Electronic health records were supposed to lower administrative costs, but they may not be getting the job done, according to a new study published this week in JAMA.

Administrative costs made up as much as a quarter of professional revenue for some patient encounters, according to the study, which focused on a single academic medical center. Researchers attribute much of the high cost to varying contracts between the hospital and health plans and payer as well as varying price schedules.

“After investing more than $30 billion in health IT, we haven’t improved the administrative efficiency,” said Dr. Kevin Schulman, one of the study authors and the associate director of the Duke Clinical Research Institute. “That was one of the big promises of digitizing records.”

For the study, researchers estimated the time each billing step took for a 1,500-bed academic healthcare system in North Carolina. Based on the calculated time and salary information, they estimated personnel costs and also added in overhead costs.

As visit complexity increased, so did the time and costs associated with billing and insurance activities. The estimated total time to process a bill for the least expensive type of encounter, a primary-care visit, was 13 minutes, at a cost of $20.49. The average time for the most expensive type of visit, an inpatient surgical procedure, was 100 minutes, at a cost of $215.10.

Costs associated with billing were even higher when researchers took the cost of the EHR software into account, rising to $32.52 for a primary-care visit and $319.80 for an inpatient surgical procedure.

Across the types of patient encounters, billing costs made up between 3.1% (inpatient surgery) and 25.2% (emergency department visit) of professional revenue.

“These findings suggest that significant investments in certified health information technology have not reduced high billing costs in the United States,” the researchers wrote.

The researchers could not attribute the high costs to “any significantly wasteful or inefficient efforts” in billing, something they speculate could be due to the fact that the health system uses a single billing organization.

Instead, they attribute the costs to differing contracts with payers and price schedules that remain unstandardized.

“We think the costs are due to the complexity of the market itself,” Schulman said. “Part of that complexity comes from the fact that every insurance company has their own way of doing things,” he said. “This is a cost that’s passed onto the provider organizations.”

Any time there’s complexity associated with a system, there are costs associated too, said John Kelly, principal business adviser for software firm Edifecs.

“Payers and providers haven’t really agreed to exchange a lot of information,” he said. “By automating the exchange of information, you can make that complexity easy.”

But the EHR alone won’t solve everything.

“Adoption of certified EHR systems by hospitals appears to have been unable to cope with the complexity of multiple payer contracts,” the study authors wrote.

Nor has it brought about great change in administrative processes.

“We hope this will be a wake-up call that it’s time to focus on administrative simplification,” Schulman said.

Article source: http://www.modernhealthcare.com/article/20180220/NEWS/180229998

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In the past few weeks, Veterans Affairs Secretary Dr. David Shulkin has faced scathing criticism over a number of alleged ethical lapses including accepting free tickets to Wimbledon. Late last week, two top Democrats on the Senate Veterans’ Affairs Committee said “chaos” within the department was affecting care of the veterans the agency seeks to serve.

Shulkin this week will get a chance to distance himself from D.C. as he joins healthcare executives, technology vendors and others gathering in Las Vegas to talk shop and hear about the latest and greatest in health IT.

The Healthcare Information and Management Systems Society’s annual convention and trade show, which runs March 5-9, is expected to draw 45,000 people this year. About 42,287 attended in 2017.

Shulkin is slated to speak Friday morning with Vice Adm. Raquel Bono of the Defense Health Agency and address coordinated care. Former executive chairman of Alphabet (née Google) Eric Schmidt, who spoke at HIMSS in 2008 when Google launched its now defunct personal health record, will talk about how to implement technology effectively in healthcare and how to more quickly transform the industry.

“You see a pattern here—there’s more of a ‘roll up your sleeves and deliver’ mentality,” HIMSS CEO Harold Wolf said.

To that end, Wolf expects conference attendees, speakers and exhibitors to focus on using information technology in care delivery. “How do we put into the hands of both the clinician and the administrator more tools that help them understand end-to-end delivery and the value of it?” Wolf also expects artificial intelligence to garner attention this year, as it has in the past two or three years, as well as cybersecurity, which he called “more important than ever.”

These topics all play into the goal of coming up with new ways to deliver care. “I think the biggest issue that everyone is facing right now is how do we use digital health effectively? How do we take care of individuals outside the walls of the encounter-based paradigm?” Wolf said.


Article source: http://www.modernhealthcare.com/article/20180303/NEWS/180309959

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“This sounds like a very positive incremental improvement in the use of patient portals in the Epic customer base,” said Dr. David Kibbe, CEO of the not-for-profit governance group DirectTrust. “But it doesn’t seem to me to be a global solution. The most obvious limitation is that it’s available only to customers of Epic who also have MyChart accounts,” he said, referring to Epic’s patient portal.

According to Charles Christian, vice president of technology and engagement at the Indiana Health Information Exchange, Share Everywhere doesn’t quite count as interoperability. “It’s not really moving data around but providing access to it.”

Pamela McNutt, chief information officer at Dallas-based Methodist Health System, agreed, calling Share Everywhere “another vehicle for access to very important information. It’s really exciting, and it’s moving us closer to a patient having a personal health record that they can control.” Her system, which uses Epic, will advertise the new feature on its website and when it encourages new patients to sign up for MyChart.

