A senior official with the Office for Civil Rights said Tuesday that the Health Insurance Portability and Accountability Act (HIPAA) privacy and security rule enforcer plans to release final rules regarding the Health Information Technology for Economic and Clinical Health Act (HITECH) and HIPAA next year.
Adam H. Greene, senior health information technology and privacy specialist at OCR, told an audience at the “2010 ONC Update” that he doesn’t know a specific time in 2011 that the rules would be released, but added they would be published “contemporaneously.”
OCR’s intention is to avoid staggering compliance dates. The rules to which Greene alluded are:
Breach notification
Enforcement
HIPAA HITECH (modifications to privacy and security rules)
Greene also said a proposed rule on accounting of disclosures of EHRs will be released in 2011. HITECH calls for OCR to expand the HIPAA accounting disclosures provision to add treatment, payment, and healthcare operations disclosures when they're through an EHR. HITECH calls on the HHS secretary to balance the interest of individuals who want to learn the information versus the burden on covered entities.
HITECH also calls for "periodic audits" of HIPAA compliance, but federal regulators have yet to announce any details of the plan other than who is helping them craft one, Booz Allen Hamilton.
Asked about the status of the audit program Tuesday, Greene said, "That's the $1.5 million question, I suppose, is, you know, when will this audit program begin and what are the chances that I'm going to be audited? And I wish I did have more information for you on that. A lot of it can depend on what potential audit program we initiate. I mean, you know, if it's more of a classic audit program of, you know, either us directly or through contractors visiting a sample, that time frame may be very different than for example if you tried to do something that touched the entire business community and associate committed — certification process or something like that."
"Giving up too much time for others; that's how it was in those days. It was the norm for medicine."
In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is David B. Nichols' story.
"Aviation" and "medicine" were the two highest scores from his high school career aptitude test. And for the past 31 years, David B. Nichols, MD, has been commuting once a week to Tangier Island, piloting his own plane or helicopter. The 15-minute flight takes Nichols to an area where the residents have triple the rate of diseases he has seen any place else.
Islanders with major injuries like fractures and even heart attacks sometimes wait days for Nichols to arrive to provide them with care, due to difficulty traveling to the mainland.
"We have people here dying in their 20s and 30s of heart attacks; it's a big, big issue," he says.
Nichols is currently facing his own mortality—cancer is this superhero's kryptonite.
Six years ago he survived melanoma in the back of his left eye, only to learn that this year the cancer had spread to his liver, giving him only a few months left to live. The family physician, 62, knows his kind is a dying breed. Seventy hour workweeks and after-hour appointments are not as common as when he started his practice.
"Giving up too much time for others; that's how it was in those days. It was the norm for medicine," he says. "I can understand why today younger doctors don't want to work the long hours; they want to go home to their families."
Compared to other areas of Virginia, Tangier Island families often fall below the norm in some areas, making healthcare accessibility a challenge. For example, the island falls below the state averages for median household income, employment, and house values.
The average population on the island was 605 people in July 2007, a tiny dot on Google maps amidst the Chesapeake Bay. There are few cars. There is one medical clinic. Nichols describes the area as "something out of a Norman Rockwell painting." The residents speak an Elizabethan English derived from their heritage and isolation.
Nichols first encountered the people of the remote island on a family trip, and began traveling back and forth in 1979 doing missionary work on the island —treating patients "like family." That's when he made the decision not to leave the islanders stranded without healthcare.
"Turns out the mission's in my backyard—which I think is the case for a lot of places in America—there can be a lot of room to help people without going to Africa or other places," he adds.
The patient care is often more expensive than what Nichols brings in financially; he subsidizes a majority of the care he provides as owner of White Stone Family Practice, part of the Riverside Health System, based in Hampton Roads, VA.
Over the years, Nichols' notoriety has snowballed. In 2006, his colleagues secretly nominated him for “Country Doctor of the Year,” a national competition. He won. Nichols has also been called "Dr. Copter" because of his love of helicopters and "Dino Doc" for his so-called "ancient" practice of long hours and a life's work of patient dedication.
He recalls one card from a patient he helped one evening during his off-hours 19 years ago. "It's amazing the little things that people remember when you go out of your way to take time out and help someone else."
Today, hundreds of cards from patients offering love, thanks, prayers, and good-byes litter his house as terminal cancer forces the family physician toward retirement and the end stage of a life of patient care. Before his diagnosis, Nichols had no intentions of retiring soon.
Nichols' time for others is sandwiched between his own blood work tests, media interviews, and family time. Nichols still takes flight to Tangier for visits.
