Electronic health records

House Approves Critically Needed Changes to Physician EHR Requirement

Posted in Electronic health records, Electronic Medical Records, Mass. Legislature on February 13th, 2014 by MMS – 10 Comments

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UPDATED: March 20, 2014

Read an update about this issue here.

The Massachusetts House this week approved changes in state law that would disconnect medical licensure from a physician’s use of electronic health records. The issue has been a major focus of the MMS’ advocacy efforts this year.

Under current law, effective Jan. 2015, physicians who wish to renew their license must demonstrate that they utilize EHRs that are at the level of the federal government’s meaningful use program.

MMS President Ronald W. Dunlap, MD, has met several times this year with legislative leaders, and cautioned that if the requirement is enforced, more than 10,000 physicians could lose their license, most of whom cannot, under law, qualify for Meaningful Use incentives. The resulting impact on the health care system would be devastating.

The House language would instead require practicing physicians to demonstrate that they use “digitized patient-specific clinical information.” Practicing physicians who don’t use digitized health records would be given the opportunity to demonstrate that they know how to use such records, by a method to be determined by the Board of Registration in Medicine.

Following a recent meeting between MMS President Ronald W. Dunlap and House Ways and Means Chairman Brian Dempsey (D-Haverhill), the House approved the language Wednesday by a very wide margin.

Unfortunately, the Senate’s supplemental budget bill did contain not such language, so the matter now heads to conference committee, where Chairman Dempsey has indicated will be a strong advocate for the substitute language.

We’d like to extend a big thank you to Chairman Dempsey and the House of Representatives for their actions this week.

Feds Extend Meaningful Use Attestation Deadline By One Month

Posted in Electronic health records, Electronic Medical Records on February 10th, 2014 by MMS – Comments Off

data 2The Centers for Medicare and Medicaid Services announced last week that it is extending the deadline for attesting to meaningful use for the 2013 reporting year by one month, to March 31, 2014, at 11:59 p.m. ET. The previous deadline was Feb. 28.

The criteria must still have been met by Dec. 31, 2013, the end of the reporting period for incentive payments.

The extension does not apply to the Medicaid portion of the EHR inventive payment program.

The President’s Podium: Mass. Medicine, After Cost Control

Posted in Board of Medicine, Electronic health records, Electronic Medical Records, Global Payments, Health IT, Health Policy, Health Reform, Regulation, Uncategorized on December 9th, 2013 by MMS Communications – 1 Comment

By Ronald Dunlap, M.D., President, Massachusetts Medical Society  

Massachusetts entered its second phase of reform with the 2012 passage of DSC_0003 Dunlap 4x6 color 300 ppi_editedChapter 224, cost control legislation officially titled “An Act Improving the Quality of Health Care and Reducing Costs Through Increased Transparency, Efficiency and Innovation.”

While the first phase, Chapter 54 passed in 2006, was indeed landmark legislation and served as the model for the Affordable Care Act, Chapter 224 alters the state’s health care industry perhaps like no other law.

The changes this law brings are vast, from payment reform to giving the Attorney General new powers in the health care marketplace. Although 224 does include some benefits for physicians (medical malpractice reform for one), other provisions pose significant challenges, particularly for physicians in small practices. Here are two that raise concern.

Health Information Technology (HIT) One of the biggest challenges presented by Chapter 224 is its embrace of health information technology. Physicians will be required – as a condition of licensure – to demonstrate proficiency in all aspects of health information technology by January 1, 2015.

While MMS supports HIT and recognizes its intent to improve patient care, this provision of the law could severely disrupt medical care. Because the statutory language creating the requirement is tied to Federal standards of “meaningful use” (which in turn is tied to participation in Medicare and Medicaid), it raises concerns that strict interpretation of this provision would lead to denial of license renewals for some 26,000 physicians.  Our state has a high certification rate for meaningful use, with more than 14,000 physicians having met stage 1 requirements, but nearly 40,000 physicians have a Massachusetts license, and most are not included in the population targeted for meaningful use certification.

