Medicare to Pay Bonuses for 'E-Prescribing'

Starting next year, doctors can earn additional money from Medicare if they use electronic prescribing systems, U.S. health officials said Monday.

The bonus program, which will continue for four years, is designed to streamline the prescription process and cut down on errors. In 2009 and 2010, Medicare will give doctors an additional 2 percent bonus on top of their fee for “e-prescribing.” In 2011 and 2012, the bonus will drop to 1 percent, and in 2013, the bonus will drop again to 0.5 percent, officials said.

“There are terrific human and financial costs to illegible prescriptions,” Mike Leavitt, secretary of the U.S. Department of Health and Human Services, said during a Monday afternoon teleconference.

According to the Institute of Medicine, 1.5 million Americans are injured every year by drug errors, Leavitt said. Another study found that each year pharmacists make more than 150 million phone calls to doctors to clarify what was written on the prescription, he added.

“That’s a lot of people needlessly hurt and a lot of time spent trying to sort out bad handwriting,” Leavitt said.

“E-prescribing will help deliver safer or more efficient care to patients,” Leavitt said. He noted that the law that set up the Medicare prescription drug program in 2006 mandated that participating pharmacies be able to accept e-prescriptions.

After five years, bonuses for e-prescribing will be phased out; doctors who haven’t adopted e-prescribing will be reimbursed at lower rates, Leavitt said. There will, however, be exceptions for doctors who have legitimate reasons for not complying.

“We expect this will have a profound effect on the adoption and use of e-prescribing,” Leavitt said.

Medicare started paying bonuses to doctors last year for using the Physician Quality Reporting Initiative, which collects data on the quality of care delivered by doctors. Medicare recently paid the first bonuses to more than 56,000 doctors, totaling more than $36 million. Payments ranged from $600 for individual doctors to $4,700 for group practices.

The new bonuses for e-prescribing will be on top of those paid as part of the Physician Quality Reporting Initiative and other Medicare reimbursements. Medicare expects to save up to $156 million over the life of the e-prescribing program in fewer adverse drug events.

Despite the advantages of e-prescribing, barriers to implementing such systems remain. One of the largest barriers is the cost.

“It is fairly costly for a small practice to begin to change over to e-prescribing,” Dr. James King, a family physician in Tennessee and president of the American Academy of Family Physicians, said during the teleconference. “These incentives will help.”

It’s estimated that it will cost about $3,000 per doctor to initiate an e-prescribing system. It also takes between $80 and $400 a month to maintain and operate a system, Kerry Weems, acting administrator of the U.S. Centers for Medicare & Medicaid Services, said during the teleconference.

Other barriers include state laws that prohibit e-prescribing across state lines, King said. And, there are areas in the country where computer systems are slow and inefficient, he said.

AHA: Stretch Meaningful Use Timeline

The federal government should extend the transition to a fully functional electronic health records system beyond 2015, according to the American Hospital Association.

The AHA has sent a comment letter on the initial proposal of a workgroup of the HIT Policy Committee to define meaningful use of electronic health records to David Blumenthal, national coordinator for health information technology.

“Our members believe that the functional abilities of the EHR that would result from implementation of the draft definition are correct, but that the proposed sequence for adoption is overly aggressive and unrealistic for most,” according to the AHA. “Increasing the requirements for being considered a meaningful user every two years should provide enough time for adoption, but only if the initial requirements are set at an achievable level. The AHA encourages the committee, ONC and the Centers for Medicare and Medicaid Services to develop a ‘meaningful use’ adoption timeline that begins with fewer functional requirements and extends the transition to a fully functional EHR beyond 2015.”

Computerized physician order entry, for instance, should not be required until after 2015 or beyond, the AHA contended in the comment letter. “Most hospitals are not prepared to make such significant advancements under the proposed implementation timeline, so rushing to adopt could compromise patient safety and the success of this effort,” the letter states. “Our members, including those with significant previous HIT investments and CPOE, consider a 2011 CPOE requirement to be unrealistic.”