While airborne with his son on the way to the island, "I told him I wished I could see it through to the end. And he goes, 'Dad, at least you're going out with a bang.'"
And a bang it was, as the islanders honored their doctor in August.
Planes packed the tiny runway at Tangier Island. The magnitude of the crowded street could not be captured with a camera lens. Witnesses came to watch Nichols' vision for a healthcare facility come to fruition after five years in the making. The new Tangier Island Medical Clinic comes equipped with primary care, emergency services, wellness and prevention programs, and a surprise: the name "David Nichols Medical Center" branded on the outside. The facility was built to replace the existing 50-year-old clinic. Nichols' medical legacy continues as Elizabeth Inez Pruitt—island resident and physician assistant—oversees care under the supervision of Keith Cubbage, MD, of White Stone Family Practice.
Now islanders can receive an enhanced level of care with colonoscopies, digital x-rays, EMRs, gastroscopy, cardiac stress testing, a modern lab, and a surgical suite for minor injuries.
"I would say that there is not one other family practice building anywhere in this country that could top this," he says.
“I've received way more than what I've given," he says of his legacy on the island. "I hope people will remember, Dr. David Nichols tried his best to help people."
New details emerged Tuesday about the Centers for Medicare & Medicaid Services' anticipated Innovation Center. In an announcement, CMS Administrator Donald Berwick and center Director Richard Gilfillan formally introduced the ACA-directed program designed to research and test new means of providing and paying for healthcare.
CMS says it is consulting various stakeholders, including hospitals, physicians, health plans, and consumers, as it tests different care delivery and payment models, such as the patient-centered medical home (PCMH), in hopes of finding a more effective delivery system for Medicare and Medicaid beneficiaries.
"By working together with innovative and committed providers, we can create a system that works better for everyone," said Gilfillan in a statement. "We want to identify, validate and scale models that have been effective in achieving better outcomes and improving the quality of care, but may be relatively unknown."
New initiatives the center will undertake include:
The Multi-Payer Advanced Primary Care Practice Demonstration, an eight-state, 1,200-member "medical home" project to evaluate the effectiveness of an integrated delivery model in which providers receive more coordinated care payments from Medicare, Medicaid and private health plans.
The Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration to test how well providers working in teams are able to serve low-income patients at up to 500 community health centers.
A state "health home" plan option that allows Medicaid patients with at least two chronic conditions to designate a provider to help coordinate their treatment.
Medical practices that have avoided implementing an electronic health record system (EHR) because of the associated costs may not have such a strong argument, according to a study published by the Medical Group Management Association (MGMA). Data collected from both hospital/IDS-owned and independent practices indicates that practices that have implemented an EHR system produced better financial results than those that have not.
Multi-specialty and single-specialty practices, including primary care, nonsurgical, and surgical specialties with an EHR had almost $50,000 more in operating margin—total medical revenue per full-time-equivalent (FTE) physician—than practices that still use paper medical records.
And while overall expenses rose among EHR-enabled practices (approximately $106,000 per FTE physician), median revenue per FTE physician was also greater at $179,000 for the year. "The potential of improved financial performance should be an encouragement for many organizations to purchase and use an EHR," said William Jessee, president and CEO of MGMA in a statement.
The results, detailed in the report Electronic Health Records Impacts on Revenue, Costs, and Staffing: 2010 Report Based on 2009 Data, also points out that multispecialty hospital/IDS-owned practices with an EHR, while not quite achieving the results of their unaffiliated counterparts, also realize better operating margins than those without at just over $42,000 in 2009.
The report indicated that while an EHR's expense was quite high during the first year, other operating expenses tended to decline. In fact, non-hospital/IDS owned practices realized 10 percent greater operating margin in their fifth year with an EHR than the first.
"Adopting an electronic system can be costly and time consuming, and understanding the impact it will have on the practice is critical," saidWilliam F. Jessee, MD, FACMPE, CEO of MGMA in a statement. "While the implementation process can be very cumbersome, these data indicate that there are financial benefits to practices that implement an EHR system."
While IT staffing per FTE physician increased moderately after five years with an EHR (0.13 to 0.15), practices were able to reduce medical records and transcription staff by 44 percent, resulting in significant savings on labor.
Although increasing numbers of practices are looking to automate their medical records in light of financial incentives from Medicare under the federal stimulus package, proving "meaningful use" of the technology—a requirement for practices to receive up to $44,000 in funding to help offset EHR implementation costs—still presents a challenge for many medical groups, according to Jessee.
