Stocks in the healthcare sector have performed better than their counterparts in other industries due to steady demand, strong earnings, and finances and expectations of industry consolidation. While the sector has long been viewed as defensive, healthcare's success comes even as other traditionally defensive sectors have been hurt in the broader downturn.
Fires during surgery are raising concerns about the risks of burn injuries to patients. Patient-safety groups and medical specialty organizations are stepping up efforts to raise awareness of risks and provide guidelines for prevention. Hospitals are conducting operating-room fire drills that teach how to fight fires that break out on the drapes, gowns, or skin of surgical patients and extinguish flames. They're also developing training programs to educate staffers on the dangers of burns from medical equipment and procedures.
China announced that it was investigating whether 17 Japanese tourists had received illegal kidney and liver transplants in China.
China has banned all transplants for foreigners because an estimated 1.5 million Chinese are on waiting lists for transplants. The ban was issued May 1, 2007. "China strongly opposes organ transplant tourism," the Ministry of Health said in a statement on its Web site, adding that the hospitals and medical personnel "who carried out the organ transplants against the rules will be severely dealt with according to the law."
Young adults are the nation's largest group of uninsured—there were 13.2 million of them nationally in 2007, or 29%, according to the latest figures from the Commonwealth Fund. These "young invincibles" are people in their 20s who shun insurance either because their age makes them feel invulnerable or because expensive policies are out of reach. They borrow leftover prescription drugs from friends, attempt to self-diagnose ailments online, stretch their diabetes and asthma medicines for as long as possible and set their own broken bones. When emergencies strike, they rarely can afford the bills that follow.
Today U.S. President Barack Obama signed into law a $787 billion economic American Recovery and Reinvestment Act of 2009 that includes provisions for heightened enforcement of HIPAA and stiffer penalties for privacy and security violations, as well as sets aside billions of dollars to invest into electronic health records (EHR) implementation and exchange. The Act also calls for extended HIPAA security provisions to business associates (BA).
According to a February 13 release on the Web site of Waller Lansden Dortch & Davis, LLP, a law firm based in Nashville with extensive HIPAA and healthcare regulatory experience, to ensure the security of protected health information (PHI) the Act includes provisions requiring BAs to implement:
Security policies and training
Physical security safeguards (e.g., door locks)
Technical security safeguards (e.g., computer encryption and password protection)
The Act suggests that Congress recognizes the need to move to EHRs but with stricter enforcement and protection of patient privacy, according to John Parmigiani, MS, BES, president of John C. Parmigiani & Associates, LLC, Ellicott City, MD, and chairperson of the team that created the HIPAA security rule.
Penalties to facilities that have privacy breaches range from $100 to $50,000 per violation, depending on whether the facility could have reasonably avoided the breach. The Act also gives states' attorney generals the power to seek civil damages and attorney's fees for HIPAA privacy breaches.
"Because [the Act] speaks to privacy and security breach notifications, increased enforcement of patient privacy, audit trails, encryption, and a definite concern for driving the attainment of an EHR while protecting patient information, it emphasizes the critical ingredient in fostering widespread implementation, acceptance, and use of e-health: trust," Parmigiani says. "This includes trust among patients, providers, and payers to effectively and efficiently deliver healthcare and share healthcare information."
The HIPAA provisions in the economic stimulus Act fall under the Health Information Technology for Economic and Clinical Health (HITECH) Act. According to Waller Lansden Dortch & Davis, the Act also includes:
New security breach notification requirements. The government wants to expand security breach law with increased notification to patients. Covered entities that experience a breach involving 500 or more patients must immediately report it to the secretary of HHS, who will then post the name of the provider or insurer on its public Web site. Covered entities that experience a breach involving 500 or more patients who reside in the same area must report it to the local media. BAs must report a notice of a breach, including the identify of the patient(s) whose PHI was accessed, acquired, or disclosed to the provider or health plan with which it partnered. Vendors using personal health records (PHR) must notify patients and the Federal Trade Commission (FTC) of any breach caused by their products or services.
HIPAA pre-emption on new provisions. Providers and health plans must comply with state security breach laws "to the extent that they exceed the new security breach notifications provisions of the [Act]," according to the law firm.
