the data. We have a data-saturated environment right now. There is a lot of noise around that data, but what does it all mean? A very important piece of all this, and this ties into interoperability, is the semantics of the data. Let’s keep challenging the data, keep asking questions, and if we have asked so many questions and challenged different pieces, then we have created this fog, but we could sift through that to find direction and truth. It’s not about you, me, a specific provider or vendor, it’s about the collective. What are we doing as the collective to move forward? Let’s have the conversation that way.


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CMS Announces $284 Million Saved in Pioneer ACO Program After Two Years

CMS Announces $284 Million Saved in Pioneer ACO Program After Two Years | EHR and Health IT Consulting | Scoop.it

After two years in existence, the Pioneer Accountable Care Organization (ACO) program has saved the Medicare program $384 million in total, or $300 per Medicare beneficiary per year. Participating providers saved Medicare $279.7 million in 2012 and $104.5 million in 2013. That amount of savings was announced on the website of the Department of Health and Human Services (HHS), and came via an independent evaluation report released May 4 by HHS. What’s more, as the announcement noted, the independent Office of the Actuary in the Centers for Medicare and Medicaid Services (CMS) has certified that the Pioneer ACO program is model “is the first to meet expansion to a larger population of Medicare beneficiaries.”


According to the announcement, “The independent evaluation report for CMS found that the Pioneer Accountable Care Organization (ACO) Model generated over $384 million in savings to Medicare over its first two years – an average of approximately $300 per participating beneficiary per year – while continuing to deliver high-quality patient care. The Actuary’s certification that expansion of Pioneer ACOs would reduce net Medicare spending, coupled with Secretary Sylvia Mathews Burwell’s determination that expansion would maintain or improve patient care without limiting coverage or benefits, means that HHS will consider ways to scale the Pioneer ACO Model into other Medicare programs.”


Reacting to the development, HHS Secretary Sylvia Mathews Burwell was quoted in the online announcement as saying, “This is a crucial milestone in our efforts to build a health care system that delivers better care, spends our health care dollars more wisely, and results in healthier people. The Affordable Care Act gave us powerful new tools to test better ways to improve patient care and keep communities healthier. The Pioneer ACO Model has demonstrated that patients can get high quality and coordinated care at the right time, and we can generate savings for Medicare and the health care system at large.”

The Pioneer ACO Model, one of the first payment models launched by CMS, gives experienced health care organizations accountability for quality and cost outcomes for their Medicare patients. Doctors and hospitals who form Pioneer ACOs can share in savings generated for Medicare if they work to coordinate patient care, keep patients healthy and meet certain quality performance standards, or they may be required to pay a share of any losses generated.


Currently, more than 600,000 Medicare beneficiaries are assigned to Pioneer ACO organizations.


The announcement touted the fact that Medicare beneficiaries enrolled in Pioneer ACOs, on average, “report more timely care and better communication with their providers; use inpatient hospital services less and have fewer tests and procedures;  have more follow-up visits from their providers after hospital discharge.” The announcement also noted that the Pioneer ACO program’s evolution harmonizes with broader federal efforts, including with Secretary Burwell’s goal of tying 30 percent of Medicare payments to quality and value through alternative payment models by 2016 and 50 percent to such models by 2018.

Reacting to Monday’s news, the Charlotte-based Premier Inc. released a statement, attributed to Blair Childs, senior vice president for public policy for the nationwide health alliance. “Today’s announcement proves that innovative care delivery models such as the Pioneer ACO  program are effective at generating cost savings, while simultaneously improving quality and beneficiary satisfaction with care,” Childs said. “For more than a decade, members of the Premier alliance have been national leaders implementing payment and delivery reforms that improve quality while safely reducing costs.”


Still, Premier’s Childs said in the statement that, “While we support the desire to expand the Pioneer ACO program through track 3, as described in the Medicare Shared Savings Program (MSSP) proposed rule, we believe important changes need to be made, including:

  • Strengthen the assignment process by allowing Medicare beneficiaries to attest to participation in ACOs;
  • Establish a more appropriate balance between risk and reward, including higher shared savings for high-quality providers and a period where risk can be phased in over time;
  • Modify the current benchmark methodology to mitigate the impact on ACOs that lower expenses and achieve savings, and to allow ACOs to decide how to best account for regional and local cost trends;
  • Employ a risk-adjustment methodology that truly takes into account  an individual beneficiary’s acuity;
  • Adopt payment waivers to eliminate barriers to care coordination; and
  •  Provide more comprehensive and timelier data on ACOs’ patients.”


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Three Vendors are Driving Patient Engagement and Portal Use

Three Vendors are Driving Patient Engagement and Portal Use | EHR and Health IT Consulting | Scoop.it

Driving patient engagement is still vital for the healthcare sector despite certain inconsistencies from the Centers for Medicare & Medicaid Services (CMS). Even though CMS has proposed new Stage 2 Meaningful Use regulations that drop the 5 percent requirement of patients viewing, downloading, and transmitting their health information to just one patient per provider, the organization still expects eligible professionals and hospitals to meet a much larger percentage – currently proposed to be 25 percent – of patients viewing their medical data through patient portals under the Stage 3 Meaningful Use requirements. As such, providers would be wise to continue integrating patient engagement strategies at their facility.

Vendors play a vital part in developing effective patient portals to assist providers in driving patient engagement among their community of consumers. A report from the research firm KLAS examined which vendors in particular have been most useful in moving forward patient portal adoption amidst healthcare providers.Driving Patient Engagement

Athenahealth, Epic, and Medfusion were reported to be at the top of their game when it comes to increasing portal adoption throughout the patient population. More than half of the customers under all three vendors report that at least 20 percent of their patients have accessed the patient portal. This is well above the previous 5 percent threshold that CMS initially unrolled under Stage 2 Meaningful Use regulations.

KLAS discovered these findings after interviewing 186 medical provider organizations on which vendors have really made a difference in meeting their needs and advancing health IT and patient engagement for a brighter tomorrow.

The KLAS report focused on three main areas regarding patient portal strategies: enterprise, ambulatory, and EMR agnostic. A variety of factors associated with increasing patient portal adoption were addressed in the report including product performance and vendor guidance.

“Value-based care is forcing patient portals to evolve from being merely tools for reactive regulatory compliance to becoming valuable instruments that allow patients to proactively engage in their own care,” said report author Coray Tate. “Providers report that vendor guidance and functionality that patients find useful, such as billing and self-scheduling, are the most effective ways to encourage portal adoption among patients.”

A study published by the American Health Information Management Association (AHIMA) further outlines the use of the patient portal particularly among teenagers and parents. The researchers studied the attitudes of these two groups through one teen digital bulletin board, one parent digital bulletin board, and two focus groups for each faction. Videos and transcripts from the sessions were then analyzed.

The results showed that both teenagers and parents found that patient portals are beneficial and should be used to help teens better manage their own healthcare. Some teenagers were concerned that physicians would not be keeping certain information private and will let their parents see data that is meant to be protected. One parent said: “This kind of access will help my teen become much more interested in her healthcare and also motivate her to take control. And that will be great.”

With greater teamwork between vendors, providers, and the patients themselves, there should be a rise in the use of portals and patient engagement.


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As CMS Becomes Lenient, Providers Tackle Patient Engagement

As CMS Becomes Lenient, Providers Tackle Patient Engagement | EHR and Health IT Consulting | Scoop.it

While patient engagement remains a top priority for many medical organizations across the country, the Centers for Medicare & Medicaid Services (CMS) released a proposed ruling modifying meaningful use requirements and specifically relenting on a major patient engagement objective.


Previously, Stage 2 Meaningful Use requirements called for 5 percent of a provider’s patient base to access, download, and/or transmit their electronic health information, but now this objective has been changed for the years 2015 to 2017 in the proposed ruling. If the proposed rule becomes initiated as part of the meaningful use requirements for the next several years, eligible hospitals and physicians will need to ensure that just one patient views, downloads, or transmits their electronic medical data.


