The presidential candidates made mention of information technology during the debates last week. In this blog for Information Week, Mary Hayes Weier takes a look at the technology policies of Barack Obama and John McCain.
Medical records have faced an impasse preventing a transition to the digital age, and patient charts are still paper-based in most doctors' offices across the country, writes Kevin Pho, MD, in this opinion piece for USA Today. President Bush's goal was for every American to have an electronic medical record by 2014, and both presidential nominees Barack Obama and John McCain's health reform plans include language that modernizes the country's health information system. But despite the advantages of computerized records, adoption of the technology remains distressingly low due to several problems, Pho says.
There were two topics on everyone's lips this year at the American Health Information Management Association's 80th annual meeting: the upcoming conversion from the ICD-9 code set to ICD-10 and the permanent launch of Medicare's Recovery Audit Contractor (RAC) Program.
The changes to the code set combined with the announcement earlier this month from the Centers for Medicare & Medicaid Services that it is moving ahead with the RAC program have left many in the industry nervous about just how much the changes will affect their practices.
On the big switch
During the four days of sessions held last week in Seattle, panelists from throughout the industry tried to give some insight and relief to attendees who are puzzled about how to handle the upcoming ICD-10 conversion. CMS acting administrator, Kerry Weems stressed that stakeholders need to "be serious about the date" of the conversion, emphasizing that providers should not wait until the eleventh hour to begin learning the more than 155,000 codes associated with ICD-10 (compared to 17,000 in ICD-9).
The proposed date for implementation of the rule is Oct. 1, 2011, however, a final deadline for conversion won't be set until the agency has a chance to review comment from the public (comments must be received by EOB October 21). Weems says though the comments are largely in favor of the conversion, the proposed implementation date remains the primary point of contention. And, though the government has been known to waffle on important deadlines in the past (I know, it's shocking), Linda Kloss, chief executive officer at AHIMA, told attendees the time to make the switch is … well, yesterday.
"We are a decade behind the rest of the world in this vital element of patient care and control, and that just is not acceptable," she says. While Kloss says AHIMA recognizes there will be significant costs associated with converting to ICD-10 (ranging from $83,200 for a small practice to as much as $2.73 million for a large practice, according to a new study), the longer we wait, the more extensive those costs are likely to be, since more systems will have to be converted retroactively. The general consensus from all of the speakers is to act as if the Oct. 1, 2011 deadline is set in stone and begin preparing now. Get hospital staff up to speed and learn the new codes, because the switch, whether it occurs in three years or five, will happen.
Like it or not, RAC is here to stay
After recovery audit contractors reported recovering $1 billion (the government actually netted about $700 million after appeals) in improper Medicare payments during CMS' three-year pilot program, the feds decided to make the RAC program permanent, striking more than a little fear in the hearts of hospital administrators across the nation. During an informal panel on Sunday, conference goers were given tips about how to handle the auditing process.
"If they are able to take one thing away from this panel, we hope it would be an understanding that 8% of the RAC revenues came from technical denials, which means that the hospital simply didn't get the medical records to the RAC in time. That is not acceptable, that information has got to get out. No matter how you handle it, internally or externally, you have to be able to get a hold of those records and get them out," says Nancy Hirschl, president, Hirschl and Associates and a participant in Sunday's panel.
Hirschl and the other panelists recommended five steps to help hospitals prepare for RAC auditors:
Develop a RAC team dedicated solely to dealing with RAC inquiries.
Conduct a risk assessment and perform data mining to identify what the RAC will be looking at (hint: they are looking for improper payments, says Hirschl). By identifying where you could potentially have problems, you can mitigate your risk now.
Provide a financial reserve plan to your chief financial officer. "By letting them know what they will need to provide financially, you are one step closer to being prepared," Hirschl says.
Perform a needs assessment to understand operationally how RAC will affect your day-to-day staff. Do you need to hire more people? Will you outsource? Have these procedures in place ahead of time.
Understand and develop an internal strategy for how your organization will deal with disagreeing. Will you appeal every case?
And of course, take advantage of the technology available to you. There were plenty of vendors on hand this year offering a myriad of solutions for both ICD-10 and RAC.
Now that I'm home from AHIMA, sifting through my various press packets and session notes, I can see that the overall theme from this year's conference was that the next few years are going to be filled with change for healthcare—EHRs, PHRs, ramifications from next month's election, ICD-10 and RAC, genomics, and biometrics. It seems there is no end to the incredible (and sometimes trying) changes on the horizon for HIM and IT professionals.
Kathryn Mackenzie is technology editor of HealthLeaders magazine. She can be reached at kmackenzie@healthleadersmedia.com.