Epic argues that this kind of data exchange does indeed qualify as interoperability and, more importantly, makes that interoperability patient-directed, said Sean Bina, Epic’s vice president of access applications. “Whether traveling internationally, receiving home care, or simply seeking a second opinion, patient-driven interoperability is now a reality even when the caregiver doesn’t have an interoperable EHR,” he said.

Patient control over medical records is a requirement under meaningful use, which specifies that patients are supposed to be able to view, download and transmit their data. Epic’s Share Everywhere achieves the crucial “transmit” portion of that trio, centering the data around the patient rather than around a single provider and maintaining a patient’s privacy under HIPAA along the way, since the patient is the one moving the information.

The industry has long touted the potential benefits of patient-centered care, calling it an important part of the Triple Aim, since it will improve outcomes and lower costs. But, Christian said, “at times, we may be asking too much of the patients.” Sometimes, he said, patients want providers to initiate the exchange of data.

“It’s an idea that makes a ton of sense, to put patients in the middle of interoperability,” said Dr. Christopher Longhurst, CIO for UC San Diego Health. But, he said, he’s found that “when you ask our patients, most of them tell you they don’t want to be in the middle.”

Epic’s Care Everywhere—not to be confused with Share Everywhere—helps in that quest. Using the technology, organizations exchange 2 million records per day with Epic and other vendors’ systems. Epic is also a member of Carequality, an initiative of the Sequoia Project whose framework supports data transfer among its members. Carequal- ity members will soon be able to exchange data with members of the Commonwell Health Alliance, co-founded by Epic market rival Cerner Corp., greatly expanding interoperability.

Share Everywhere will be available for free in November to Epic users. Epic declined to say what the average cost of implementing its EHR is. But installing new systems can be expensive: The installation of an Epic EHR at Vanderbilt University Medical Center in Nashville this fall, for instance, is estimated to cost $214 million.

Asked if providers might be drawn to purchase Epic because of Share Everywhere. Longhurst said likely not. “It’s not a game-changer,” he said.

Article source: http://www.modernhealthcare.com/article/20170916/NEWS/170919908

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Until recently, pharmacists relied on their intuition and network of other pharmacists they would call if a suspicious prescription surfaced. Today, nearly all prescription pads are tamper-proof, if physicians haven’t already transitioned to electronic prescribing. More Cincinnati doctors are using e-prescribing, said Hart, who lauded the trend. And more states are also using interstate communication systems that track the types of prescriptions and where they are filled.

The Ohio Automated Rx Reporting System is one of the statewide databases that collect real-time information on controlled substances sold to pharmacies, including when and where they are dispensed. The statewide databases feed into an interoperable communication system called PMP Interconnect that connects pharmacists throughout the country to track usage, prescribing and dispensing patterns. The prescription monitoring program, headed by the National Association of Boards of Pharmacy, was started in 2011 and is online in 42 states, with more in the queue.

Providers in 27 states have also integrated PMP Gateway into their EHR systems, bringing prescription-usage and -filling trends to their fingertips. It alerts physicians when a patient has received several opioid prescriptions over a short period of time, among other behaviors.

These types of systems are vital in curbing the number of counterfeit prescriptions, advocates argue. Some 33,000 illegal online pharmacies are operating at any given time, driven by attractive profit margins and fragmented regulations, according to the Alliance for Safe Online Pharmacies. A new push for “.pharmacy” domains has helped patients identify legitimate sources for online drugs, said Libby Baney, ASOP’s executive director.

Arming providers, pharmacists and law enforcement with interoperable data is crucial and those throughout the industry should be encouraged or even compelled to buy in, Baney said.

“Policy and enforcement have not kept pace with the consolidation of the supply chain and distribution of medicines, particularly with online sales,” she said. “We need to harmonize domestic and international regulations and increase transparency.”

But the databases are not a panacea, critics warn, and much more needs to be done to improve coordination among regulators and those in the drug supply chain.

Under the recently implemented Drug Supply Chain Security Act, manufacturers will need to create individual serial numbers for every prescription, which ideally would help determine where the drugs came from and how they got to the patient.

“We will start to get a lot more visibility in not only the flow of these drugs but understand who held them and where they traveled along the supply chain, said Paul Cianciolo, who heads health systems development for TraceLink, a company that provides a digital track-and-trace network for the pharmaceutical supply chain.

Article source: http://www.modernhealthcare.com/article/20170916/NEWS/170919916

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Kentucky health systems to merge

On September 23rd, 2017, posted in: Industry News by

Two health care providers in eastern Kentucky have announced plans to merge.

Appalachian Regional Healthcare and Highlands Health System say they hope to finalize the deal by early next year. No terms were disclosed

Highlands Health System President Harold C. Warman said the merger would ensure that the communities served by the Prestonsburg-based system will continue to have local access to quality health care.

Under the agreement, Highlands Regional Medical Center will operate as Highlands ARH Regional Medical Center, and will become the 12th hospital in the Appalachian Regional Healthcare system. Outpatient facilities in Floyd, Johnson, Martin and Magoffin counties also are included in the merger.

Appalachian Regional Healthcare is a not-for-profit health system serving 350,000 residents across Eastern Kentucky and Southern West Virginia.

Article source: http://www.modernhealthcare.com/article/20170921/NEWS/170929973

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