Even though CMS may be changing some patient engagement requirements, healthcare providers are still geared toward improving patient satisfaction as well as medication adherence. At the 2015 HIMSS Annual Conference and Exhibition in Chicago, the company TowerView Health was announced the winner of the 9th annual Venture+ Forum pitch competition meant for startups, according to the company’s press release.


Last week, 15 startup companies were chosen to take part in pitching live presentations to a panel of investors and healthcare experts. TowerView Health pitched to the investors a solution that assists patients with chronic diseases manage their complicated medication schedules.


TowerView’s pillbox allows patients to receive a pre-filled medication tray directly from their pharmacist. This pillbox is capable of sending reminders to patients if they miss a dose or don’t take a prescribed drug on time. The company works with health plans and at-risk providers to offer this particular service to patients for free.

“HIMSS and the mHealth Summit are focused on creating opportunities, providing business-building content, fostering partnerships and supporting entrepreneurs and early-stage companies developing innovative new health technologies.  The Venture+ Forum is an excellent resource for companies to network and connect with healthcare providers, payers, channels, institutions and strategic dealmakers,” Richard Scarfo, Vice President of Personal Connected Health Alliance at HIMSS, said in the press release.


TowerView Health isn’t the only organization looking to increase patient engagement. For example, HealthPrize Technologies, LLC and MeadWestvaco are collaborating on a new patient engagement and medication adherence platform, according to a news release.

Another organization called IntegraMed Fertility has adopted web-based patient engagement applications that are likely to revolutionize care and patient satisfaction through this network. The Patient PLUS portal from Anthelio Healthcare Solutions provides a much-desired self-service aspect that’s missing from much of the medical industry. These self-service capabilities include automating appointment scheduling and pre-registration. It also allows for viewing and accessing medical histories, electronic records, laboratory results, and radiology reports while at home or in a healthcare setting. Secure messaging tools for strengthening the patient-physician relationship are also available through this portal.

“Patient PULSE is a perfect fit for these patient-centered clinics, as it provides a multitude of ways to personalize the patient portal experience, providing additional support and communication opportunities for patients while empowering them to take a more active role in their care,” Asif Ahmad, CEO of Anthelio Healthcare Solutions, said in a public statement.


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Modifications to Meaningful Use for 2015 through 2017

Modifications to Meaningful Use for 2015 through 2017 | EHR and Health IT Consulting | Scoop.it

On April 10, 2015, the Centers for Medicare & Medicaid Services issued a new proposed rule for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs to align Stage 1 and Stage 2 objectives and measures with the long-term proposals for Stage 3, to build progress toward program milestones, to reduce complexity, and to simplify providers’ reporting. These modifications would allow providers to focus more closely on the advanced use of certified EHR technology to support health information exchange and quality improvement.

Better Care, Smarter Spending and Healthier People
The proposed rule is just one part of a larger effort across HHS to deliver better care, spend health dollars more wisely, and have healthier people and communities by working in three core areas: improving the way providers are paid, improving the way care is delivered, and improving the way information is shared to support transparency for consumers, health care providers, and researchers and to strengthen decision-making.


Vision for the Future


The proposed rule issued today is a critical step forward in helping to support the long-term goals of delivery system reform; especially those goals of a nationwide interoperable learning health system and patient-centered care. CMS is also simplifying the structure and reducing the reporting requirements for providers participating in the program by removing measures which have become duplicative, redundant, and reached wide-spread adoption (i.e., are “topped out”). This will allow providers to refocus on the advanced use objectives and measures. These advanced measures are at the core of health IT supported health care which drives toward improving the way electronic health information is shared among providers and with their patients, enhancing the ability to measure quality and set improvement goals, and ultimately improving the way health care is delivered and experienced.


Simplifying and Streamlining


The proposed rule would streamline reporting requirements. To accomplish these goals, the NPRM proposes:

  • Reducing the overall number of objectives to focus on advanced use of EHRs;
  • Removing measures that have become redundant, duplicative or have reached wide-spread adoption;
  • Realigning the reporting period beginning in 2015, so hospitals would participate on the calendar year instead of the fiscal year; and
  • Allowing a 90 day reporting period in 2015 to accommodate the implementation of these proposed changes in 2015.


Supporting Interoperability and the Adoption of Electronic Health Records


The EHR Incentive Programs support the adoption and meaningful use of certified EHR technology to allow providers and patients to exchange and access health information electronically and support interoperability broadly. The program supports interoperability by requiring the capture of data in structured formats as well as the exchange of data in standardized form as well as the sharing of this data electronically with other providers and with patients.

The proposed rule would reduce required reporting, allowing providers to focus on objectives which support advanced use of EHR technology and quality improvement, including health information exchange.


Improving Outcomes for Patients


The rule would support improved outcomes and measurement of those outcomes. By proposing to simplify the reporting requirements, the proposed rule would allow providers to focus on objectives that support advanced use of EHR technology, including quality measurement and quality improvement. The rule supports providers leveraging their resources and health IT to coordinate care for patients, to provide patients with access to their health information, and to support data collection in a format that can be shared across multiple health care organizations.


Program Registration and Participation Milestones


As of March 1, 2015, more than 525,000 providers have registered to participate in the Medicare and Medicaid EHR Incentive Programs. In addition, more than 438, 000 eligible professionals, eligible hospitals, and CAHs have received an EHR incentive payment. As of the end of 2014, 95% of eligible hospitals and CAHs, and more than 62% of eligible professionals have successfully demonstrated meaningful use of certified EHR technology.


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CMS Issued a New Proposed Rule for EHR Incentive Programs

CMS Issued a New Proposed Rule for EHR Incentive Programs | EHR and Health IT Consulting | Scoop.it

MS issued a new proposed rulefor the Medicare and Medicaid EHR Incentive Programs to align Stage 1 and Stage 2 objectives and measures with the long-term proposals for Stage 3.


The modifications would allow providers to focus more closely on the advanced use of certified EHR technology to support health information exchange and quality improvement. The new rule proposes a change in the reporting period for meaningful use from one year to 90 days in 2015.


Proposed Changes for EHR Incentive Programs


Together with the proposed Stage 3 notice of proposed rulemaking (NPRM) issued on March 20, 2015, the proposed rules align and merge the “stages” of meaningful use requirements.

The proposed rule changes the programs by:


  • Streamlining reporting by removing redundant, duplicative, and topped-out measures
  • Modifying patient action measures in Stage 2 objectives related to patient engagement
  • Aligning the EHR reporting period for eligible hospitals and CAHs with the full calendar year
  • Changing the EHR reporting period in 2015 to a 90-day period to accommodate modifications


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Stage 3 Meaningful Use Proposed Rule: Is More Time Needed?

Stage 3 Meaningful Use Proposed Rule: Is More Time Needed? | EHR and Health IT Consulting | Scoop.it

With the comment period open for providing feedback on the Stage 3 Meaningful Use proposed rule, the Centers for Medicare & Medicaid Services (CMS) along with the Office of the National Coordinator for Health IT (ONC) are likely to receive a multitude of opinions regarding the revision of these meaningful use requirements.


EHRIntelligence.com spoke with Bruce Eckert, National Practice Director at Beacon Partners, to get his perspective on the Stage 3 Meaningful Use proposed rule. Eckert mentioned how Stage 3 will likely advance the utilization of health IT tools even further.


“If the Stage 3 requirements were widely adopted, it would be a significant increase in industry capabilities, a big advancement for healthcare IT and good for the industry in many ways,” Eckert said. “But I think it’s going to be very challenging to bring a significant number of providers up to that level.”


Additionally, Eckert explained that requiring providers to reach the threshold of 25 percent of patients viewing and downloading their health information is a difficult stipulation to achieve. Currently, under Stage 2 Meaningful Use requirements, providers only need to ensure that 5 percent of patients view and access their health records electronically.


“We as an industry have struggled with [a similar stipulation] under Stage 2, so the greatly increased percentage under Stage 3 is likely to be a challenge,” Eckert stated. “I think it’s going to depend on the organization and the demographics. For many of our clients, we found that if they market their portal well, they will get well above the 5 percent of participation. [However,] 25 percent of participation based on today’s experience is high. It’ll take effort.”