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The Health Resources and Services Administration is handing out $18.9 million in grants to 25 organizations nationwide. The grants are designed to help community health centers implement e-health records and other aspects of health IT. The bulk of the money, $14.3 million, will go to 12 health networks, clinics, and similar organizations, including one local government agency, the Yellowstone City County Health Department in Billings, MT. Another recipient is OCHIN, a regional health information network based in Portland, OR. Those grants are specifically for EHR implementation.
While hospitals and other providers have long been quick to adopt breakthrough technology in medical devices, procedures, and treatments, less attention has focused on innovations in networking and communications. This is partly because of concerns about breaches in security and patient privacy, and because healthcare until recently was a service always performed locally. But that is about to change, as IT security will eventually meet the expectations of the healthcare industry. When it does, powerful IT networks crisscrossing the globe will change the way much of healthcare is delivered.
The practice of prescribing medications electronically has been getting a good amount of attention recently. Everyone from CMS Acting Administrator Kerry Weems to Senator John Kerry and Former House Speaker Newt Gingrich are pushing hard for greater adoption of e-prescribing among providers. During last week's National E-prescribing Conference in Boston about 1,400 people gathered to hear Centers for Medicare & Medicaid Services acting Administrator Kerry Weems outline an e-prescribing incentive payment program that promises physicians and other eligible professionals incentive payments of 2% or less of their billing fees from Medicare. That program gets underway in 2009, and by 2012 Medicare will start deducting a financial penalty to those doctors who fail to e-prescribe.
For those providers who either remain baffled by how e-prescribing works or aren't convinced the switch is worth the trouble, the eHealth Initiative last week announced the publication of a "how-to" guide for clinicians looking to make the switch. The group worked in collaboration with the American Medical Association, the American Academy of Family Physicians, the American College of Physicians, the Medical Group Management Association, and the Center for Improving Medication Management to help providers make the decision about how and when to transition from paper to electronic prescribing systems, says Janet Marchibroda, eHI's chief executive officer. "One of the things we learned when we were putting this together is that making this transition is not a cakewalk. It's challenging and support is needed. The incentives are terrific, we believe they are exactly what's needed to jump start adoption, but we also recognized that without some help and guidance, even that wouldn't be enough," says Marchibroda.
The 43-page guide is broken into to two distinct sections. The first section is designed for clinicians and practices new to e-prescribing. It provides some basic information as to what exactly e-prescribing is, how it works, and who could benefit from it. The second section is geared toward office-based clinicians who have made the decision to transition to electronic prescribing, but aren't quite sure how to do it. What's interesting about the guide is that, although it was created by proponents of e-prescribing, it still spends a good amount of time preparing the reader for the inevitable pitfalls that will come with making the switch. In fact, there are nearly three pages dedicated to spelling out the barriers new adopters can expect to face.
The first (and probably one of the biggest) challenges listed are cost and ROI. "Even physicians receiving free e-prescribing systems may face financial costs in the areas of practice management interfaces, customization, training, maintenance, and upgrades as well as time and efficiency loss during the transition period," the guide says. Next up is the problem of change management, "It is important not to underestimate the change management challenges associated with transitioning from paper prescribing to e-prescribing. . . if some of the providers and staff are particularly technology averse, it can be difficult to get everyone onboard with such a dramatic change." The guide goes on to list 11 other potential stumbling blocks in a pretty straightforward way.
"What's different about this guide is that it was created with input from a number of different stakeholders. We consulted with health plans, the AMA, and AARP, just to name a few. It is not a marketing piece, it really reflects the insights of clinicians," says Marchibroda.
And, from what I can tell, she's right. Yes, the groups clearly want you to switch to e-prescribing, and the guide spends a good amount of time outlining the benefits. But it also offers up a step-by-step process for how to choose an e-prescribing program, when to do it, how to get buy-in from the rest of the staff, and a number of strategies and tools for integrating e-prescribing with current healthcare delivery practices.
The hope, says Marchibroda, is that this guide and the new incentives just around the corner will bump adoption up from its current paltry numbers. Of the 1.47 billion new and renewal prescriptions eligible for electronic routing, only about 2% or 35 million were transmitted electronically in 2007, with 35,000 clinicians using this technology, according to Marchibroda. Those numbers are expected to nearly triple in 2008, with e-prescriptions rising to 100 million, and the number of e-prescribers increasing to 85,000, or about 14% of office-based prescribers, she says.
If your hospital is considering making the big switch to e-prescribing and you have any questions about just how it all works, it is probably worth your time to download the guide and give it a quick read.
Kathryn Mackenzie is technology editor of HealthLeaders magazine. She can be reached at kmackenzie@healthleadersmedia.com.
Note: You can sign up to receive HealthLeaders Media IT, a free weekly e-newsletter that features news, commentary and trends about healthcare technology.