Restricting access to PHI. A patient can now restrict access to his or her PHI, so long as the patient request meets certain requirements.
Right to accounting on EHRs. Currently, patients can request an accounting of PHI disclosures dating back six years from the request and HIPAA doesn't currently require disclosures for treatment, payment and healthcare operations to be included in the list. The new Act allows patients to go back three years but requires covered entities to include treatment, payment, and healthcare operations disclosures.
Kate Borten, CISSP, CISM, president of The Marblehead Group in Marblehead, MA, says the HIPAA provisions in the Act is "HIPAA Administrative Simplification taken to the next level.
The Administrative Simplification provisions of HIPAA (HIPAA, Title II) required HHS to establish national standards for electronic healthcare transactions and national identifiers for providers, health plans, and employers.
"The Act contains billions to fund health IT for expanding the implementation and exchange of electronic records," Borten adds. "To do that successfully and safely, Congress recognizes the need for broader and stronger, more explicit privacy and security controls."
Experts say one of the major changes for providers is the law's requirement for BAs to adhere to the security requirements of HIPAA. "HIPAA covered entities are no longer their 'brothers' keepers' since business associates will become directly subject to the HIPAA privacy and security rules, as well as to the penalties which have become stricter," Borten says.
It also makes BAs adhere to the same provisions as covered entities. "This enforces the 'chain of trust' concept envisioned by the crafters of the security rule," Parmigiani says. "So, in a way, it modernizes HIPAA to make it more in tune with an emerging e-health environment."
The Act further strengthens rules for the marketing and release of patient information, according to Parmigiani. For example, patients can now opt out of fundraising communications by hospitals. Parmigiani also believes the Act signals the new administration's focus on more rigorous regulatory enforcement.
Dom Nicastro is a senior managing editor for HCPro, Inc's Revenue Cycle division. He manages the Patient Access Resource Center.
Editor's note: To learn more about HIT initiatives, view the American Recovery and Reinvestment Act of 2009.
Healthcare providers looking for assistance with the adoption of EHRs may be in for a pleasant surprise, according to the Health Information Technology (HIT) Extension Program included in the American Recovery and Reinvestment Act of 2009 that President Barack Obama signed yesterday.
Title XIII of the Act focuses on HIT and quality, with $19 billion in grants and loans set aside for infrastructure and incentive payments under Medicare and Medicaid for providers who adopt certified EHR technology. The grants and loans include $17 billion slated for incentives, with $2 billion allotted to jump-start health IT adoption.
The Act also formalizes in statute the establishment within the Department of Health and Human Services an Office of the National Coordinator for HIT that was created during former President George W. Bush's administration. In addition, the Act establishes HIT policy and standards committees to promote a nationwide infrastructure.
Effectiveness of the incentives remain unknown Will this be the much-needed fire to spark a widespread EHR adoption? Industry experts remain skeptical.
"I think it will help the industry move forward over the long haul, but do I think that we're going to see significant transformation over the next year or even two years? No I don't," says Chris Apgar, CISSP, president of Apgar & Associates, LLC in Portland, OR. "Yes, funds must be available, but ultimately, when it gets down to it, providers have to buy into it, and that's not going to be quick."
Others say the allotted funds may not be enough considering the colossal financial burden associated with an EHR implementation.
"Compared to the percentage of the GNP [gross national product] that healthcare is and the billions and billions of dollars that it costs to provide healthcare, it's sort of a drop in the bucket," says Darice Grzybowski, MA, RHIA, FAHIMA, president of HIMentors, LLC in LaGrange, IL. "However, any incentive for hospitals to adopt better electronic document management technologies is a step in the right direction. Motivation to get started is half the battle."
Interoperability remains yet another challenge in fostering a nationwide infrastructure, Apgar says. "Just because I incentivize someone to purchase and install an electronic health record doesn't mean that the electronic health record can talk to another electronic health record," he adds.
Smaller providers, clinics, and physician practices may benefit most from the financial assistance because of their tighter budgets, Apgar says. The information that these providers—particularly primary care physicians—gather is also important from a health data exchange standpoint, he adds. These physicians hold the much-needed patient demographic information, medical history information, and anecdotal data that will help improve overall patient care across a variety of settings.