“The counter to that is that policymakers are looking ahead to 2018,” the Beacon Partners representative continued. “In almost three years, society will continue migrating to online activities and part of that is using online services for health-related activities. It’ll be a challenge but I have a bit of optimism about it.”


When asked whether there will likely be many comments asking to lower this percentage during the comment period, Eckert replied in the affirmative and encourages healthcare organizations to express their opinions formally to CMS during the comment period. The director went on to discuss the importance of health information exchange (HIE) within the Stage 3 Meaningful Use proposed rule.


“It’s really important that our industry figure out how to [accomplish HIE]. It’s a big piece to the puzzle of care coordination and improving the quality of care. We have to make it work one way or another,” said Eckert. “Right now, under Stage 2, Direct Protocols turned out to not be ready for wide-spread usage. I think it will be by Stage 3. By leveraging Direct, I think we can achieve the Stage 3 level by 2018.”


Eckert stated that he is more optimistic about this objective under the Stage 3 Meaningful Use proposed rule and is “fairly positive about healthcare exchange.” However, Eckert was not as hopeful about most providers meeting all Stage 3 Meaningful Use requirements by the January 1, 2018 deadline.


“I think it’s going to be tough [to meet the deadline.] The reason is because we’re going to run into the same problem that we did with Stage 2. The problem is the [short] timeline for the vendors to develop the products,” Eckert explained. “From today until January 2018, there is about 33 months left. That is a little less time than there was from the [release of the] 2014 CEHRT proposed rule until the October 2014 deadline for most organizations to implement 2014 CEHRT.”


“CMS released the flexibility rule in late 2014 to grant extra room at that point because many vendors were either not ready or had gotten systems out late and providers were not able to fully implement these tools,” said Eckert. “I can see the same scenario developing here because the vendor timeline to create the considerably advanced capabilities is relatively short. The big rush to get these capabilities deployed in time is going to be a challenge.”


Eckert also discussed the increased focus on patient engagement under the Stage 3 Meaningful Use proposed rule. Physicians will have more options and tools available to communicate with patients.

“Studies that have been done in the past about patients using electronic messaging finds that it replaces the telephone,” Eckert mentioned. “Patients use electronic communication to ask questions or send information to providers that they would have done via telephone. Electronic messaging is more time efficient for the physician’s office than the telephone is. Providers will really appreciate the change in the Stage 3 rule around secure electronic messaging.”


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CMS Confirms Readiness to Assist During ICD-10 Transition

CMS Confirms Readiness to Assist During ICD-10 Transition | EHR and Health IT Consulting | Scoop.it

The ICD-10 compliance deadline of October 1 is less than a week away, creating a frenzy of preparation amongst coders, billers, and providers. The Centers for Medicare & Medicaid Services (CMS) senior officials recently held a conference call to answer questions regarding implementation, and specifically addressed the issue of CMS as a resource come October 1.


The September 24 call included CMS Principal Deputy Administrator Patrick H. Conway, MD, MSc, and ICD-10’s recently appointed ombudsman William Rogers, MD.


The bulk of the call consisted of a question and answer session which generally revolved around the roll of CMS as a resource for clinician practices experiencing issues with transition. Specifically, many callers were concerned with the potential government shutdown that could occur on October 1 if Congress cannot reach an agreement on the federal budget.


“In the event of a shutdown, we will continue -- and I want to be clear on this -- to pay claims,” Conway said. “We will continue to implement the ICD transition.”


Rogers made it clear that the Medicare administrative contractors (MACs) would still be working in the event of a shutdown, so claims will be accepted and paid during that time.


Conway elaborated on that point during another question, stating that payment systems are an essential part of the Medicare program and would still function in the event of a shutdown.


“In terms of staffing, we do have the flexibility to ensure core operations are operational and in effect,” Conway stated. “And obviously, our payment systems are a core piece of the Medicare program that will continue to be fully operational.”


Conway also addressed the issue of claims processing timelines and how that will affect real-time assessments of the transition. Although it would be ideal for CMS to have a clear idea of the state of the transition as soon as it occurs, Conway explains that due to the typical billing timeline, it will in reality take about one billing cycle.


“The Medicaid claims can take up to 30 days to be submitted and processed,” he said. “This end can take approximately two weeks. The Medicaid claims can take up to 30 days to be submitted and processed. For this reason, we expect to have more detailed information after a full billing cycle is complete.”


The questions on the call revolved around the cost of ICD-10 implementation, especially considering systems upgrades. According to Conway, the cost greatly relied on the specific circumstance of the practice or facility. Rogers shed light on the costs for smaller practices.

“[M]ost smaller practices just use a super bill,” Rogers explained. “t requires a little bit of an expansion of the number of diagnoses on the superbill. But they can easily cross walk their ICD-9 based super bill to an ICD-10 super bill.”


Rogers also assured callers that CMS has ample resources to ensure a smooth transition, and that they themselves will be able to serve as a resource for clinician practices. He explained that he, along with all of CMS, can serve as a major resource for providers who have questions regarding the transition process, and encourages providers to contact the ombudsman email address when in need of assistance.

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Groups Call for Final Changes to Meaningful Use Requirements

Groups Call for Final Changes to Meaningful Use Requirements | EHR and Health IT Consulting | Scoop.it

A group of eight hospital associations have joined voices to ask the Department of Health & Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) to move forward with finalizing proposed changes to meaningful use requirements made earlier this year.


"As organizations representing hospitals and health systems across the country, we are writing to urge the Department of Health and Human Services (HHS) to release, in the immediate future, a final rule making modifications to the meaningful use requirements under the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs for fiscal years (FY) 2015 to 2017," they state in a letter to HHS Secretary Sylvia Mathews Burwell.


CMS first indicated that it was considering reducing meaningful use requirements between 2015 and 2017 earlier this year. In January, Deputy Administrator for Innovation & Quality and Chief Medical Officer Patrick Conway, MD, authored a blog post revealing that the federal agency "intended to be responsive to provider concerns about software implementation, information exchange readiness, and other related concerns in 2015."


CMS did not release the proposed rule in question until April and the proposal has made little progress since then which has drawn consideration from multiple industry associations. Just last week, the College of Healthcare Information Management Executives (CHIME)called on the HHS Secretary to finalize the rule.


Now it is the case that the following eight hospital associations have come together to make a similar request:


  • America’s Essential Hospitals
  • American Hospital Association
  • Association of American Medical Colleges
  • Catholic Health Association of the United States
  • Children’s Hospital Association
  • Federation of American Hospitals
  • Premier healthcare alliance
  • VHA Inc.


According to these organization, the finalized rule is long overdue:

The rule is past due, given that it will affect the current program year for meaningful use. Indeed, under current rules, meaningful use applies to fiscal year performance for hospitals. FY 2015 ends on Sept. 30 — fewer than 60 days from now. We recognize that the Centers for Medicare & Medicaid Services (CMS) also proposed to change meaningful use reporting for hospitals from a fiscal to a calendar year. Under that policy, the last possible reporting period would begin on Oct. 3. However, the proposed rule also allowed other reporting periods for earlier dates in FY 2015. Even if reporting is moved to a calendar year, hospitals need the certainty of a final rule now to determine the best reporting period to choose and begin the process of reviewing performance and ensuring they have met all of the revised requirements.

That is not to say that these hospital groups are content with the provisions of the proposed rule as is:

Other proposed changes, such as making e-prescribing of discharge medications mandatory or adding new public health reporting measures, however, would make meeting Stage 2 more difficult. And, given the delay in the release of a final rule, they would be virtually impossible for hospitals to accommodate. Hospitals simply will not have sufficient time to understand the new requirements, work with their vendors to purchase and implement new or revised technology that would accommodate them, and invest in the training and work flow changes necessary to meet the new requirements.

With the closing of the fiscal year coming for eligible hospitals at the end of September, the hospital groups are concerned that the delayed release of the final rule would impose burdens on these providers and have far-reaching consequences.


"Widespread failure to meet meaningful use due to unrealistic regulatory requirements and insufficient technology will undermine hospitals’ ability to use EHRs to improve care and involve patients in their care. It will also result in significant financial penalties for the hospital field. Therefore, we urge HHS to release a final rule as quickly as possible," they add.