Additionally, the costs of establishing HIT can be huge. The outlay for such items as implementation, maintenance, software and hardware upgrades, conversion to Federal ICD-10 codes, training, and data conversion could approach well over half a million dollars for some practices while not including the “opportunity loss of income” from decreased productivity.  While the law allows for assistance to providers for HIT, the level of help is unknown, and the financial burden can be crippling to small practices.

The law further requires all providers to implement fully interoperable electronic health records that connect to the statewide health information exchange by January 1, 2017 (a goal not in sight) and imposes penalties for noncompliance. These technologies are not only critical for physicians to practice medicine, but also to participate in quality measurement programs.  The specter of this kind of commitment to HIT, however, with its financial outlay, is certain to make physicians pause and think, especially those close to retirement.

MMS has had lengthy discussions with the Board of Registration in Medicine (responsible for implementing the HIT requirement) and has testified in support of legislation to delay this requirement and provide relief to physicians. Our voice has been heard, and we are hopeful such relief will be forthcoming.

Data Collection and Reporting Chapter 224 is equally enthusiastic about data collection and reporting.  It creates a “provider organization registration program,” requiring organizations to provide detailed information about their operations: costs, financial performance, utilization, total medical expenses, and patient referral practices, among other information.  This data is hard to extract from many EMR systems.

This information will be collected by the Center for Health Information and Analysis (CHIA), a new independent state agency created by 224 that takes over most of the responsibilities of the Division of Health Care Finance and Policy, which was abolished by the law. Physician groups are now required – for the first time – to submit such data. The law contains language focusing on the reporting on risk-bearing groups while exempting smaller groups, but the applicability of this language has not been fully tested yet, so it isn’t clear how reporting requirements will be enforced and upon whom.

On a promising note, CHIA Executive Director Aron Boros told our House of Delegates at the Interim Meeting on December 6 that CHIA’s goal is to gather “reliable and meaningful” information through an “engaged transparent operation.”  He believes his agency must be “transparent, open, and collaborative” to build credibility.

The law also stipulates that by January 1, providers must disclose to patients within two working days of their request, how much a proposed procedure or service costs and what the health plan offers as payment.

I am not optimistic that physicians will be prepared within a month’s time to inform patients about specific or estimated costs for all procedures. We are encouraging legislators and the Health Policy Commission to implement the law incrementally, by considering the most expensive procedures first.

HIT and data collection/reporting requirements are but two areas that Chapter 224 dramatically changes. These changes, coupled with constant concerns over Medicare reimbursements as well as added requirements such as those imposed by ICD-10 codes, continue to strain physician practices.

What policymakers and regulators must keep in mind is that, even in a highly sophisticated medical environment like Massachusetts, no less than 64 percent of our physicians are in practices with fewer than 25 physicians. Policies and regulations that burden these practices and reduce their viability will not only affect the quality of care but will also reduce health care access for Massachusetts residents.

The President’s Podium appears regularly on the MMS Blog, offering Dr. Dunlap’s commentary on a range of issues in health and medicine. For a section by section analysis of Chapter 224, click here.  

 

Annual Education Program: How Technology Is Improving Patient Care

Posted in Electronic health records, Health IT, medical homes on May 10th, 2013 by MMS Communications – Comments Off

From electronic health records to medical devices to the latest in research, technology is continuing to push into new frontiers in medicine, and that bodes well for patient care.

In introducing the 2013 Annual Education Program, Navigating the Currents of Change: Integrating Innovative Technologies Into Your Clinical Practice, MMS President Richard Aghababian, M.D. said “Incorporating technology into our approaches to patient care is one of the biggest challenges we face as physicians today. The tools and data we now have at our disposal are truly amazing. But we must balance the machines with the humans side of medicine.”