The AHA calls for the definition of meaningful use in 2011 to focus on getting the majority of hospitals running with a basic EHR. Appropriate functions for 2011 should include clinical documentation of patient demographics, problem lists, medication lists, discharge summaries, and results viewing for lab reports, radiology reports and diagnostic tests, the AHA advises.

The association, mirroring comments of the American Medical Association and some 80 other physician organizations in a separate comment letter, also noted that providers must work during the same time period to migrate to the HIPAA 5010 transaction sets and ICD-10 code sets.

Patients cheer on EHR technology, not afraid of privacy risks

Show me the technology! That is the conclusion of a study from the Beth Israel Deaconess Medical Center (BIDMC) to be released in the Journal of General Internal Medicine (JGIM) in June. The study reveals that consumers who are defined as “internet-savvy” are ready to take a chance on electronic health records (EHR) despite warnings of potential privacy risks.

The study, supported by the Robert Wood Johnson Foundation (RWJF), investigated whether or not patients were comfortable making the leap with their health care providers to the digital age through the adoption of EHRs. In the tech-savvy cities where they held focus groups, the answer was a resounding ‘yes.’ Not a terrible surprise given that they investigated consumers in Boston, Portland, Tampa and Denver—some of the more tech-educated spots in the country. However, investigators did attempt to include a diverse group of people, drawn from both urban and rural areas. Additionally, they included health professionals in their study to compare their perspectives about health technology relative to consumers.

The findings should not come as a major surprise since an estimated 60 percent of households across all states have a home internet connection. Citizens are increasingly interested in managing their lives via computer—EHRs seems a natural progression in this evolution.

Yet, the study findings echo a sense of surprise at the willingness of consumers to give up some of their privacy in order to obtain greater transparency with respect to their health information. In actuality, it may be more of a reflection of the distrust and frustration with the current patient-physician/health care provider relationship where one may deem transparency of much greater importance than whether or not someone uncovers that they have kidney stones…

States take bigger role in promoting EHR adoption

Maryland further strengthened the goals of the stimulus package or the American Reinvestment and Recovery Act (ARRA) this past week by passing legislation that required insurers to provide “monetary” incentives for physicians to adopt electronic health records (EHR).

The bill, signed by Governor Martin O’Malley, is one of the first of its kind to give sharper teeth to the EHR movement. Insurers may choose from a variety of fiscal incentives including increased reimbursement and lump-sum payments, according to Health IT News. The effort is viewed as a double incentive to providers to join the digital transition that promises to increase health care system efficiency while reducing medical errors for patients. Maryland is not alone in its effort to promote the change from paper to portal; other states are reviewing similar measures that would jumpstart implementation.

Included in the Maryland bill is a requirement for the state to bring a piloted health information exchange (HIE) live by October 1. The goal of the HIE, often comprised of business and community representatives, is to provide support to health care system stakeholders with the goal of increasing efficiency and quality.

Wait, have we heard of an HIE before? Yes. For clarification purposes, regional health information organizations (RHIO) and HIEs are terms used interchangeably; the HIE is simply a new name for a RHIO—it has yet to be determined if it is also a newer and better RHIO. Lingo aside, HIE investment is up.

Other states are looking to HIEs/RHIOs to play a prominent role in EHR adoption. New York, Texas, and Florida are all investing in these information exchanges.

In New York, the Western New York Clinical Information Exchange, known as HealthElink, signed on 6 EHR software vendors to provide community pricing to its clients.

In Texas, the legislature passed two pilot health information exchange programs that promote data transfer between local agencies.

Florida, having received a $9+ million grant from the Federal Communication Commission (FCC), is exploring how to expand broadband access across nine rural hospitals to increase the speed and efficiency of health data transfer.