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Is ‘Safe Harbor’ Needed After ICD-10 Implementation Deadline?

Is ‘Safe Harbor’ Needed After ICD-10 Implementation Deadline? | EHR and Health IT Consulting | Scoop.it

As the ICD-10 implementation deadline drew closer, more lawmakers began attempting to develop a different type of transition period in which healthcare providers would not be penalized for reporting inaccurate ICD-10 codes. For example, HR 2247, the ICD-TEN Act, would create a “safe harbor” for providers in which they wouldn’t be denied reimbursement “due solely to the use of an unspecified or inaccurate sub-code.” 


The Coalition for ICD-10 states that the Centers for Medicare & Medicaid Services (CMS) has often accepted less specific codes under ICD-9 and, when the ICD-10 implementation deadline hits, the new reporting requirements will have no difference in level of specificity.


“CMS has reiterated numerous times that their acceptance of unspecified codes will not change as a result of the ICD-10 transition,” the Coalition for ICD-10 explains. “Furthermore, it would be inappropriate and a violation of coding rules to require a level of specificity that is not documented in the medical record. Indeed, CMS has made it abundantly clear that it would be inappropriate to select a specific code that is not supported by the medical record documentation or to conduct medically unnecessary diagnostic testing in order to determine a more specific code.”


Essentially, the ICD-TEN Act was proposed due to physician fears that there may be a significant increase in the number of claim denials once the ICD-10 implementation deadline takes effect.

However, the latest CMS end-to-end testing results show that there is only a 2 percent denial rate of claims due to ICD-10 errors. This shows that the physician fears may be unfounded.


According to the Coalition for ICD-10, a “safe harbor” transition period is not necessary and the current status of the ICD-10 implementation deadline should take effect on October 1 as is.


Additionally, CMS released its acknowledgement testing results taking place between June 1 and June 5. CMS accepted a total of 90 percent of claims submitted across the nation during this time period.

While a 10 percent denial rate is significant, CMS holds that the majority of claim rejections were due to submission errors within the testing environment that won’t affect the processing of claims when real claims are submitted after the ICD-10 implementation deadline.


It is time for providers to be ready for the ICD-10 implementation deadline or else risk having their claims rejected once October 1 hits. Any provider who submits ICD-9 codes after the deadline risks having the claims returned to their facility, returned as unprocessable, or rejected, according to apamphlet from CMS.


“As we look ahead to the implementation date of ICD-10 on October 1, 2015, we will continue our close communication with the Centers for Medicare and Medicaid Services to ensure that the deadline can successfully be met by stakeholders,” House Energy and Commerce Committee Chairman Fred Upton (R-MI) and House Rules Committee Chairman Pete Sessions (R-TX) stated at the end of 2014. ““This is an important milestone in the future of health care technologies, and it is essential that we understand the state of preparedness at CMS.”

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Bracing for ICD-10 Implementation Deadline amid ICD-9 Shortfalls

Bracing for ICD-10 Implementation Deadline amid ICD-9 Shortfalls | EHR and Health IT Consulting | Scoop.it

With the ICD-10 implementation deadline only three and a half months away, it is beneficial for healthcare providers to continue their last-minute preparations for the coming ICD-10 transition. The Centers for Medicare & Medicaid Services (CMS) includes a variety of tools and resources for providers to utilize when getting ready for the ICD-10 implementation deadline.


From the Road to 10 website to videos and expert columns, CMS is working toward preparing healthcare providers for the coming ICD-10 implementation deadline on October 1, 2015. In a video called “ICD-10: Getting from Here to There – Navigating the Road Ahead,” Dr. Ricardo Martinez, Fellow of the American College of American Physicians, discussed how the International Classification of Diseases (ICD) version 10 is a significant improvement over the more outdated ICD-9 codes being utilized across healthcare facilities today.


The video also went over key steps that small medical practices should incorporate when preparing for the ICD-10 implementation deadline. In particular, providers will need to understand how the new codes will differ from the older ICD-9 codes.


“As a practicing physician, I see the limitations of ICD-9 every day and why input from the medical community into the development of ICD-10 has been so valuable,” Martinez explained. “ICD-9 is outdated – even antiquated by today’s practice standards – and it limits the speed and accuracy with which I can gather information, gain insights, and, more importantly, care for my patients.”


“Today, ICD-9 doesn’t even address laterality, which signifies if a condition affects the left or the right limb,” continued Martinez. “On a professional note, when recently faced with a complex patient who had an acute stroke in history of a previous stroke, we had to search through many old records to determine whether that old stroke was left or right side, wasting valuable time that could have been dedicated to patient treatment. With a single code, ICD-10 will provide us with more detail. Better data makes better care possible.”


“To help small provider practices and other healthcare professionals with the transition to ICD-10, the Centers for Medicare & Medicaid Services is actively working with physicians, industry leaders, and others,” Martinez mentioned. “Healthcare has been using the international classification of diseases for over a century to identify and track diseases and help us improve our care for our patients.”


“Although most of the world transitioned to ICD-10 years ago, the currently used version of ICD-9 is fundamentally unchanged since its implementation in the United States in 1979,” Martinez stated. “One major limitation of ICD-9 is that it predates many modern technological advances and clinical terminology reflecting the use of CT scans, for example, which were also invented in 1979. Therefore, an update was necessary to account for these innovations in medicine.”


“For years, practitioners noted the need for increased specificity within clinical terminology, documentation, and coding to accurately represent the care provided to their patients,” Martinez clarified. “Under sponsorship of the World Health Organization (WHO), a group of physicians developed the basic structure for ICD-10. Then, each specialty provided input on the subset of procedure or diagnosis code needed. Addressing both the changes in medicine and the need for increased specificity, ICD-10 will capture greater detail in the clinical encounter for each patient.”

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CMS Official on Future of Health IT: “It’s Time to Build Something Magnificent”

CMS Official on Future of Health IT: “It’s Time to Build Something Magnificent” | EHR and Health IT Consulting | Scoop.it

When it comes to health IT policy mandates, provider organizations have long questioned what’s behind the rulemaking process, with many showing further concern regarding federal leaders’ expertise levels and their lack of willingness to change based on public opinion. At the Centers for Medicare & Medicaid Services (CMS), senior technical director of Medicaid health IT Jason McNamara pays no attention these criticisms. “Those types of comments are tied to the old 1970s and 1980s way of thinking about the government, which was slow and hard to move, which sort of like a battleship in the ocean, took time to change. That’s not part of the government I’m with now,” McNamara says.  


McNamara has a wide variety of skills and projects he works on at CMS, ranging from Medicaid electronic health record (EHR) incentive programs to meaningful use rule development to health information exchange (HIE) strategies to consulting on state health IT development under the state innovation model (SIM) grants. McNamara, who focuses on the Medicaid side at CMS, recently spoke with HCI Associate Editor Rajiv Leventhal further about the perception of the government in the health IT landscape, as well as current trends and challenges he’s seeing in the industry from a policy perspective. Below are excerpts from that interview.


Tell me about how you got involved with CMS and what your current role there is?


I work in the data systems group, and if you think about the data systems group, in the context of Medicaid, we essentially work on anything IT related as long as it touches the administration of a Medicaid program or Medicaid beneficiaries. So I like to loosely interpret that as the IT arm of Medicaid. I am a technologist by trade; I spent five years in the Marine Corps, and have trained in communications and technology. I set myself up for a public safety IT focus, which evolved into health IT over the years,  and 15 years later, here I am. I also did work as a consultant implementing EHRs, building proprietary systems for large hospital systems, eventually moving over to the Department of Defense (DoD) and Veterans Administration (VA), having worked on their clinical applications as well. I was clinical operations director for ALTA, the DoD EHR system. Then in 2012 with HITECH legislation coming down, I have been managing EHR incentive programs ever since.


What are your insider thoughts on the DoD EHR contract bid?


