ORLANDO, Fla.—A day after releasing two significant proposed regulations, leaders from the CMS and the Office of the National Coordinator for Health Information Technology spread out across HIMSS19 in Orlando to talk up what they say will finally put patients in the driver’s seat.

“We had two big goals. One transcendent goal was to empower patients to control their healthcare,” Dr. Donald Rucker, head of ONC, said during a media briefing Tuesday, adding that modern technology, including the near-ubiquitous use of smartphones and apps, allows patients to take more control of their care by virtue of gaining more access to their data.

Through the two proposed rules—724 pages from ONC and 250 from the CMS—regulators intend to push the industry to make use of application programming interfaces to speed up how patients can access information on their mobile devices.

“With APIs, you get your data into your platform, your tools, your display,” Rucker said. “If you want to go to another provider, you can.”

The proposals also spell out how regulators will fight data-blocking by payers, vendors and providers. The ONC rule lays out seven exemptions for withholding information, including preventing patient harm, promoting security of health information and responding to requests that aren’t feasible.

HHS had already taken steps last year to punish hospitals and physicians financially for not sharing patient information.

“The idea that patient data belongs to providers or vendors is an epic misunderstanding. Patient data belongs to patients,” CMS Administrator Seema Verma said to a round of applause during a speech Tuesday evening.

She called information blocking “a thing of the past,” suggesting that organizations that continue the practice will see fewer opportunities to participate in government-sponsored programs.

Former government officials praised the Trump administration’s actions.

“We needed this rule as a call to action for the private sector,” Mike Leavitt, who was HHS secretary under President George W. Bush, said during a panel discussion earlier in the day that included Verma.

Verma reinforced that notion during a press briefing with reporters, saying that the CMS is using its power as the nation’s largest payer to prompt other parts of the industry to follow.

“The federal government invested $34 billion (in electronic health records) and look at where we are,” Verma said. “The industry has not done the right thing,” which has forced the government to step in.

She pointed out that more than 1,500 developers have been working on apps for the agency’s Blue Button initiative, which Verma launched at HIMSS in 2018. That project allows beneficiaries to collect patient data, including claims information from insurers, on their mobile devices.

Aneesh Chopra, who served as chief technology officer under President Barack Obama, noted that the initial meaningful use regulations merely set a floor for what kind of and how information could be shared. The proposed regulations should serve as a catalyst to put more useful data in play.

Indeed, Karen Murphy, executive vice president and chief innovation officer at Geisinger, equated electronic health records to electronic filing cabinets. Murphy, who acknowledged she hasn’t read the rules yet, added that the inefficiency in today’s digital environment lead to increased costs and inefficient care.

One area where the CMS and ONC won’t yet be pushing the industry is on patient matching and ensuring the patients are linked to the correct record.

Congress has for decades limited HHS’ ability to pursue a national patient identifier. Those restrictions have loosened during the past couple of years and ONC in 2017 awarded $75,000 to six grantees to develop patient matching algorithms. In its proposed rule, the CMS asked for comments from the industry on how it can tackle patient matching.

“How can we put weight of CMS behind patient identification and patient matching,” Verma asked during her speech.

For his part, Rucker said that technology is evolving quickly, suggesting in a pro-consumer market, the industry will be forced to respond.

Verma also noted that the CMS is seeking information on how to start applying health IT standards to post-acute providers.

Article source: https://www.modernhealthcare.com/article/20190212/NEWS/190219988

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ORLANDO, Fla.—For as much as the CMS tries to move away from it, the phrase “meaningful use” continues to hang over the agency’s information technology agenda.

While the release of proposed regulations last week to bolster data exchange generally got a positive response at HIMSS19, industry stakeholders stressed the need for sharing relevant—meaningful—information.

“There’s patient access to non-administrative data and access to clinical-level,” said Nader Mherabi, senior vice president, vice dean and chief information officer at NYU Langone Health. “Sometimes the government gets that all mixed up. What we need is meaningful, just-in-time exchange. Giving me a (lengthy) continuity of care document when I only have 10 minutes to see a patient is useless. It has to be something that I can make sense of. That kind of exchange is much more important.”

The long-awaited proposals from the CMS and the Office of the National Coordinator for Health IT aim to push more data into patients’ hands.

Speaking at HIMSS19 last week, CMS Administrator Seema Verma called it the “beginning of the data revolution.” Verma drove home her belief that the industry failed to fulfill the promise of the meaningful use program—which was renamed Promoting Interoperability last year—and maximize the more than $30 billion the federal government spent to digitize healthcare, thus forcing the government to step in to drive change.