Hospitals that have been given incentives to collaborate with one another can significantly reduce surgical complications, according to a study conducted by the Michigan Surgical Quality Collaborative (MSQC)—a group hospitals throughout the state that joined to help improve surgical outcomes—and published in the Archives of Surgery.
The study was funded by Blue Cross Blue Shield of Michigan (BCBSM) and its Blue Care Network, which paid hospitals to pool and share patient data in hopes of utilizing the information to help lower adverse events related to surgery. BCBSM also covered technology costs related to data acquisition and analysis.
Information on general and vascular surgeries was collected between 2005 and 2007 at 16 Michigan hospitals, with the analysis finding that blood infections, septic shock, prolonged ventilation use, and cardiac arrest decreased approximately 10% among hospitals that shared data, versus the control group that did not collaborate with one another in which complications did not experience any measureable reduction.
According to study author Darrell A. Campbell, Jr., M.D., professor of surgery and CMO at the University of Michigan Health System, hospitals are making an effort to improve quality and cut costs across the board in the way they think is best, but this approach has met with only limited success.
"The collaboration of hospitals in terms of identifying and disseminating information about best practices is actually a much more effective way of improving quality," he says. "Our idea was to get a number of hospitals together so we could share and distribute information about best practices throughout a community of hospitals."
Campbell believes the results largely reflect the fact that data from the individual hospitals results is not reported to BCBSM, fostering a better environment for collaboration, even among competing hospitals. "The approach we’ve tried is called ‘pay for participation,’ rather than pay for performance," he says. "We think this fosters a less competitive atmosphere."
And while there are obvious benefits to patients if medical staffs are able to lower surgery complication risk factors, the study proved there are financial incentives as well, given that a complication can add weeks to a hospital stay and tens of thousands of dollars to the bill.
"Surgical complications are very expensive," Cambell says. "Once something bad happens following surgery, it takes a lot of resources to help the patient recover." Authors of the report estimated that by reducing complication by only 1.8 percent a year would offset costs incurred by a health plan to support a similar pay for participation program within three years.
Campbell went on to say that if projects like this were more widely adopted, surgical outcomes would accelerate across the board. "This is a system and approach the nation could take to improve quality. I hope that we are able to interest the government in adopting, or at least incentivizing, this approach in many different regions across the country."
Pharmacists might soon be leaving the confines of their drug-filled fortresses to work alongside primary care physicians. Two studies indicate that adding pharmacists to the primary care team for joint care management increases medical benefits.
In an American Diabetes Association report, researchers analyze the impact of pharmacists on controlling hypertension and other cardiovascular health issues in patients with type 2 diabetes. Over a six-year period, the multidisciplinary team monitored 260 patients' blood pressure at Edmonton, Alberta-are primary care clinics, 153 of whom were not adequately controlling their hypertension.
Study participants achieved an approximate 10% decrease in systolic blood pressure within one year, which translates into a 3% reduction in the risk of developing cardiovascular disease by patients who received intervention, according to according to co-author Scot H. Simpson, BSP, PharmD, MSc.
"Pharmacists can take responsibility to monitor the effects of drug therapy and, working in collaboration with the physician and other members of the healthcare team, recommend alternatives to resolve or prevent drug-related problems," says Simpson, faculty of pharmacy and pharmaceutical sciences at the University of Alberta. "Pharmacists can use their knowledge of pharmacology, therapeutics and drug interactions to recommend different treatment options, change dosages or add drugs when patients are not achieving guideline-based treatment targets."
Additionally, the presence of a pharmacist tended improve patients' adherence to medications, according to Simpson. "One of the most surprising observations was that approximately 40 percent of patients had changes to their antihypertensive medications, yet we saw a significant improvement in blood pressure control for the intervention group," he says.
A report in the Archives of Internal Medicine indicates that when pharmacists collaborate with physicians to find the best medication treatments, as well as advise on lifestyle and dietary improvements, they are able to significantly lower ambulatory care patients' blood pressure.
The study found that three-fourths of participants who encountered both a physician and pharmacist were able to lower 24-hour blood pressure readings to within an acceptable range, compared with only half who achieved the same results in situations where only the physician was present.
While research has shown that physician-pharmacist collaboration is a good thing for patients, there are still challenges—including the appropriate compensation strategies—to integrating pharmacists into this environment.
In Alberta, where the diabetes-blood pressure study was conducted, the establishment of primary care networks has already created an opportunity for pharmacists and other allied healthcare professionals to become active members of primary care teams, according to Simpson. "Salaries for these clinicians are paid out of a central budget for the network."