Well it’s needed, it’s time to modernize that infrastructure. If you look at the infrastructure that’s in place, it’s antiquated. Some of those legacy systems were developed in the 1970s and 80s. Clearly it’s time to change the way they’re deploying their clinical technologies. This proposal will give us an opportunity to modernize a much needed environment. I have to maintain vendor neutrality here, but folks know some of the largest vendors that have partnered to help develop interoperable solutions, and it’s good that they have come to the table here.


What are the biggest priorities right now for you at CMS?


We have been very focused on Affordable Care Act work; we spent a lot of time deploying that, and now we’re breathing easier and are more focused on modernizing our systems on the Medicaid side, moving them into a real-time, progressive, shared-service model across Medicaid states. We are also heavily focused on data, deploying systems both at the state and federal levels to help analyze the massive amounts of Medicaid data we have. That is huge for us over the next 12 months.  And then we are of course continuing to work on health IT an HIE, an area that has lot of area for growth both from a policy and deployment perspective.


Ideally, in a perfect world, what would be the role of the government in this industry?


It depends on the topic. If you look at the National Health Information Network (NHIN), that was an Office of the National Coordinator for Health Information Technology (ONC) program,  and they managed it 100 percent at the federal level. As time progressed, they changed that and it got run over to a non-profit, Healtheway, who has since taken it over. In that regard, the government was widely used as a kickstarter to deploy that program, which is now self-sustaining in the private market. So I think it was important to push that forward. We took a step back and let the market drive that, and it’s been successful.


 Standards are an interesting topic as to what role the government plays, and we’re still trying to figure that part out. There has been a lot of conversation around open source products, as we have been playing with this idea in the Medicaid space. But how do we administer those open source products? What is our role? We have started to dabble in that market, but how do we translate that back into the community and let them market-ize the platform?


Basically, there isn’t one answer to this question. Everyone would agree that government has an important role, and we have to figure out what that looks like in each separate scenario.


How would you respond to the criticism that federal leaders aren’t appropriately apt to make such impactful health IT policy decisions?

In our government, these are folks who are industry experts who gave up lucrative positions and high paying jobs to help do good. They come from the smartest universities such as Harvard and Johns Hopkins, they were CIOs in large hospitals, and data geeks form get go with three or four computer degrees. So I don’t see this in the world I live in. It is true that it’s difficult for policy makers to keep in touch with where the rubber meets the road. We have to understand the impacts of the policy decisions and how it translates, and we’re getting better at it. We are receptive to public reception and very perceptive into how folks see the program. I’m a technologist, I started by implementing EHRs, so when someone tells me I don’t know what I’m talking about with EHRs, it is offensive. The government is made up of people who want to do good and are here for good reasons. They are underpaid and overworked. I know colleagues that haven’t had a day off in two or three months. So I can’t really associate with those types of comments.

What did you think about the news that Karen DeSalvo is likely out at ONC, and what would you like to see from the next National Coordinator?


I think it's a logical step for her career and her success.  Karen is a dear friend and colleague and she is one who can just get things done. There's value in that mindset no matter where you are in the health system. I think the next coordinator will have to continue to push the community with health IT adoption and interoperability. More importantly, push agencies towards modernizing their various policies that have a direct or indirect impact in the use of technology.  In short, the last five years have been spent laying the foundation. It's time to build something magnificent. 


What are your biggest challenges and pain points right now at CMS?

The way we have done business in the last 30 years is significantly changing; helping become a change agent is a very sensitive thing around everything related to Medicaid. We are not your grandmother’s Medicaid program anymore—it’s a different environment and building that trust is something we’re very focused on. It will become more complicated and important as we liberate data and start to tell stories about our beneficiaries. We have begun to publish a lot of data, and then folks get access to it, analyze, and make connections. We need to make sure communications across systems is continual, that’s a big focal point for us.


With respect to EHRs, we are very mindful of providers who have never had technology in practice. They are a minority but they do exist, as a specific percent are struggling with that. So it’s a challenge considering that from a policy perspective. Also, from a federal perspective, figuring out what’s the value in what we pay for? The data systems group has a $5 billion IT portfolio across states, but what does that mean and how do we create an environment where we make taxpayers dollars most effective installing systems? That’s very complicated, especially when working with legacy systems.  


You help write the EHR certification criteria for the meaningful use program. Can you get into detail about what’s behind that?

We create an advisory group, which comes from the private sector—doctors and CIOs—not public servants.  That committee looks at the program, takes public comment, and has very intimate conversations about how it will look from a clinical and systems perspective, and how it will be deployed. So we take in recommendations, and sometimes the idea starts with a simple Word document. We’ll toss around ideas and end up with some direction. The committee acts as an objective filter for that. So once we do that, we make a notice for proposal.  


For the meaningful use program, we put that on the street and take public comment. We are required to respond back—most people don’t even know that. If there’s a policy objective or measure we use and there’s a lot of comment, we can go back, change it and finalize it. We take our process from the Hill, we interpret what we think they’re trying to achieve for regulation, and then we finalize that with our rulemaking process. Then we go forward and deploy the program. When we start to hear questions from provider groups or associations, we create a sub-regulatory guidance, which provides clarity to what we intended when people have difficulty interpreting things. And we can use riders to modify and make amendments as well.  


What has the Stage 3 feedback been like so far?


I think we are at a place where Stage 3 was an aggregate of comments that we have heard over the years. We have learned lot of lessons with Stage 1 and 2, and we are now seeing a much more simplified version. How is this connecting to other programs? It aims to simplify the administration process. Folks have been generally favorable—there have been some concerns about the details of the regulation, and we will publicize those as we start to finalize it. Stage 3 is a much needed policy change, generally speaking.


You have worked with a ton of EMR vendors in the past. How would you rate their willingness to be more open systems?

I think at the end of day, vendors are there for their customers. That means a few things: customers have to hold the vendors accountable, customers have to be knowledgeable, they have to know what they want, and they have to know what’s happening. Too often we see providers pointing fingers at vendors, but are you asking them the right questions and holding them to those standards? Chances are if you hold someone to a standard, he or she would like to perform to that standard.


I think vendors want to support their customers, do good by them, stay in business, and grow revenue, and the way to do that is to solve problems of customers. You can’t get answers to those problems unless you ask questions, though. The vendors are trying, some have built infrastructure around housing their data in an effort to move data within the context of their own systems. I think that’s okay for now. But when folks talk about restricting and closing access, that’s a problem for me. We meet with vendors regularly, people don’t realize that. If we’re hearing problems from providers over and over again we can go right to the executive leaders of those vendors to work those out.

If you had to give a message to the industry as they move forward in a challenging time, what would it be?


We have to keep asking questions and challenge the data. We have a data-saturated environment right now. There is a lot of noise around that data, but what does it all mean? A very important piece of all this, and this ties into interoperability, is the semantics of the data. Let’s keep challenging the data, keep asking questions, and if we have asked so many questions and challenged different pieces, then we have created this fog, but we could sift through that to find direction and truth. It’s not about you, me, a specific provider or vendor, it’s about the collective. What are we doing as the collective to move forward? Let’s have the conversation that way.


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CMS Official on Future of Health IT: “It’s Time to Build Something Magnificent”

CMS Official on Future of Health IT: “It’s Time to Build Something Magnificent” | EHR and Health IT Consulting | Scoop.it

When it comes to health IT policy mandates, provider organizations have long questioned what’s behind the rulemaking process, with many showing further concern regarding federal leaders’ expertise levels and their lack of willingness to change based on public opinion. At the Centers for Medicare & Medicaid Services (CMS), senior technical director of Medicaid health IT Jason McNamara pays no attention these criticisms. “Those types of comments are tied to the old 1970s and 1980s way of thinking about the government, which was slow and hard to move, which sort of like a battleship in the ocean, took time to change. That’s not part of the government I’m with now,” McNamara says.  

McNamara has a wide variety of skills and projects he works on at CMS, ranging from Medicaid electronic health record (EHR) incentive programs to meaningful use rule development to health information exchange (HIE) strategies to consulting on state health IT development under the state innovation model (SIM) grants. McNamara, who focuses on the Medicaid side at CMS, recently spoke with HCI Associate Editor Rajiv Leventhal further about the perception of the government in the health IT landscape, as well as current trends and challenges he’s seeing in the industry from a policy perspective. Below are excerpts from that interview.

