Quality Care Reality Bites

Quality Care Issues and Costs No one can argue that improving quality care is a worthy goal.  Interpretation of how it is best done gets bogged down especially when it comes to figuring out what’s required, obtaining and interpreting the  information, translating it into inadequate software templates developed by non-medical techs, then reporting it in a way that is manageable for payers. As is commonly reported because so many vendors jumped onto the EMR (electronic medical record) bandwagon to develop proprietary software products, the missing ingredient was standardization.  All of those myriad systems now in use by providers cannot talk to each other at all, so much of the effort is wasted, in fact, it has markedly slowed any realistic benefit. A major part of the effort was to create value-based care, that is, what was the patient seen for, what was done and what was the outcome.  The idea pushed by Medicare with the Reauthorization Act in 2015 was designed to improve the payment process for value-based care, so providers get paid more if they can prove the care was better? Providers try hard to meet the increasing requirements but how has that affected their practices?  A study was done of 1000 practices representing several specialties; the results showed that the office staff averaged 15.1 hours per week per physician to try to fulfill the new standards.  The costs were calculated at a surprising  $40,000 per physician per year –  a whopping $15.4 billion per year spent on just that part of the new regulatory mandates.  That does not include the time spent in understanding the rules, trying...

Quality Care Reporting Costs are High

You hear much about the ideals of improving quality patient care.  As the process moves forward, it struggles with the issues of standard rules, the interpretation, and the delivery and results of the data, not to mention the high costs for providers to try to make it work.  The penalties are in place as well, with the underlying threat of lower or no payment for services. The push for value-based care continues to create problems for physicians. Insurers (with Medicare in the vanguard and passage of the Reauthorization Act in 2015) were designed to speed up value-based payments. The goal is to get physicians to report care results and tie them to payments. Recently, Health Affairs published a story in the March issue about a study done on the costs of trying to get the reporting and provide the information to insurers. The authors randomly selected 1000 practices from MGMA membership and had them fill out a survey. They represented 4 specialties, cardiology, orthopedics, primary care, and multispecialties. The results show the staff averaged 15.1 hours per week per physician on quality measures. The costs were calculated at $40,069 per physician per year which translates to $15.4 billion spent on just that element of practice. The time burden in terms of even understanding the measures, then trying to provide the data, then interpret the reports from payers has not yet even been quantified. In theory, the goal is worthy, but the system thus far is clearly not efficient and the rules keep changing. One of the main problems is the lack of standardization of the criteria to be used...

Privacy Rule and Email (HIPAA)

The Privacy Rule in HIPAA allows health care providers to communicate electronically by email with patients, provided reasonable safeguards are used to protect private information. See 45 C.F.R. § 164.530(c).  The safeguards may get somewhat complicated requiring specialized software, file management, encryption, communication disclaimers, and retention of records to the extent that it can be a major deal.  A bit of humor to illustrate the disclaimer problem. Attached to each email: Notice: This e-mail is confidential and should not be used by anyone who is not the original intended recipient. It should not be photocopied, transmitted via walkie-talkie, CB radio, satellite dish, cable TV, overhead projector, smoke signal, Morse code, pig Latin, sign language, short hand, or any other means. This e-mail is under no circumstances to be translated into French. This e-mail is not to be ridiculed, mocked, judged in a competition, or read aloud in funny accents while wearing fake mustaches and/or hats of any sort including, but not limited to, bandanas. Do not taunt or provoke this e-mail. People taking certain prescription medications may experience nausea, dizziness, hysteria, vomiting, and temporary loss of short term memory while reading this e-mail. Please consult your physician before reading this e-mail. All models depicted in this email are 18 years of age or older. If you have received this e-mail in error it’s probably because the person typing it may have been impaired so please ignore it, do not read the contents above or below, and above all, do not share with ANYONE .    ...

EMR Problems Reported to Congress

EMRs (Electronic Medical Records) problems have been defined by NCHI and reported to Congress. The nightmare of initiating and implementing the EMR has some clearly identifiable problems. The National Coordinator for Health Information (NCHI) has formulated a report to Congress on the state of the HITECH Act to develop the EMR. The federal government invested over $28 billion to aid in the development and use of health information technology in which an electronic health record would be available that would meet security requirements and could be shared in a usable format between related providers and patients as well. The end result was to improve health care and provide a wealth of epidemiologic information not to mention the huge boon for administrative policy. The billions invested were to provide incentive programs to develop and implement the goals of the EMR. Clearly, the process has not worked as it should have mostly because of the disparate and proprietary software programs — too many vendors with a vested interest in competitive profiting and protecting their turf. NCHI pointed out some of the offenses, for instance, “blocking information,” by charging fees that make it economically impossible to access or use the data and using transaction fees for each time a user sends or receives or even searches e-information. They charge for common types of interfaces like connecting to labs and hospitals. Providers do not appreciate the cost of extracting data from their own systems and are not pleased with how difficult and expensive it is to opt out of an existing vendor’s program in order to purchase or migrate to another. The various...

Medical Transcription History

Medical records have been kept on patient care since people first developed the ability to write.  At the beginning of the 20th century, stenographers entered the scene who took the doctor’s dictation in shorthand.  This method was used until the invention of audio recording. What followed: dictabelts and dictaphone transcribers typewriters word processors computer processors voice...

Value-Based Reimbursement and PCMC

Value-based reimbursement will largely be the new law of the land as the Senate stepped up to pass the Medicare Sustainable Growth Rate (SGR) repeal. Thankfully, the repeal helped physicians avoid a 21% Medicare payment cut as well as moved the value-based reimbursement forward. The threat of deep cuts to fee-for-service Medicare payments having been eliminated, providers are now expected to participate in the unified Merit-Based Incentive Payment System (MIPS). Quality reporting (PQRS) and Value Based Modifier (VBM) programs allowing providers to attest only once on clinical quality measures (CQM???). The healthcare industry had an anxious period during its spring recess, but finally the Senate joined the House in approving the legislation by an overwhelming 92-8 vote. This brought an era of definite uncertainty for Medicare holders and their providers and will create more innovation in care models that will lower costs and still work on quality care issues. They will also be able to obtain financial bonuses by participating in innovative care delivery models like the patient-centered medical home (PCMH). The expectation through reformation of health care delivery is to promote population health management with better care coordination, and increased use of health information exchanges together with clinical analytics for patient risk stratification and more comprehensive preventive care. The SGR repeal allows for a five percent bonus for those providers who will accrue at least a quarter of their Medicare revenue through alternative care models and value-based reimbursement arrangements by 2018. The Agency for Healthcare Research and Quality (AHRQ) recognizes that revitalizing the Nation’s primary care system is foundational to achieving high-quality, accessible, efficient health care for all...