Other states are vying to develop strategies for technology adoption that support EHR implementation as stimulus dollars dangle overhead. Now that EHRs are heavily banked by both federal and state government, HIEs and RHIOs may take a greater role in aiding communities in EHR adoption. These exchanges hope to serve as important providers of data warehousing as well as offering leadership for the development of criteria for data sharing and data quality. States view HIEs/RHIOs as vehicles for transporting dollars toward the development of technology infrastructure and they are moving as quickly as possible to get their take.

FISMA—a roadblock for EHRs?

The Federal Information and Security Management Act (FISMA), passed by Congress in 2002 to better protect the federal government against cyber attacks, mandates information security standards for all federal agencies. This includes the flow of data between the Centers for Medicare and Medicaid (CMS) and their contractors—over 200 hundred of them, processing billions of Medicare claims. The new worry from CMS, according to Government Health IT, is that healthcare providers sharing EHR files will be required to meet FISMA standards, which include an annual security test and FISMA certification.

A CMS spokesperson is quoted as saying that this would be more than “burdensome” for both CMS and health care providers and organizations.

The conundrum is that information will be moving between the HIPPA world (the private sector) and the FISMA world (the government)—that latter of which is much more secure, from a protocol/standards perspective. Federal agencies are held to a higher standard than the private sector with respect to information security.

For a long time, consumer groups have argued that HIPPA is a weak standard for patient information security. Yet, many worry that if FISMA is applied to the private sector, there will be a compliance crisis that will be costly to remedy. But why shouldn’t the transfer of health information be held to the highest security standards? Advocates of a middle ground argue “yes,” but not quite as stringent as FISMA. They standards should be more of a more of a “HIPPA-plus” or “FISMA-lite,” in the words of Vish Sankaran, a program director for the Federal Health Architecture project to connect health information entities.

In other words, get health care providers better engaged in securing healthcare information but do not stunt the growth of the EHR movement by placing the bar too high.

In the end, the Office of Management and Budget will dictate the debate through their determination of what falls under the FISMA umbrella. In August of 2008, OMB issued some guidance, stating that FISMA applies to groups that “possess or use Federal information—or which operate, use or have access to Federal information systems (whether automated or manual)—on behalf of a Federal agency.” OK, that could include a ton of organizations.

Outsourcing Medical Billing

In the past few years there is a dramatic change in the medical field and its treatment. Initially, while processing the insurance claims there are many administrative difficulties during the preparation of insurance policy procedures and dealing with complicated claim forms. To overcome with these obscurity doctors look out for outside help, and hire representatives to advise them, attend information about insurance company seminars, and provide them with regular clear financial reports.

This is process is called as medical billing outsourcing. Outsourcing Medical Billing acquire a profound working knowledge of the technologies and processes that are decisive to successful Business Process Outsourcing and afford a absolute scale of Back Office Outsourcing services in the areas of Medical Billing, Claim Adjudication, Call Center and Financial service. The most of the physician time is saved by means of medical billing outsourcing process. So that, physicians can much more concentrate on curing their patients. A medical billing firm will have the knowledge and experience technocrats to take care of all the medical billing issues. It makes free the other staff to concentrate on other aspects of running the practice which leads to added security to finance and transactions

State of Indiana Holds Leadership Position in Electronic Health Record Growth

Few would question that dramatic change in the U.S. health care arena is well on the way. With billions of dollars on the table to fund systemic change in critical records management and other aspects of service delivery, what will American health care services look like a few years from now?

Health care reform champions have long complained that secure IT systems exist where consumers can pull out cash from an ATM anywhere in the world. That said, patients today often can’t so much as transfer from one clinical floor to the other without filling out multiple duplicate forms about their medical histories. In the past, some medical records have been lost, misplaced or misfiled too often sometimes with devastating results.

Health care reform is expected to speedily address this unfortunate information transfer gap. With large and small hospitals alike embracing high-speed fiber-based broadband, the capacity increasingly exists for instantaneous access to digital X-ray and MRI images, patient histories and even direct physician-to-patient consults.