Perhaps this research is just what's needed to encourage the greater adoption of multidisciplinary care teams that have generated so much interest in the United States over the last several months.
Fed up with what they say are supplier kickbacks to group purchasing organizations (GPOs), medical device manufacturers are spreading the message that these arrangements are actually driving up costs rather than lowering them as intended.
Their argument is presented in a study underwritten by the Medical Device Manufacturers Association (MDMA) and conducted by economists Robert E. Litan of the Kauffman Foundation and Hal J. Singer with Navigant Economics. Researchers concluded that even though GPOs are now entering "multisource" contracts—the result of Congressional pressure to create more competitive rates—compensation practices have incentivized GPOs "to maintain some monopoly pricing."
According to MDMA President and CEO Mark Leahey, eliminating the supplier-funded GPO model in which purchasing organizations receive a percentage (commonly 2 to 3 percent) of revenues generated under the contract would save public and private healthcare organizations more than $35 billion annually. "This study proves that GPOs not only fail to bend the cost curve for healthcare down, they are preventing hospitals and patients from getting the best products at the best prices."
The conclusions are the result of an analysis of more than 8,000 medical device aftermarket transactions in which the winning GPO price—determined by an auction held by the GPO that grants suppliers the right to provide their products to member hospitals—was put up for bids from other suppliers after the initial auction.
"The transactions data suggest that, when exposed to competition in the aftermarket, hospitals were able to achieve average savings of approximately 10 to 14 percent across the entire database (2001 through 2010)," the authors said in the report. Additionally it claims that in more than half of the aftermarket auctions, device makers were persuaded to lower their prices by an average of 7%.
MDMA is not hiding its agenda by publishing the report; it has lobbied Congress to remove safe harbor provisions granted to GPOs in the 1986 Social Security Act and change compensation practices, effectively making it illegal for GPOs to collect money from vendors. "So long as GPOs are compensated via an equity interest in the concession, they have an inherent conflict that limits their ability to negotiate the best prices for their member hospitals," concludes the study.
GPOs are, of course, expressing their displeasure with the results of the study. "All independent, empirical, and nonindustry studies of GPOs—including examinations by the GAO, FTC, DOJ, academia, and the 8th Circuit Court of Appeals—have found that GPOs save hospitals money," said Health Industry Group Purchasing Association (HIGPA) President Curtis Rooney in a statement. "Hospital purchasing executives are smart shoppers in an aggressive and competitive market, and they voluntarily turn to GPOs to help them find the best products for the best deal."
Rooney also called the study's claims that device manufacturers would voluntarily reduce their prices under a new GPO model a "slap in the face" to healthcare providers that participate in GPOs.
The trade group representing the healthcare industry's GPOs says their efforts to improve transparency, accountability, and fair product discounting have been validated by a federal government report released last month.
A Government Accountability Office report interviewed GPOs, hospitals, and device vendors, and determined that hospitals increasingly rely on GPOs as the primary means to help keep the costs of medical products and services in check.
Healthcare reform has come to the Office of Personnel Management (OPM), the agency charged with managing the federal government's civil service personnel. In accordance with a mandate in Affordable Care Act passed earlier this year, OPM has created the Health Claims Data Warehouse, a database of personal information generated from employees' healthcare claims.
Records from the current Federal Employee Health Benefit Program (FEHBP) and National Pre-Existing Condition Insurance Program populate the database, which OPM says will help the agency track the costs of care delivered to enrollees. Data from a third program, the Multi-State Option Plan, will be added when it gets underway in 2014.
According to a statement from OPM Director John Berry, the Health Claims Data Warehouse is intended as a tool for analyzing health services data from [federal employee health benefit plans.] "The warehouse will allow OPM to better understand the health of federal employees, as well as the cost and quality of care they receive. The warehouse will give OPM the ability to manage the program so that employees and tax-payers get the best value."
Recorded data—kept for a seven-year period—will include personal identifying information such a patient's name, Social Security number, date of birth and gender; contact information including phone number and address; provider charges and reimbursement amounts; and specific medical details including diagnoses and procedures.
OPM says it will use the information to provide economic modeling of health trends, risk-adjusted profiles, pharmacy pricing, and provider contracts. However, the law allows for other "routine uses" such as by law enforcement agencies that are "investigating, prosecuting, enforcing or implementing a statute, rule or order" as well as when the data is needed in response to congressional inquiries or for judicial proceedings.
Data will be protected by electronic security protocols and rules that restrict access to employees with the appropriate clearance, according to OPM. And while the information often will be deidentified for specific analyses, watchdog groups question why a federal agency needs to store personal health data in a central location and claim the risks of intrusion are too great.