Tell me about how you got involved with CMS and what your current role there is?

I work in the data systems group, and if you think about the data systems group, in the context of Medicaid, we essentially work on anything IT related as long as it touches the administration of a Medicaid program or Medicaid beneficiaries. So I like to loosely interpret that as the IT arm of Medicaid. I am a technologist by trade; I spent five years in the Marine Corps, and have trained in communications and technology. I set myself up for a public safety IT focus, which evolved into health IT over the years,  and 15 years later, here I am. I also did work as a consultant implementing EHRs, building proprietary systems for large hospital systems, eventually moving over to the Department of Defense (DoD) and Veterans Administration (VA), having worked on their clinical applications as well. I was clinical operations director for ALTA, the DoD EHR system. Then in 2012 with HITECH legislation coming down, I have been managing EHR incentive programs ever since.

What are your insider thoughts on the DoD EHR contract bid?

Well it’s needed, it’s time to modernize that infrastructure. If you look at the infrastructure that’s in place, it’s antiquated. Some of those legacy systems were developed in the 1970s and 80s. Clearly it’s time to change the way they’re deploying their clinical technologies. This proposal will give us an opportunity to modernize a much needed environment. I have to maintain vendor neutrality here, but folks know some of the largest vendors that have partnered to help develop interoperable solutions, and it’s good that they have come to the table here.

What are the biggest priorities right now for you at CMS?

We have been very focused on Affordable Care Act work; we spent a lot of time deploying that, and now we’re breathing easier and are more focused on modernizing our systems on the Medicaid side, moving them into a real-time, progressive, shared-service model across Medicaid states. We are also heavily focused on data, deploying systems both at the state and federal levels to help analyze the massive amounts of Medicaid data we have. That is huge for us over the next 12 months.  And then we are of course continuing to work on health IT an HIE, an area that has lot of area for growth both from a policy and deployment perspective.

Ideally, in a perfect world, what would be the role of the government in this industry?

It depends on the topic. If you look at the National Health Information Network (NHIN), that was an Office of the National Coordinator for Health Information Technology (ONC) program,  and they managed it 100 percent at the federal level. As time progressed, they changed that and it got run over to a non-profit, Healtheway, who has since taken it over. In that regard, the government was widely used as a kickstarter to deploy that program, which is now self-sustaining in the private market. So I think it was important to push that forward. We took a step back and let the market drive that, and it’s been successful.

 Standards are an interesting topic as to what role the government plays, and we’re still trying to figure that part out. There has been a lot of conversation around open source products, as we have been playing with this idea in the Medicaid space. But how do we administer those open source products? What is our role? We have started to dabble in that market, but how do we translate that back into the community and let them market-ize the platform?

Basically, there isn’t one answer to this question. Everyone would agree that government has an important role, and we have to figure out what that looks like in each separate scenario.

How would you respond to the criticism that federal leaders aren’t appropriately apt to make such impactful health IT policy decisions?

In our government, these are folks who are industry experts who gave up lucrative positions and high paying jobs to help do good. They come from the smartest universities such as Harvard and Johns Hopkins, they were CIOs in large hospitals, and data geeks form get go with three or four computer degrees. So I don’t see this in the world I live in. It is true that it’s difficult for policy makers to keep in touch with where the rubber meets the road. We have to understand the impacts of the policy decisions and how it translates, and we’re getting better at it. We are receptive to public reception and very perceptive into how folks see the program. I’m a technologist, I started by implementing EHRs, so when someone tells me I don’t know what I’m talking about with EHRs, it is offensive. The government is made up of people who want to do good and are here for good reasons. They are underpaid and overworked. I know colleagues that haven’t had a day off in two or three months. So I can’t really associate with those types of comments.

What did you think about the news that Karen DeSalvo is likely out at ONC, and what would you like to see from the next National Coordinator?

I think it's a logical step for her career and her success.  Karen is a dear friend and colleague and she is one who can just get things done. There's value in that mindset no matter where you are in the health system. I think the next coordinator will have to continue to push the community with health IT adoption and interoperability. More importantly, push agencies towards modernizing their various policies that have a direct or indirect impact in the use of technology.  In short, the last five years have been spent laying the foundation. It's time to build something magnificent.

What are your biggest challenges and pain points right now at CMS?

The way we have done business in the last 30 years is significantly changing; helping become a change agent is a very sensitive thing around everything related to Medicaid. We are not your grandmother’s Medicaid program anymore—it’s a different environment and building that trust is something we’re very focused on. It will become more complicated and important as we liberate data and start to tell stories about our beneficiaries. We have begun to publish a lot of data, and then folks get access to it, analyze, and make connections. We need to make sure communications across systems is continual, that’s a big focal point for us.

With respect to EHRs, we are very mindful of providers who have never had technology in practice. They are a minority but they do exist, as a specific percent are struggling with that. So it’s a challenge considering that from a policy perspective. Also, from a federal perspective, figuring out what’s the value in what we pay for? The data systems group has a $5 billion IT portfolio across states, but what does that mean and how do we create an environment where we make taxpayers dollars most effective installing systems? That’s very complicated, especially when working with legacy systems.  

You help write the EHR certification criteria for the meaningful use program. Can you get into detail about what’s behind that?

We create an advisory group, which comes from the private sector—doctors and CIOs—not public servants.  That committee looks at the program, takes public comment, and has very intimate conversations about how it will look from a clinical and systems perspective, and how it will be deployed. So we take in recommendations, and sometimes the idea starts with a simple Word document. We’ll toss around ideas and end up with some direction. The committee acts as an objective filter for that. So once we do that, we make a notice for proposal.  

For the meaningful use program, we put that on the street and take public comment. We are required to respond back—most people don’t even know that. If there’s a policy objective or measure we use and there’s a lot of comment, we can go back, change it and finalize it. We take our process from the Hill, we interpret what we think they’re trying to achieve for regulation, and then we finalize that with our rulemaking process. Then we go forward and deploy the program. When we start to hear questions from provider groups or associations, we create a sub-regulatory guidance, which provides clarity to what we intended when people have difficulty interpreting things. And we can use riders to modify and make amendments as well.  

What has the Stage 3 feedback been like so far?

I think we are at a place where Stage 3 was an aggregate of comments that we have heard over the years. We have learned lot of lessons with Stage 1 and 2, and we are now seeing a much more simplified version. How is this connecting to other programs? It aims to simplify the administration process. Folks have been generally favorable—there have been some concerns about the details of the regulation, and we will publicize those as we start to finalize it. Stage 3 is a much needed policy change, generally speaking.

You have worked with a ton of EMR vendors in the past. How would you rate their willingness to be more open systems?

I think at the end of day, vendors are there for their customers. That means a few things: customers have to hold the vendors accountable, customers have to be knowledgeable, they have to know what they want, and they have to know what’s happening. Too often we see providers pointing fingers at vendors, but are you asking them the right questions and holding them to those standards? Chances are if you hold someone to a standard, he or she would like to perform to that standard.

I think vendors want to support their customers, do good by them, stay in business, and grow revenue, and the way to do that is to solve problems of customers. You can’t get answers to those problems unless you ask questions, though. The vendors are trying, some have built infrastructure around housing their data in an effort to move data within the context of their own systems. I think that’s okay for now. But when folks talk about restricting and closing access, that’s a problem for me. We meet with vendors regularly, people don’t realize that. If we’re hearing problems from providers over and over again we can go right to the executive leaders of those vendors to work those out.

If you had to give a message to the industry as they move forward in a challenging time, what would it be?

We have to keep asking questions and challenge the data. We have a data-saturated environment right now. There is a lot of noise around that data, but what does it all mean? A very important piece of all this, and this ties into interoperability, is the semantics of the data. Let’s keep challenging the data, keep asking questions, and if we have asked so many questions and challenged different pieces, then we have created this fog, but we could sift through that to find direction and truth. It’s not about you, me, a specific provider or vendor, it’s about the collective. What are we doing as the collective to move forward? Let’s have the conversation that way.