Such is the basis for emerging telehealth applications where physicians, specialists and other medical professionals can leverage high-speed and secure data platforms to deliver health care services in a more efficient and cost-effective manner. Unfortunately, even in a lightning-fast Internet-fueled world, much of the present state of medical record keeping still represents an anachronistic throwback to a pre-digital age.

While the technology has existed for health care institutions to develop full-spectrum electronic medical records (EMR) and electronic health record (EHR) systems for more than three decades, as of 2006 less than 10 percent of American hospitals had a fully integrated system. This statistic makes many medical experts cry foul as integrated EHR systems can improve patient safety, reduce errors and promote efficient standards of care.

If that’s not enough, a 2005 RAND Corporation study estimated that efficient exchange of medical records among doctors and hospitals in the U.S. (also known as a health information exchange or HIE) would save $81 billion annually. Other estimates have put that figure as high as $450 billion per year. Throw in better outcomes and a potential higher quality of life and one can only wonder why this hasn’t happened earlier.

Here enters the Obama administration’s American Recovery & Reinvestment Act (ARRA), which includes unprecedented billions of dollars for EHR conversion and development. This access to massive funding has resulted in many hospitals scrambling to update their systems. The ARRA includes both funds for planning and execution as well as cash for physicians to convert their outmoded legacy systems into a 21st century model.

With so few hospitals presently deploying fully integrated systems, where could American hospitals and health care organizations find proven models for EHR and EMR implementation? How about Indiana?

Led by the Indiana Health Information Exchange (IHIE), the Hoosier state is home to not one but four operating health information exchange organizations. This represents a remarkable development as many states in the U.S. today don’t even have a single health information exchange that’s nearing implementation much less operational.

How does it work in the Hoosier state? Created by the Indiana-based Regenstrief Institute, the IHIE securely connects 39 hospitals, 10,000 physicians and more than 6 million patients. It delivers real-time lab results, reports, medication histories and treatment histories that are sent instantly to where they’re needed regardless of the hospital system or location, according to IHIE officials.

Indiana health care leaders haven’t been bashful about touting their early success, openly profiling the IHIE as a proven working model that should be closely reviewed and copied across the United States.

“Indiana has seen how health information exchange drives better health care for our patients, increases efficiencies for our health care professionals and saves health care dollars. Replicating this kind of platform throughout the U.S. would have incredible positive implications on our health care outcomes and cost savings,” IHIE Chairman Vincent C. Caponi (also the CEO of St. Vincent Health said.

The benefits of participating in an HIE or adopting best practices within an EHR system are by no means limited to large hospitals in urban areas as Major Hospital in Shelbyville, Ind. (population 18,000) has eloquently demonstrated.

This 86-bed community hospital was recently named one of America’s top 100 hospitals by Thompson Reuters and its early adoption of state-of-the-art technology is one of the reasons why. Only the St. Vincent Health and St. Francis Hospital systems (which are much larger than Major Hospital) were also included as central Indiana health institutions named in the 2009 benchmark study.

How did this happen? Working in the shadow of much larger hospital systems in nearby Indianapolis, Major Hospital trumped its hefty competitors by instituting the beginnings of a full-scale EMR back in the mid-1990s.

The result, according to Major Hospital CEO Jack Horner, is reflected in both the growth of the hospital and its more than 25 vertical medical practices. They are all linked together by fiber-based broadband connectivity. That coupled with aggressive recruitment and retention of top physicians and hospital staff has led to substantial growth and a high degree of patient satisfaction.

While many other hospitals (large or small) across the nation are just now ditching their legacy systems and working to implement full-scale EHR platforms, Major Hospital is already well into direct physician order and advanced applications all to the benefit of the hospital’s patients.

Major Hospital was one of the first health care institutions outside of Indianapolis to join the Indiana Health Information Exchange. Its success demonstrates that EHR systems can work well in either large or small health care organizations.