The educational program on Friday, May 10 included four distinguished clinicians and scientists who addressed concrete examples of how the latest technologies have made advances in the surveillance, diagnosis and management of disease, and how those technologies are being incorporated into patient care.

Dr. Robert L. Jesse, Principal Under Secretary of Health at the Department of Veterans Administration, discussed health information technology and how it affects patient care.

Dr. Marc Semigran, Medical Director of the Massachusetts General Hospital Heart Failure and Cardiac Transplant Program, talked about how technology and the latest medical devices are improving and extending the lives of patients with heart disease.

Dr. Suzanne  Topalian, Professor of Surgery and Oncology at Johns Hopkins School of Medicine, examined how nanotechnology and targeted immunotherapy are making progress in the battle against various forms of cancer.

Dr. John Moore, of MIT’s Media Lab, discussed the application of technology for patient empowerment within the medical home model.

The participants’ presentations, along with their biographical information, are available for viewing here.

 

Key Similarities and Differences Between the House and Senate Payment Reform Bills

Posted in Accountable Care Organizations, Defensive medicine, Electronic health records, Electronic Medical Records, Health IT, Health Reform, Malpractice, Mass. Legislature, medical liability reform, Payment Reform on June 8th, 2012 by MMS – 1 Comment

After two years of discussion and debate, the Massachusetts Legislature must now deal with two huge pieces of payment reform and cost control legislation.

Earlier this week, the House passed its legislation by a wide margin, following eight hours of deciding which of 275 amendments it would accept. The Senate passed a separate bill on May 17.

During the House debate this week, the MMS sought to protect most small and medium physician groups from the House’s very rigorous reporting requirements. The original House bill exempted groups with fewer than 10 physicians. Due to MMS advocacy, the House agreed to increase the exemption to 25, which we will try to increase further during the conference committee’s deliberations.

When the members of the conference committee are appointed, they will have until adjournment on July 31 to agree on a single bill and get it passed by both chambers.

Despite their many similarities, reconciliation and consolidation of the bills is not expected to be an easy task.

Key Similarities

  • Cost containment: Each bill states that overall health care costs should rise in concert with the growth in the state’s economy. (Differences noted below.)
  • State oversight: Each creates a new state agency to certify provider groups, and collect volumes of information on quality measures and costs. The House agency is placed inside the executive branch, under the Executive Office of Health and Human Services. The Senate agency is an independent entity.
  • Market power: Both bills require payers to negotiate separate contracts for each hospital facility, with some exceptions.
  • Alternative payment models: The bills define ACOs and their requirements. They provide a 2 percent bonus in Medicaid payments to providers starting in July 2013, if they move to alternative payment methodologies.
  • Electronic Health Records: Each requires physicians to be proficient in the use of electronic medical records. (Differences noted below.)
  • Medical liability: Both mandate waiting periods for civil suits brought against health care providers. They require disclosure of case information to patients and providers; protect statements of apology from being admissible as evidence; provide for early payments to patients without prejudice. They reduce the prejudgment interest rate in malpractice cases from 4 percent to 2 percent. No contract may prohibit a physician from serving as an expert witness.
  • Determination of Need: They expand the Determination of Need process to include more new technologies, transfers of ownership and site expansions.
  • Administrative simplification: Both bills require standards forms for utilization review.
  • Peer review: Both bills expand the peer review statute. The House specifically provides ACOs with peer review protection; the Senate provides such protections to any provider group that conducts peer review activities.
  • Charitable immunity: They raise the charitable immunity cap from $20,000 to $100,000 (affects most hospitals in Massachusetts).
  • Physician assistants and nurse practitioners: Each bill provides more independence to physician assistants and nurse practitioners.
  • Limited service clinics: Both bills eliminate some existing regulations for the operation limited service clinics, such as those located in pharmacies; however their approaches differ.