Still others have a more hopeful outlook now that Congress has stepped up to the plate. AHIMA, for example, has been a long-time proponent of widespread EHR adoption.
"Besides the overall impact of improving patient care through the adoption and use of standard electronic health records, AHIMA is pleased that Congress recognized the need for individuals educated and trained health information management and informatics to facilitate the adoption, implementation, and management of EHRs, and electronic health information exchange," says Dan Rode, MBA, CHPS, FHFMA, vice president of policy and government relations for AHIMA in Washington, DC.
Funds to assist in a variety of initiatives
The $19 billion in state and federal funds will be available through the National Coordinator, Health Resources and Services Administration, the Agency for Healthcare Research and Quality, CMS, the Centers for Disease Control and Prevention, and Indian Health Services to provide the following:
An HIT Research Center that will render technical assistance and publish best practice guidance
Regional centers to assist and educate providers as well as disseminate information from the Center to various regions of the country
Planning and implementation grants for states or state-designated entities
Grants to establish loan programs to state or Indian tribes for the purchase of certified EHR technology, provide training, or upgrade systems to meet certification requirements
Competitive grants to fund demonstration projects to integrate EHR technology into the clinical education of health professionals
Assistance in the creation or expansion of medical health informatics education programs at institutions of higher education or consortia of institutions
And it doesn't stop there. Aside from the planning and implementation grants and loans, the Act also creates several incentives for the adoption of EHRs. The allocation schedule (i.e., when and how monies will be distributed) has not yet been clarified.
Potential negative consequences for no implementation
Hospitals that don't jump aboard the EHR bandwagon could see larger—and negative—ramifications down the line, Apgar says. "In the future, Medicare may require providers to have an interoperable EHR that meets national standards as a prerequisite for participation. Medicare will use its buying power rather than regulation or statute."
But just because the funds are available doesn't mean that they will benefit every provider, particularly those who may not need a certified system that includes all of the bells and whistles, Apgar adds. "From a business standpoint, it may not make sense to accept a couple thousand dollars and put it in a system that doesn't do what you need it to do," he says.
Incentives could boost health IT jobs
Aside from creating an impetus to implement EHRs, the stimulus plan could also significantly spark employment in the HIT sector, according to a January 2009 report published by the Information Technology and Innovation Foundation (ITIF), a Washington think tank. ITIF estimates that a $10 billion investment in HIT would create as many as 212,000 new or retained U.S. jobs a year.
"It will definitely have favorable implications from an employment perspective for those in the HIT or HIM fields," says Daniel J. Pothen, MS, RHIA, CHPS, CHPIMS, CCS, CCS-P, CHC, director of clinical informatics and health information services at Mission Hospital/CHOC in Mission Viejo, CA.
Editor's note: To learn more about HIT initiatives, view the American Recovery and Reinvestment Act of 2009. Click on "bill text division A" in the "conference report" column for more specific information related to EHRs and Title XIII.
Lisa Eramo, CPC,is Senior Managing Editor ofMedical Records Briefing, a monthly publication from HCPro, Inc.
Chung-Ang University Medical Center is working to attract foreign patients who are seeking high-quality surgery at relatively low costs. Administrators are now in the process of upgrading the hospital's quality of care. The hospital could also begin working with foreign insurance firms.
Japanese Finance Minister Shoichi Nakagawa resigned this week amid criticism for slurring and yawning during a news conference over the weekend at the G-7 meeting in Rome. This is posing serious problems for Japanese officials, as the global recession and the country's economy worsen.
Research by the International Society for Stem Cell Research shows that increasingly, foreign healthcare clinics are adverstising unproven and costly stem cell therapies to medical tourists. The organization established a task force with healthcare officials from 13 countries in an effort to develop guidelines for clinics offering experimental therapy without appropriate transparency, oversight or patient protections.
Chinese authorities are investigating whether 17 Japanese tourists had received illegal kidney and liver transplants in China. The country in 2007 banned all transplants for foreigners, called "organ tourists," since approximately 1.5 million Chinese are on waiting lists for transplants.