Not discounting the value that claims data might provide for demographic and health risk analyses, privacy advocates say the better option would be to have each health plan store the data and provide it to OPM on an as-needed basis.
A final rule on the database was published this week in the Federal Register, and the system will officially launch on November 15.
Recruiting physicians-in-training is just as important as recruiting physicians as residents are on the front lines of patient care interfacing with more patients than any other provider in the hospital. It’s worth your time to make sure you’re recruiting the highest quality candidates.
Residency programs are beginning to use social media sites, such as Facebook, YouTube, and Twitter to reach tech-savvy, generation Y, recruits.
There’s no well-defined recipe for social networking success. “[Social networking] is unorganized and you don’t know what you’re going to get,” says Kathy Corey, former administrative director for the internal medicine residency program at Washington University School of Medicine in St. Louis.
Make the most out of your resident recruitment efforts with the following tips.
Professionalism first
Draw a sharp line between your personal profiles and the ones you manage for the program. The best way to do this is by creating program-specific accounts.
On Facebook, a company or organization doesn’t use a personal profile. Instead, it can have a public page that allows the organization to engage with customers, employees, or other interested parties on the site. These types of pages are sometimes referred to as fan pages.
Rather than adding friends like on a personal page, people become fans of the site. Residents, potential candidates, alumni, or faculty can become “fans” of the page and will receive your updates whenever something new is posted.
On sites like Twitter or YouTube, you do not need to set up a special type of account. The username for the program’s account should relate to your hospital, area, or training program. Twitter status updates or YouTube video posts should also be solely program or training related.
Don’t dive in without a plan
Don’t simply join every social networking site without first giving your strategy thoughtful consideration. Determining how you want to use the social media will help you tailor communication to your audience, Corey explains.
What are your goals—communicating with residents and alumni, attracting new applicants, or both?
“Our goal was to get information about our program out there for applicants,” says Bjorn Peterson, MD, second-year resident at Regions Hospital.
By posting pictures from graduation events, pearls from interesting case conferences, information about the area, and unique experiences that residents have had on certain rotations, Peterson says an applicant can get a sense of the program, the residents, and the quality of training.
Keep your goals in mind when deciding which sites to join and spend time building up a presence. Twitter offers the ability to send real-time updates to residents, so it is a great way to quickly disseminate information to large groups of people, Corey says.
However, if your goal is to get potential candidates interested in your program, consider posting a video about your program on YouTube. It can include a virtual tour of the department, feature interviews with residents and key faculty members, and showcase your facility.
Privacy and other legal concerns
You’ve probably heard horror stories of residents posting inappropriate comments or less-than-professional photos on social networking sites. This may make you apprehensive about putting your program out in the Web world, but the risks are smaller than you might think, say Peterson and Corey.
Facebook, Twitter, YouTube, and most blogs allow you to assign administrators to the profile. Only these people can post communications coming from the program. As long as you chose trustworthy individuals to administer the site, you don’t have much to worry about.
On Facebook, any of your fans can comment on your page, so there is a risk that someone will post something inappropriate, but it’s not likely, Peterson says. Most fans are residents, alumni, or candidates, and they are smart enough not to jeopardize their position within the program by posting something unprofessional. Additionally, administrators typically have the ability to delete comments if necessary.
Keep it fresh; keep it real
One of the rules for attaining success in social networking is to ensure that the content on your site is always current. Develop a plan for updating the page. Reach out to residents and faculty members to add content.
“Try to get several different people involved. Create ownership with residents and senior staff. It will create less work for the coordinator in the long run and it makes your page more dynamic because more people are involved,” Peterson says.
Identify residents or other staff members who are avid social networking users in their personal lives and ask them to contribute to the program’s site.
“We have several staff members who have come on board who are willing to post updates periodically,” says Peterson, adding that many attending physicians in his program use Twitter. They have linked their Twitter posts to the program’s Facebook page so their tweets appear on both Twitter and Facebook.
California regulators on Wednesday approved WellPoint Inc's (WLP.N) plan to raise rates for individual health insurance policies by an average of 14 percent, after errors were found in the company's original rate hike request. An initial bid by WellPoint's Anthem Blue Cross unit for an average 25 percent rate increase for around 600,000 policyholders drew heavy criticism earlier this year from Democrats as they rallied support for the recently passed U.S. healthcare reform law. WellPoint, the largest U.S. health insurer by membership, said it intends to put the new rates—with increases as high as 20 percent—into effect Oct. 1.