Key Differences

Cost Containment

  • The House’s benchmark is 3.6 percent for 2012 and 2013. In 2014 and 2015, it would be equal to the growth rate projected in the Governor’s budget submissions. From 2016 to 2026, it would be equal to a half percentage point below the Gross State Product (GSP) from 2016 to 2026, and equal to one point above GSP after 2027.
  • The Senate’s cost benchmark is a half point above GSP through 2015, and equal to GSP from 2016 to 2026.
  • The House imposes a penalty on providers who costs are 20 percent higher than the benchmark. It establishes rate setting for governmental units. The House gives the state the ability to force providers to reopen contracts that it considers contributing to excessive spending. The House gives the attorney general to block unreasonable increases in rates, and block changes that adversely affect patient access and the quality of care. In the Senate bill, groups that exceed the benchmark must file improvement plans.

Market power

  • The House subjects provider groups of 10 or more physicians to a market impact review.
  •  The Senate gives the attorney general the power to prevent excess consolidation and collusion.

Certification

  • The House requires any physician group with 25 or more physicians to be certified by the Department of Public Health.
  • The Senate requires certification for all providers entering into alternative contracts. It exempts groups with less than $500,000 in annual net patient service revenue and fewer than five affiliated physicians, if the group does not accept risk.

Electronic Health Records

  • The House requires providers to adopt EHRs that are fully interoperable and connect to the statewide health information exchange.
  • The Senate updates existing the requirement for EHR proficiency by 2015 by requiring physicians must demonstrate the skills to comply with the federal government’s meaningful use requirements. It creates an institute to facilitate the implementation of interoperable records statewide, and promote the use of other health information technologies.

Data Tracking and Analytics: No Longer Avoidable in Physician Practices

Posted in Accountable Care Organizations, Electronic health records, Health IT, meaningful use on March 29th, 2012 by MMS – Comments Off

In an age where the federal government has settled on a total of 33 quality metrics in its final rule for accountable care organizations, figuring out how to track data and meet quality and performance benchmarks is becoming a critical part of a physician’s role in providing quality care to patients.

More practices in Massachusetts are focusing on data and analytics, because where risk-based contracts and accountable care delivery models are becoming increasingly prevalent. Understanding practice level and physician level data is a key to success, starting at the point of payer contract negotiation.

Many practices are challenged by where to start, which is not surprising given the alphabet soup that exists in terms of recognized metrics, HEDIS, NQF, NCQA, PQRI, PCPI to name only a few.

The good news is that while many are just beginning on this path, several practices have been operating in the data and analytics space for many years, and they are happy to share their lessons learned as well as the upside and downside of their experiences.

One such practice, South East Texas Medical Associates (SETMA), under the leadership of Dr. Larry Holly,  has worked to hone its data analytic capabilities to successfully manage their patient population, and has demonstrated success in improving metrics in areas such as diabetes management.

Of course, this is the result of years of evolution and a level of comfort with the metrics that are being tracked. That being said, SETMA has demonstrated success in working with the plans in risk based contracts as a result of their efforts.

Again, it took years for SETMA to perfect its strategy. One should not fear data tracking and analysis but embrace the initiative by starting with a few metrics that are important to the practice.  There is plenty of opportunity to tweak, improve and revise your processes over time.

As experienced practices such as SETMA will tell you, it’s about starting somewhere and perfecting your process over time.  On that note, why not start now?

If you’d like to learn more about how to approach data and how organizations like SETMA were able to successfully use data, join us at MMS on March 30th for the program titled “The Importance of Data in Physician Practice”.  Visit http://www.massmed.org/DataAnalytics2012
– Kerry Ann Hayon

David Szabo: Due Diligence Needed to Protect Patient Information

Posted in Electronic health records, Electronic Medical Records on January 18th, 2011 by MMS Communications – Comments Off

Legal issues continue to loom ever larger in the world of medicine. The establishment of accountable care organizations is presenting new challenges for physicians, and now, the implementation of the federal HITECH (Health Information Technology for Economic and Clinical Health) Act – the law enacted last year to promote the adoption and meaningful use of health information technology – should and must prompt them to give more due diligence to the privacy and security of patient information. 

