Health IT

Why Your Windows XP Computer Could Become a HIPAA Security Risk

Posted in Health IT, HIPAA, practice management on April 3rd, 2014 by MMS – 1 Comment

photo by stevendepolo via flickr.comIs your practice using computers that run Microsoft Windows XP? If so, you could be exposing your practice to security risks in the near future.

After April 8, Microsoft will stop supporting Windows XP, its venerable but aged operating system. This means that Microsoft will no longer send you regular software updates to correct new security holes and software bugs.

Will your XP computers suddenly become non-compliant? Not simply because Microsoft is withdrawing technical support. But without software regular patches, your computers may be increasingly vulnerable to the hackers and trolls who scour the internet. Usually they’re seeking credit card and bank account information, but if your system has security holes, they could access your patients’ protected health information more easily.

Will your computers continue to run on XP? If they’re functioning today, they probably will continue to function for a while. But many computer consultants are advising their clients to assess their risk and determine how they will modernize their systems.

Can I upgrade myself? Many computer users have tried upgrading to Windows 7 or 8 on their existing machines, but some have reported the process to be difficult, and sometimes a failure altogether. Many older machines simply don’t have the processing power or memory to run the newer versions of Windows. Sometimes the best solution is to get new hardware. Microsoft does offer brave, intrepid do-it-yourselfers  free data-transfer software.

Our advice? Talk to your computer vendor or consultant, and develop an upgrade plan. Granted, Microsoft derives commercial benefit from this decision, but security-sensitive users are left with little choice.You don’t necessarily have to upgrade today, but it’s not wise to delay the process indefinitely.

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

CMS to Delay ICD-10 Implementation

Posted in Electronic Medical Records, Health IT on February 14th, 2012 by Erica Noonan – 6 Comments

The acting administrator of the Centers for Medicare and Medicaid Services said today  her agency may delay adoption of a complex new insurance coding system.

Speaking at a conference of the American Medical Association on Tuesday, Marilyn Tavenner (right) said CMS is considering giving the nation’s doctors more time to switch to the ICD-10 systems.  Currently, the law requires implementation by October 2013.

(UPDATE: On Feb. 16, the CMS formally announced an indefinite postponement of the deadline to comply with the ICD-10 system.)

“I’m committing today to work with you to reexamine the pace at which we implement ICD-10,” Tavenner said to loud applause from hundreds of physicians. “I want to work together to ensure that we implement ICD-10 in a way that (meets its) goals while recognizing your concerns.”

Proponents say the switch from ICD-9 to ICD-10 will bring the U.S. medical system in line with much of the rest of the world, while allowing health officials to better track the nation’s health and monitor diseases.  The new system has some 68,000 codes, five times the amount under the current system.

The AMA and other physician groups say switching to ICD-10 coding will cost medical practices anywhere between $83,290 and more than $2.7 million, and that the pressure is too much while physicians are also coping with complex new electronic health record requirement mandates.

Lynda Young, M.D., president of the Massachusetts Medical Society, praised Tavenner’s openness to delaying ICD-10 implementation.

“This is a good thing, and it will give us more time to get ready,” said Dr. Young. “There are serious time and cost issues for practices trying to implement all of these changes at once.  We want to give people a chance to take care of the other changes first.”

Tavenner said her office would formally announce its intention to craft new regulations within the next few days.

More on the CMS announcement:

Erica Noonan

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.

State Steps Up EHR Support Services for Physicians

Posted in Electronic health records, Electronic Medical Records, Health IT, meaningful use on September 9th, 2010 by MMS – Comments Off

The state agency charged with helping physicians and hospitals implement electronic health records has released its list of 18 certified “implementation organizations” to act as consultants to practices during the implementation process.

They range from hospitals and health care systems, to private consulting firms, to even a few EHR vendors themselves.

The state also unveiled a list of 10 certified vendors of EHR software, and said that it’s made arrangements through Webster Bank to provide loans to physicians to help them purchase and install the software.

In addition, Dr. JudyAnn Bigby (pictured), secretary of the state Executive Office of Health and Human Services, issued an open letter today to all physicians inviting them to take advantage of the state’s support services. (.pdf)

She wrote, “As a physician, I understand that making the transition to electronic health records is challenging, but the Patrick Administration and the team of professionals at the Regional Extension Center will help you every step of the way.”

She invited physicians to become members of the state’s Regional Extension Center, which will provide direct support services to practices worth $4,500, upon payment of a registration fee up $600 to $800. The application form is available here. (.pdf)

General information about EHRs from the Massachusetts eHealth Institute is available to anyone, regardless of whether they’ve joined the Regional Extension Center.

MMS on Meaningful Use Criteria: “Too Much, Too Soon”

Posted in Health IT, meaningful use, Medicare on March 15th, 2010 by MMS – Comments Off

119779298_9325985cc0_oThe MMS told the Centers for Medicare and Medicaid Services today that its proposed rules for a national electronic health record incentive program are too aggressive, and would deter  many physicians from participating in the program.

The MMS said the program “asks for too much, too soon” from many physicians, especially those in small practices. Read the MMS letter here. (.pdf, 6 pages)

The comments were a response to the federal government’s proposed  definition of “meaningful use,” the criteria that would determine whether physicians can recoup more than $40,000 of Medicare or Medicaid subsidies per person for installing an EHR. Today was the deadline to submit comments on the widely anticipated rulemaking.

Among the proposal’s shortcomings, according to the MMS:

  • Not enough representation from small practices on its advisory committee
  • Pediatricians are disadvantaged because few would meet the minimum 20% Medicaid patient panel to qualify
  • Specialists are disadvantaged because the criteria are focused on primary care physicians
  • The high administrative burden on small practices, who must redesign their workflow to implement an EHR
  • Hospital based physicians who also practice in outpatient clinics are unfairly excluded from the program

The MMS recommendations include:

  • Lengthen the schedule for adoption and compliance
  • Reduce the number of required criteria
  • Provide partial reimbursement for partial completion of the criteria
  • Create a separate track for those who do not yet have full health IT capabilities

The American Medical Association’s comments today were similar. In a document co-signed by 94 state and specialty medical societies (including the MMS), the AMA said it worries that physicians who install an EHR will find the requirements “overly complex and unattainable.”

The American Hospital Association called for a “rational timeline,” and criticized the lack of clarity in several sections of the proposed rules.