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Updated Clinical Quality Measures Revealed by CMS

Updated Clinical Quality Measures Revealed by CMS | EHR and Health IT Consulting | Scoop.it

Eligible hospitals and healthcare professionals looking to meet meaningful use requirements and obtain financial incentives from the Medicare and Medicaid EHR Incentive Programs will need to keep track of electronic clinical quality measures (eCQMs), which are part of clinical quality reporting programs such as the Physician Quality Reporting System (PQRS).

Today the Centers for Medicare & Medicaid Services (CMS) announced the annual update for the 2014 electronic clinical quality measures. Healthcare providers will need to utilize these updated measures to report 2016 quality data electronically for CMS quality reporting programs. These programs include PQRS, the EHR Incentive Programs, and the Inpatient Quality Reporting Program (IQR).EHR Incentive Programs

EHRIntelligence.com recently spoke with William O’Byrne, Executive Director of NJ-HITEC, to learn more about their PQRS data registry and how it helps providers successfully submit the data necessary to reach pay-for-value measures and meaningful use provisions.

“In the past, payment structures have always been based on the number of services that physicians provide. If they do 20 things in one appointment, then they get paid for 20 different things or they get a bundled payment,” O’Byrne said. “CMS has decided and are now implementing a whole new way of paying doctors and hospitals for healthcare. It’s called Pay for Value. No longer will doctors be paid for adding up many different things they did during a visit.”

“They will now have to track clinical quality measures, which are the same thing that’s in the PQRS,” O’Byrne stated. “They will also have to show that there’s a change for the better in clinical quality measures. They will get paid for value instead of for individual items. The registry is the way that CMS is going to be determining how well or how badly the doctor is doing in the delivery of healthcare.”

The reason CMS updates quality measures on an annual basis is to keep the specifications in agreement with modern clinical guidelines along with code systems. These measures need to stay pertinent and actionable within the current healthcare setting.

To keep track of the updated clinical quality measures, visit the CMS website to find 64 updated measures for eligible clinicians and 29 updated measures for eligible hospitals.QDM 4.1.2 based-HQMF version R 2.1 was used to re-specify each of the 2015 updated measure specifications.

To access the clinical quality measures for the 2014 EHR Incentive Programs, eligible professionals should click here. For more guidance on implementing the May 2015 electronic clinical quality measure specifications, eligible hospital providers and eligible healthcare professionals may benefit from the CMS Electronic Clinical Quality Measure Logic and Implementation Guidance.

The guidance offers a variety of information on the types of electronic clinical quality measures including patient-specific measures, episode-of-care measures, proportion measures, and continuous variable measures. Some of the measures include screening for clinical depression, screening for high blood pressure, HIV/AIDS treatments, assessment for complex chronic conditions, cancer screenings, diabetes foot examination, and medication management.

Through the CMS eCQM library, providers can download the whole set of measures in their relevant zip files. The Value Set Authority Center is also a useful resource, as it offers a simple way to download value sets for the eCQMs in multiple file formats. The value sets can be accessed as sets per measure or as a whole, unified set. Additionally, the Data Element Catalogue includes the complete list of 2014 eCQMs and value set names, CMS reported.

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CMS Releases Strategic Vision for Physician Quality Reporting Programs

CMS Releases Strategic Vision for Physician Quality Reporting Programs | EHR and Health IT Consulting | Scoop.it

The Centers for Medicare and Medicaid Services (CMS) has released its strategic vision for physician quality reporting programs, describing a long-term vision for CMS’ physician quality reporting programs and a future for these programs to strive toward over the next several years.

According to CMS, this vision acknowledges the constraints and requirements of existing physician quality reporting programs, as well as the role quality measurement plays in CMS’ evolving approach to provider payment, which is moving from a purely fee-for-service (FFS) payment system to payment models that reward providers based on the quality and cost of care provided.


There are five principles that the federal agency believes will ensure that quality measurement and public reporting play a critical role in improving the healthcare delivered to millions of Americans:


  • Input from patients, caregivers, and healthcare professionals will guide the programs.
  • Feedback and data drives rapid cycle quality improvement.
  • Public reporting provides meaningful, transparent, and actionable information.
  • Quality reporting programs rely on an aligned measure portfolio.
  • Quality reporting and value-based purchasing program policies are aligned.


“CMS relies heavily on quality measurement and public reporting to facilitate the delivery of high quality care,” according to a blog post from Patrick Conway, M.D., principal deputy administrator and chief medical officer at CMS. “This strategic vision articulates how we will build upon our successful physician quality reporting programs to reach a future-state where quality measurement and public reporting are optimized to help achieve the CMS quality strategy’s goals and objectives, and therefore contribute to improved healthcare quality across the nation, including better care, smarter spending, and healthier people.”


According to the blog post, the strategic vision evolved out of the agency’s desire to plan for the future in how it administers the physician quality reporting system (PQRS), physician feedback/value-based payment modifier program, and other physician quality reporting programs. With passage of legislation ending the Sustainable Growth Rate (SGR) formula, key components of these physician programs will serve as the foundation for the Merit-based Incentive Payment System, Conway added.


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Two Elements of EHR Incentive Programs Gain Greater Adoption

Two Elements of EHR Incentive Programs Gain Greater Adoption | EHR and Health IT Consulting | Scoop.it

Some key elements of the Medicare and Medicaid EHR Incentive Programs include participation in the Physician Quality Reporting System (PQRS) and the electronic prescribing of patient medication. While the Electronic Prescribing (eRx) Incentive Program ended in 2013, it is still required through meaningful use of EHR systems under the EHR Incentive Programs to prescribe drugs electronically in order to receive a financial incentive and avoid payment penalties.

The American Hospital Association (AHA) reported that in 2013 almost 642,000 eligible healthcare professionals participated in PQRS, which is a 47 percent increase from the 2012 statistic. These numbers contain around 50 percent of eligible professionals across the United States. The Centers for Medicare & Medicaid Services (CMS) released these numbers in a new report last week.


Approximately four out of 10 eligible professionals gained a financial incentive due to attesting to the PQRS objective under the EHR Incentive Programs. This is a rise of 9 percentage points from 2012. The financial incentive payments from both the Electronic Prescribing Incentive Program and the Physician Quality Reporting System reached $390.7 million in 2013. The amount of eligible professionals earning an eRx incentive rose slightly from 29 percent in 2012 to 32 percent in 2013.


In 2013, the PQRS incentive payments reached as high as $214,551,741, CMS reported. Essentially, the brief found that there is a rise in electronic prescribing use and the reporting of quality information across the healthcare sector.


However, as many as 47,000 eligible providers will receive a 1.5 percent reduction as a payment penalty in their Part B Medicare Physician Fee Schedule disbursements in 2015. The report also found that 43 percent of eligible professionals who received a payment penalty treat no more than 25 Medicare beneficiaries per year. In order to avoid further payment reductions, eligible professionals and hospitals will need to successfully attest to the requirements in the meaningful use stages.


For those looking to avoid 2016 Medicare quality reporting payment penalties, CMS published a guide outlining the steps to take. The basic process is to submit a report on quality measures data and wait for CMS to analyze the relevant data to determine whether a financial incentive or payment adjustment is guaranteed. Once CMS has completed its role, the provider can access the feedback or quarterly report to determine whether an incentive is awarded, a payment adjustment is received, or a neutral state is met in which neither incentives nor adjustments are established.


Along with the typical doctors of medicine, dentists, dental surgeons, podiatrists, optometrists, and chiropractors are considered eligible professionals who can receive incentive payments for successfully attesting to meaningful use requirements under the EHR Incentive Programs. CMS also explains the importance of reporting quality measures which includes better understanding one’s patient population, learning about one’s performance on quality measures, and seeing where the highest-cost patients receive their care. Those looking to receive financial incentives from CMS would be wise to utilize electronic prescribing software and participate in the Physician Quality Reporting System.


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Does Healthcare Fraud Impact Meaningful Use Audits?