That was the clear message from David S. Szabo, a health care attorney with Edwards Angell Palmer & Dodge, one of the featured speakers at the MMS’s January 14 CME session on Health Reform and Health IT.

Mr. Szabo took attendees through what amounted to a “legal lightening round” of issues to consider for users of electronic medical records, touching on privacy and security, obligations to notify when a data breach occurs, and best practices and risk management.

“The HITECH Act substantially increased the civil penalties to violations of the HIPAA privacy and security regulations,” said Mr. Szabo. Fines from $100 to $50,000 can now be levied on violators, depending on level of neglect and speed of correction.  

Some key elements of his presentation included the distinction between privacy and security, user requirements for electronic health information, the categories of safeguarding information, and the three steps of security requirements.

Mr. Szabo was quick to point out that state laws as well as federal laws apply to the safeguarding of information, and that violations of state law can result in civil penalties, damages, or licensure sanctions. Massachusetts, for example, is one of only two states to have an information security rule protecting “personal information.” Those who hold information about state residents must adopt a written information security policy and follow reasonable security practices to protect that information.

Among his suggestions for best practices: setting clear policies and procedures, intensive training, and privacy, security and data breach insurance. Additional details of his presentation are available here.

New England CMS Director Says Physicians Must Adapt

Posted in Electronic health records, Electronic Medical Records, Health IT on January 17th, 2011 by MMS – 1 Comment

The “dizzying” pace of change in our health care system requires physicians to adapt quickly to this new world, says chief medical office of CMS’ New England Region, Dr. William Kassler.

Speaking at the Massachusetts Medical Society’s health IT conference on Friday, Dr. Kassler began his remarks by outlining the impressive breadth of innovation occurring at the national level.

He then told physicians in the audience that the only way to take advantage of these innovations is to embrace information technology.

Later, in response to a question about whether physicians should wait to adopt EHRs until interoperable health information exchanges become a reality, Dr. Kassler said, “I reject the idea that you need a fully functional EHR to get the benefits.” He said the benefits from the decision-support tools in a freestanding EHR is “reason enough to invest.”

David Blumenthal: Physician Professionalism and Health IT

Posted in Electronic health records, Electronic Medical Records, Health IT on January 14th, 2011 by MMS – 1 Comment

Dr. David Blumenthal, the leader of the federal government’s health IT initiative, keynoted the MMS’ health IT conference with remarks today asserting that adoption of health IT is a professional imperative for physicians.

“Information and its management is a core competency for the profession,” he said. “Can we be technically competent if we don’t manage information using the most capable and available technology?”

Dr. Blumenthal also extolled explosion of innovation in the EHR industry, and that every major electronics company is trying to build a better EHR. He said a “tidal wave of change” is coming, and predicted there won’t be another opportunity in our lifetime to have the government subsidize the implementation of EHRs.

AMA Releases Comprehensive Physicians’ How-To Guide on ACOs

Posted in Accountable Care Organizations, Electronic health records, Electronic Medical Records, Global Payments, Payment Reform on January 10th, 2011 by MMS – Comments Off

Photo by MyTudut via FlickrThe American Medical Association has released one of the most comprehensive resources produced so far to help physicians evaluate their options for practice integration, accountable care organizations, and other issues, following the passage of federal health reform last year.

The resource may also be helpful to Massachusetts physicians who are thinking about what statewide payment reform and ACOs could mean to them.

Here are some of the topics:

  • ACO governance issues
  • Partnering with hospitals
  • Partnering with health plans
  • CO-OPs and accountable care
  • Electronic health records and federal incentive payments
  • Managing anti-trust risk

The document is available from the AMA at no cost.

Download the document here. (.pdf, 112 pages, 781 kb)