Health IT

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.


  • 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 on Data Tracking and Analytics: No Longer Avoidable in Physician Practices

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
— 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 on State Steps Up EHR Support Services for Physicians

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

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.

AMA: Proposed “Meaningful Use” EHR Timetable is Too Aggressive

Posted in Electronic health records, Health IT on June 29th, 2009 by MMS – Comments Off on AMA: Proposed “Meaningful Use” EHR Timetable is Too Aggressive

The American Medical Association and 81 state and specialty medical societies told federal officials last week that proposed milestones for the physician installation of electronic health records is too aggressive because physicians “lack the necessary infrastructure, standards, and systems” to achieve the council’s proposed timetable.

The Massachusetts Medical Society was one of the state medical societies co-signing the letter.

The letter proposes a detailed alternate timetable that “is aimed at ensuring that the bar is not set too high or too low; one that is reasonable and ensures that all eligible physicians in all size practices and specialties are able to take advantage of the incentives specified” in the stimulus bill.

The letter states that the path to widespread use of EHRs should last several years. It also stated that specific check points should be met before moving from one implementation phase to the next. “This check point will help ensure not only physician readiness and the capacity of the system to meet these goals,” said the letter, “but will also help assure continued access to safe, quality care for patients.”

The federal stimulus bill signed into law earlier this year gives physicians up to $44,000 in Medicaid or Medicare incentives starting in 2012 if they can demonstrate a “meaningful use” of electronic health records. Physicians and hospitals have been awaiting the specific definition of “meaningful use” since then. The Health Information Technology Council, a new entity created by the stimulus bill, released its proposed timeline on June 16 and accepted comments through June 26.

The council will now review the comments and is expected to issue final standards by the end of the year.

AMA Federation letter

AMA Federation Proposed Timetable

State Seeking Input on How to Spend Health IT Funds

Posted in Health IT on April 7th, 2009 by MMS – 1 Comment

The Massachusetts Health Information Technology Council has scheduled five hearings to hear suggestions how it should implement electronic health records (EHRs) and health information exchanges (HIE) for physicians and hospitals across the state.

Depending on who's doing the estimating, Massachusetts will get between $40 million and $70 million over the next year from the federal stimulus bill to promote EHRs and HIEs. What should we spend it on? The council wants to hear suggestions.

The hearings will be held at five locations from April 13 to April 28.

April 13
6:00 – 8:00 pm
Massachusetts Medical Society
860 Winter St.
Waltham, MA

April 14
10:30 am – 12:30 pm
Baystate Educational Center (up to 75 people)
361 Whitney Avenue
Holyoke, MA

April 22
10:30 am – 12:30 pm
Plymouth South Middle School
488 Long Pond Rd

April 27
10:00 am – 12:00 pm Boston
1 Ashburton Place
21st floor, Conference Rooms 2 & 3
(This hearing will focus specifically on issues pertaining to public health)
April 28
10:00 am – 12:00 pm
Worcester City Hall
Levi Lincoln Chamber
455 Main Street

Here are the questions that the council says it wants to explore:

  1. What are the greatest barriers and challenges facing physicians and hospitals in implementing EHRs/HIEs that will qualify for Medicare and Medicaid incentive payments?
    Are there different types of barriers for Primary Care, Specialists or different specialties?
  2. What implementation strategies should the Commonwealth pursue to assist hospitals, physicians, health centers, and others to qualify for federal incentive payments to adopt and implement Electronic Health Records (EHRs) with a Health Information Exchange (HIE)?
    Should we prioritize by provider types?
    Should HIE be a high priority where there is substantial penetration of EHRs?
  3. What types of financing strategies, should the Commonwealth consider to assist hospitals and physicians to implement EHRs and HIEs?
    How should the State prioritize using its limited funds?
  4. What other kinds of assistance do physicians and hospitals require to adopt these technologies?
  5. Under the Federal Stimulus bill, there are significant changes to the Privacy rules/HIPAA which create conflicts between HIE and privacy. How should information be exchanged or shared without compromising the security of the data, and the privacy of the patient?
  6. What are the major challenges that Public Health Hospitals and community health centers will encounter and how can stimulus funds assist them?
  7. How can the state best ensure that EHR/HIE implementation will enhance population health and allow local communities and the state to enhance public health reporting and surveillance?
  8. What outcomes should the federal government and the state track to document the benefit of EHR/CPOE on health care quality?
  9. What experiences have you had with EHRs or HIE? What lessons have you learned from this experience?  What lessons learned from North Adams, Newburyport and Brockton should the state take into account while developing and implementing a statewide plan?
  10. What can the role of the state be to enhance the position of local HIT companies for a national role?
  11. Does the availability of federal stimulus funding in the form of Medicaid/Medicare incentive payments change your views on the adoption and use of EHRs? Why or why not?
  12. Have you already received assistance from a hospital, independent practice association, non profit or government organization in the implementation or use of an electronic health record? If so, has the assistance been effective?
  13. What are the aspects of EHR/HIE that are most important to consumers? (e.g., patient portal, clinical decision support, privacy)
  14. How can the private sector help to accelerate HIT implementation?

“Health Affairs” Tackles Health IT and Spotlights the Mass. eHealth Collaborative

Posted in Electronic health records, Health IT on March 10th, 2009 by MMS – Comments Off on “Health Affairs” Tackles Health IT and Spotlights the Mass. eHealth Collaborative

The new edition of Health Affairs, published today, is called "Stimulating Health IT." It is devoted almost entirely to the challenge of implementing comprehensive health IT systems throughout the country.

It relies heavily on case studies of EHR pilot projects. In two articles of local interest, Massachusetts eHealth Collaborative Executive Director Micky Tripathi co-authors articles about the results of his nationally renowned program.

  • In one article, Tripathi and the director of the Primary Care Information project in New York City, describe how they led successful efforts in their respective communities to implement broad-scale EHR adoption. The approaches contrast in many ways, but they share four broad lessons.
  • The second article, written Tripathi and three associates at the eHealth Collaborative, outlines how they were able to persuade 90% of patients in their communities to voluntarily allow their personal health information to be added to the community's health information exchange, while being very upfront and forthcoming with the patients about the difficult issues of privacy and consent.

This entire issue of Health Affairs is worthy of careful reading. A subscription is needed to read the full text of most articles.