Does Healthcare Fraud Impact Meaningful Use Audits? | EHR and Health IT Consulting | Scoop.it

While the majority of medical providers are preparing for the ICD-10 transition deadline and are utilizing diagnostic coding accurately, there are certainly outliers who have attempted to defraud the healthcare system and the Centers for Medicare & Medicaid Services (CMS). These outliers may even affect the CMS’ stance on meaningful use audits. Former Central Texas Hospital owner Tariq Mahmood is one such individual that has been sentenced to 135 months in federal prison last Monday for submitting false and fraudulent claims to healthcare payers including CMS.

The Cameron Herald reported that Mahmood was ordered to pay $599,128.02 to CMS and Blue Cross Blue Shield of Texas due to the violations of identity theft and fraudulent medical care claims. Mahmood had owned and operated a handful of hospitals across the state of Texas including Lake Whitney Medical Center, Central Texas Hospital in Cameron, Renaissance Terrell Hospital, Cozby Germany Hospital in Grand Saline, and Community General Hospital in Dilley.Meaningful Use Audits

Prosecutors Assistant U.S. Attorneys Nathaniel C. Kummerfeld, Frank Coan and Special Assistant U.S. Attorney Ken McGurk claimed during the trial that Mahmood and other individuals defrauded Medicare and Medicaid from January 2010 to April 2013 by submitting false identities and inexistent diagnoses and treatments.

Currently, ICD-9 diagnostic codes are being utilized by healthcare providers while the ICD-10 coding set will be required to use by October 1, 2015, which is the ICD-10 transition deadline. Mahmood, however, modified and incorrectly sequenced diagnostic codes to reflect the wrong medical conditions and diagnoses of his patients without checking their healthcare records. The names of Medicare beneficiaries and their associated numbers were also incorrectly and fraudulently used.

“Americans enjoy the best health care in the world and the cost for this care is expensive,” U.S. Attorney John M. Bales said in a statement.“What we do not need is providers like Tariq Mahmood who masquerade as physicians who pretend to care about American health care but actually are determined to loot the Medicare Trust Fund. He is now being held to account, and I congratulate the prosecution team for a job very well done.”

Former chief financial officer of the Cameron hospital and the Shelby Regional Medical Center Joe White will also be sentenced for defrauding the government and healthcare payers on Monday, April 27.

White had made a false statement regarding the meaningful use achievements of the Shelby Regional Medical Center and claimed the hospital met relevant meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs. This false statement led to the hospital being awarded $785,655 from Medicare.

Healthcare professionals that defraud the medical payer system along with federal agencies lead to difficulties among honest providers who have successfully met meaningful use requirements and are preparing to accurately and authentically send ICD-10 coding claims to CMS by the ICD-10 transition deadline. For example, current meaningful use audits are burdening a variety of healthcare professionals who have received financial incentives from CMS for meeting relevant meaningful use requirements.

The American Academy of Family Physicians has asked CMS to offer a report that outlines the reasons why some providers have failed the meaningful use audits. Since healthcare fraud is a serious issue across the nation, federal agencies are likely to continue pursuing claims under the EHR Incentive Programs and filing additional meaningful use audits.Since healthcare fraud is a serious issue across the nation, federal agencies are likely to continue filing additional meaningful use audits.

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EHR Incentive Programs Modified in New Proposed Ruling

EHR Incentive Programs Modified in New Proposed Ruling | EHR and Health IT Consulting | Scoop.it

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule on April 10 announcing specific modifications to the EHR Incentive Programs. The most important aspect of these modifications is the change to the reporting period in 2015 to a 90-day period in line with the calendar year and a similar EHR reporting period for the following year.


Previously, the meaningful use requirements would pose a financial penalty on eligible providers and hospitals that did not meet the objectives of the EHR Incentive Programs for a full calendar or fiscal year. CMS also proposed changing the reporting year for hospitals from the fiscal to the full calendar year in order to have both eligible professionals and hospitals reporting during the same time period.

Another area that the modified proposed rule affects is the patient action measures, which are part of the Stage 2 Meaningful Use requirements regarding patient engagement. The proposed rule simplifies the meaningful use regulations by removing certain reporting mandates that have become redundant or duplicative due to a variety of improvements in EHR function since the inception of the Medicare and Medicaid EHR Incentive Programs.


Comments to this proposed rule need to be sent to CMS electronically, by regular mail, via express mail, or by courier no later than 60 days after the publication of the ruling. The modifications bring greater focus to the advanced use of EHR systems and attempt to align the Stage 1 and Stage 2 Meaningful Use requirements from 2015 to 2017 with the Stage 3 Meaningful Use regulations, which are expected to be reported to CMS starting in 2018.


The document explains that the meaningful use stages under the EHR Incentive Programs continue to have an important goal of increasing EHR interoperability among providers and hospitals. In order to reduce redundancy, CMS is modifying the number of objectives and measures that providers need to meet to demonstrate meaningful use of EHR technology.


The proposed ruling document discusses how the requirement mandating that more than 5 percent of patients view and download their health information is causing undue burden on healthcare providers. CMS offers a major change to this requirement through the years 2015 to 2017. Under the modified proposed ruling, only one single patient will need to view, download, or transmit their medical information to a third party.


Additionally, CMS proposes the secure electronic messaging objective under Stage 2 Meaningful Use requirements to no longer have a 5 percent threshold but instead have a yes/no reporting requirement asking providers to attest to the statement: “The capability for patients to send and receive a secure electronic message was enabled during the EHR reporting period.”


Another modified proposal CMS put forward is to perform a security risk analysis including addressing data encryptions in certified EHR technology and adopting security updates as necessary during the EHR reporting period.


CMS hopes that these modifications will provide more flexibility to eligible hospitals and providers attempting to meet meaningful use requirements under the EHR Incentive Programs.


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Meaningful Use Audits Cause ‘Undue Hardships’ for Physicians

Meaningful Use Audits Cause ‘Undue Hardships’ for Physicians | EHR and Health IT Consulting | Scoop.it

The Centers for Medicare & Medicaid Services (CMS) have conducted meaningful use audits among healthcare participants in the EHR Incentive Programs. However, physicians in primary care and family medicine have found the audit difficult and burdensome.


The American Academy of Family Physicians (AAFP) sent a letter to CMS Acting Administrator Andy Slavitt after hearing from a multitude of members that the auditing process was causing an undue hardship. The AAFP expressed that providers believed some of the implementation costs of EHR technology would be counteracted by financial incentives under the EHR Incentive Programs.


These incentive payments are now at risk among some providers due to a random audit selection by the Office of the Inspector General (OIG) under the Department of Health and Human Services (HHS).

At the end of last year, there have been more than 650 audits among eligible hospitals and more than 10,000 audits targeting eligible professionals. The statistics are dismal among eligible professionals, as nearly 22 percent out of 8,000 audits have failed. Hospitals were better equipped with a failure rate of around 5 percent.


It is particularly difficult for physicians to produce certain documentation years after implementing EHR systems. Additionally, physician practices that have undergone significant changes or may have been acquired by larger health systems are facing significant challenges in providing the documentation necessary for the meaningful use audits.


AAFP Board Chair Dr. Reid Blackwelder stated that auditors do not seem to have a background in health IT or EHR implementation, which is leading to more miscommunication and takes doctors’ time away from direct patient care. The supposed lack of expertise as well as responsiveness from auditors is a significant issue among the AAFP members. There have been reports from physicians that some auditors have taken weeks to respond to follow-up questions or answers.

Physician practices that lack one piece of documentation required for the meaningful use audits would be left to relinquish their EHR incentive payments. The audit practice is causing some physicians to fall behind in their health IT upgrades or implementations, according to Blackwelder.


Another aspect that the AAFP letter stated is the lack of awareness among vendors regarding the documentation requirements when developing EHR systems. CMS may need to provide more information to EHR vendors regarding the paperwork necessary during the meaningful use audits.


Essentially, the AAFP asks CMS to offer a comprehensive report on the meaningful use audits with information on the number of audits conducted, the failure rate, and the exact data that led to the failed audits.


“If the government believes that a strong primary care foundation is the key to an improved and sustainable healthcare system, then we urge you to take these issues into account and provide immediate and increased relief to those who have acted responsibly and legally and had no intent to defraud or deceive by participating in the Meaningful Use program,” Blackwelder stated in the letter to CMS.


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