Among other things, the CMS wants any health plan doing business with the agency—through Medicare, Medicaid, the Children’s Health Insurance Program and Affordable Care Act exchanges—to give patients immediate electronic access to claims data by 2020. The agency also wants to mandate that hospitals immediately send an electronic notice when a patient is admitted, discharged or transferred. And that’s likely just the beginning, Verma hinted during her speech.

The agency would use participation in Medicare as the stick.

Execution of such a requirement is critical. Providers could end up on the receiving end of different admission, discharge and transfer alerts in different formats, explained Chuck Christian, vice president of technology and engagement at the Indiana Health Information Exchange. That could prove challenging for some providers.

Both the CMS and ONC also laid out plans to end data-blocking. The ONC rule specified seven exemptions for withholding information. The CMS’ actions build on rules finalized in 2018 that put providers on the hook financially for not sharing information. “The idea that patient data belongs to providers or vendors is an epic misunderstanding. Patient data belongs to patients,” Verma said.

While the CMS and the ONC have to go through a comment period before pushing out final rules later this year, the Center for Medicare and Medicaid Innovation is likely to enforce early adoption through its voluntary payment models.

“Where you eventually want to get here is relatively simple: You want patients and their delegates to get free access to electronic, easy to use information within 24 hours,” Innovation Center Director Adam Boehler said during a news briefing at HIMSS19.

To power greater patient control of data, the CMS is pushing the use of application programming interfaces—APIs. This builds on Verma’s unveiling of the Blue Button initiative at last year’s HIMSS. The project allows beneficiaries to collect patient data, including claims information from insurers, on their mobile devices. Currently, 18 Blue Button apps have been deployed and 1,500 developers are working on new ones.

APIs will speed up data exchange, but IT officials have concerns around privacy and security. Christian wondered how the agency will vet developers, for instance.

“Cybersecurity has to fundamentally change the way we do things,” said Kevin Charest, chief information security officer at Health Care Service Corp., which operates Blue Cross and Blue Shield plans in five states. “We have to be in the cloud and on premises, and we have to do all of that simultaneously, with a talent shortage and a set of tools that aren’t ready for prime time yet.”

—Aurora Aguilar contributed to this article.

Article source: https://www.modernhealthcare.com/article/20190216/NEWS/190219947

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The CMS on Thursday finalized a rule that will pay doctors for virtual visits and overhaul Medicare billing standards for office visits that haven’t changed since the 1990s.

The agency will now pay doctors for telehealth visits and communication with patients, acknowledging the time those efforts take.

The CMS also will change how physicians bill Medicare for patient visits under a relatively generic set of codes that distinguish level of complexity and site of care, known as evaluation and management visit codes.

Doctors long have been concerned about the codes’ documentation standards. The CMS has used evaluation and management visit codes since 1995.

One of the largest complaints about the E/M codes was that clinicians had to provide a comprehensive medical history each time they submit a claim. They’d rather document why a patient is receiving care in a specific instance of treatment.

Starting next year, doctors will only have to highlight what’s changed since they last saw the patient, versus restating their whole medical history.

Elsewhere in the rule, the agency plans to continue a controversial site-neutral policy launched in 2018. For the second year in a row, off-campus facilities built after Nov. 2, 2015, will be paid 40% of the outpatient rates for the services they provide.

“We are disappointed that CMS will continue its short-sighted site-neutral policies that ignore the need for hospitals to modernize existing facilities so that they can provide the most up-to-date, high-quality services to their patients and communities,” said Ashley Thompson, senior vice president at American Hospital Association.

The policy encourages fairer competition between hospitals and physician practices by promoting greater payment alignment between outpatient care settings, according to the CMS.

The agency is tweaking the Merit-based Incentive Payment System by junking 26 quality measures that it deemed ineffective after hearing from stakeholders. The proposed rule adds eight quality measures including four based on patients’ reporting of their outcomes.

The CMS also seeks to expand provider participating in MIPS. First, it is expanding eligible clinicians for the program to include physical therapists, occupational therapists, clinical social workers and clinical psychologists.

It is also finalizing an opt-in policy that allows some clinicians, who otherwise would have been excluded under the low-volume threshold, the option to participate in MIPS.

Under MIPS, doctors must hit certain quality thresholds. Those who don’t must pay a penalty that is redistributed to the high performers.

In 2021, practices are eligible for $390 million in incentive payments under MIPS, up from the $118 million the CMS expects to pay out in 2020. The raise is due to more doctors participating in the program.

The agency estimates 798,000 clinicians will be participating in MIPS in 2019, that’s up from 642,000 eligible clinicians it estimated was in the program in 2017.

Article source: http://www.modernhealthcare.com/article/20181101/NEWS/181109981

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Geisinger Health System CEO and President Dr. David Feinberg is reportedly moving to Google, where he’ll run healthcare for the company.

Google’s healthcare efforts are far-reaching, ranging from artificial intelligence to data standards to the cloud.

Neither Geisigner nor Google could be reached for comment. The Wall Street Journal first reported the news. Feinberg took himself out of the running this summer to be considered CEO of the healthcare venture launched by Amazon, Berkshire Hathaway and JPMorgan Chase. That job ultimately went to Dr. Atul Gawande.

Google’s healthcare work will play into the company’s interoperability efforts, which it pledged to pursue—along with Microsoft, Amazon, IBM, Oracle, and Salesforce—earlier this year.

Article source: https://www.modernhealthcare.com/article/20181108/NEWS/181109908

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Facing an increasingly saturated electronic health records market, software vendors like Athenahealth are under increasing pressure to consolidate and seek out new avenues for revenue and growth.

Most healthcare organizations already have EHRs in place, and vendors can no longer count on major growth from new installations alone. That’s spelled lower bookings year over year for some. Ever since Athenahealth began reporting quarterly bookings, it’s reported lower year-over-year booked business. And in the second quarter of the year, Allscripts also had a dip—32%—in booked business.

“They’re now faced with the question of how to continue to be successful and grow,” said John Kelly, principal business adviser for Edifecs. “The way to do that is to consolidate.”

Athenahealth is now the latest company to take that tack. On Monday, two private equity firms announced they plan to buy the vendor for $5.7 billion. Veritas Capital and Elliott Management’s Evergreen Coast Capital will combine Athenahealth with Virence Health Technologies, a former GE Healthcare company.

Unlike the other big EHR vendors, Athenahealth charges its customers a percentage of receivables rather than a set price. The company was also a leader in the cloud, offering cloud-based software while other vendors were focused more on traditional, server-based EHRs. Now, the majority of provider organizations are either currently hosting or are considering hosting their data off-site, according to KLAS Research.

But some question the company’s ability to compete in the EHR market, especially with larger providers. In 2017, Athenahealth had just 2.1% market share for U.S. acute-care hospitals, according to KLAS, while Epic had 26.7% and Cerner had 24.8%.

“Athenahealth really is a revenue cycle management vendor and not really a strong competitor in the clinical market,” Kelly added. “Maybe they would have been if Jonathan (Bush) had stayed.”

Bush left the company in June after reports of sexual harassment surfaced and it was made public that Bush had attacked his now ex-wife during their marriage.

Bush also faced business challenges. “He was able to build the company as a disruptor because he has a disruptor personality,” said Michael Burger, senior consultant at Point of Care Partners. “But at some point, a company grows so big that it needs to be run like a company, as opposed to a small business. The company outgrew Jonathan’s leadership.”

Some are concerned that Athenahealth’s freewheeling culture and its influence on the industry may not survive this deal.

“I’m worried about the impact this will have on creative disruption,” said David Muntz, a healthcare consultant and former principal deputy national coordinator at the Office of the National Coordinator for Health Information Technology.

But the Athenahealth brand is, at this point, still strong.

Consolidation isn’t without its challenges. When companies merge, their platforms don’t necessarily get combined at the same time, according to Point of Care Partners’ Burger. So the newly formed companies must maintain multiple platforms. Allscripts, for example, maintains distinct Practice Fusion and McKesson platforms post-acquisition.

“It’s just not easy to get customers to move to one or the other platform,” Burger said. “You would think the idea would be to move everyone onto the Athenahealth platform, because the GE platform is pretty old,” he added. But based on what’s happened with Allscripts and other acquiring companies, that’s not likely, he said.

EHR vendors that maintain separate platforms can struggle. A year after Cerner acquired Siemens Health Services, for example, 87% of users of Siemens’ EHR said they planned to leave the platform, according to KLAS.

There’s also the matter of data integration. “The overall goal is to focus on how to collect data from all the appropriate sources and then use it when you’re looking at patients, payers and providers,” Muntz said. “The challenge is how they’re going to deal with integration of the data and the processes to improve the overall workflow for the providers and payers.”

Article source: https://www.modernhealthcare.com/article/20181113/NEWS/181119985

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