Feds Want to Extend Stark Law Exception

The Obama administration has proposed two rules to extend protections that allow hospitals to donate electronic health record technology to physicians who refer patients to their facility, The Hill's "RegWatch" reports (Goad, "RegWatch," The Hill, 4/8).

Background

The Stark Law bans payments that are aimed at encouraging referrals to hospitals. In addition, the federal anti-kickback law prohibits payments that are designed to influence care for Medicare beneficiaries.

However, in an effort to encourage physicians to adopt costly EHR systems:

• CMS established an exception to the Stark Law allowing hospitals to donate EHR software to physicians; and
• HHS' Office of Inspector General established a "safe harbor" provision to protect such EHR donations from anti-kickback enforcement, provided that the physicians cover 15% of the cost of the EHR technology.

The exceptions to the Stark and anti-kickback laws are scheduled to expire at the end of 2013 (iHealthBeat, 3/29).

Details of Proposed Rules

The Obama administration's proposal includes:

• A proposed rule from CMS that would extend the Stark Law exception for EHR donations to the end of 2016; and
• A proposed rule from OIG that would extend the safe harbor protections for EHR donations to the end of 2016 (Durben Hirsch, FierceEMR, 4/9).

 

In addition to extending the EHR donation protections, the new proposed rules would remove an electronic prescribing requirement from the original rules and adjust language regarding the types of EHR systems that qualify for exceptions (Conn, Modern Healthcare, 4/9).

OIG in its proposed rule said, "We expect these proposed changes to continue to facilitate the adoption of electronic health recor[d] technology" ("RegWatch," The Hill, 4/8).

CMS in its proposed rule said that it is considering extending protections for EHR donations to Dec. 31, 2021, to align with the end of the Medicaid portion of the meaningful use program.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHR systems can qualify for Medicaid and Medicare incentive payments.

Publication, Public Comments

The two proposed rules are scheduled to be published in the Federal Register on Wednesday.

Federal officials will accept public comment on the proposed rules for 60 days after their publication (Murphy, EHR Intelligence, 4/9).

Read more: http://www.ihealthbeat.org/articles/2013/4/9/federal-officials-seek-to-extend-protections-for-ehr-donations.aspx#ixzz2PzgTjelu

Most Incentive Money Spent on More IT

by Paul Cerrato, Contributing Writer for Healthcare IT News

With no federal rules telling providers how they can spend their meaningful use incentive checks, hospitals and practices have their options wide open. While many are investing in more technology, that’s only the tip of the proverbial iceberg.

Acacia Internal Medicine Specialists in Phoenix, for example, has used part of its check to invest in a community room to hold wellness classes, and to hire a tai chi teacher. However, the prevailing trend is to use the money to fund more IT growth and pay down debt incurred while putting in the software and hardware needed to qualify for MU in the first place.

[See also: 2012: The year meaningful use took hold.]

“Most of our clients are considering the incentive funds paid as an offset for funds they are spending in advance to qualify for meaningful use and to pay for anything additional they will require to meet Stages 2 and 3,” wrote a member of a hospital technology group on LinkedIn in a discussion about how hospitals will use their MU dollars.

“The clear pattern we’re seeing among the hospitals we work with is that they are using their incentive payments to fund current and future IT initiatives.”, said Jim Adams, executive director, research and insights at The Advisory Board Company. Most have earmarked the money for EMR enhancement or optimization, he added, and some hospitals are also investing in their own health information exchanges, or rolling out an ambulatory EMR for physicians’ offices affiliated with the hospital.

The Advisory Board Company estimates that to date each Medicare eligible professional received on average about $17,300, while Medicaid eligible professionals received about $21,600. A hospital with about 34,000 discharges per year, two-thirds of whose revenue came from Medicare, can expect to receive about $13 million over the next few years, according to Adams.

[See also: EHR incentive payments top $12 billion.]

Many healthcare organizations are unable -- or unwilling -- to go on record about how they are spending the money. Some providers may be unwilling to disclose this information because they consider it proprietary, but it’s also possible they have miscalculated the anticipated ROI.

A recent analysis reported in Health Affairs came to the conclusion that EHRs are a money losing proposition for most physicians. Julia Adler-Milstein, from the University of Michigan in Ann Arbor, and her associates, surveyed 49 community practices and projected that the average doctor “would lose $43,743 over five years; just 27 percent of practices would have achieved a positive return on investment; and only an additional 14 percent of practices would have come out ahead had they received the $44,000 federal meaningful use incentive.”

Survey: Healthcare Careers Sizzling

Bernie Monegain, Editor for Healthcare IT News

Healthcare continues to be one of the hottest areas for hiring across the country – and an area where it's crucial to recruit the right talent – according to a survey by recruiting firm CareerBuilder.

CareerBuilder’s annual survey finds 22 percent of healthcare hiring managers plan to add full-time, permanent healthcare employees in this year, up three percentage points over 2012. At the same time, 23 percent of healthcare employers reported they have open positions for which they can’t find qualified talent.

Thirteen percent of all U.S. jobs are in healthcare and the Bureau of Labor Statistics estimates that the U.S. will add 5.6 million health care jobs from 2010 to 2020, the largest projected increase of any industry.

CareerBuilder announced today a new division specifically for healthcare with stronger market intelligence, more customized recruitment and information on healthcare trends and workforce issues.

[See also: Healthcare IT hiring: A new frontier.]

"The recession had very little impact on the hiring momentum of the healthcare industry and, to meet further demand, CareerBuilder has pooled a group of proficient experts into a new division that will focus solely on assisting healthcare client’s hiring needs efficiently and effectively," said Jason Lovelace, president of the Health Care Group at CareerBuilder, in a news release. "Our research suggests that heathcare hiring will accelerate in 2013 with heightened competition for high skill labor and improved compensation trends. As a result, it is essential that we arm our healthcare clients with the data and tools needed to recruit qualified talent and ultimately, positively impact patient care."

Temporary and contract hiring

More healthcare organizations are turning to staffing and recruiting companies and temporary workers to help meet increased market demands, according to Lovelace Thirty-six percent of healthcare employers plan to hire temporary and contract workers in 2013, up from 34 percent last year, the Career Builder survey shows. Among these employers, 37 percent plan to transition some temporary workers into full-time, permanent employees over the next 12 months. There are an increasing number of areas – information technology is one – where demand for skilled positions – is growing much faster than the supply.

Harris Interactive conducted the online survey on behalf of CareerBuilder, among 274 health care hiring managers and human resource professionals and 576 healthcare workers (employed full-time, not self-employed, non-government) between Nov.1-Nov. 30, 2012

HIMSS Analytics: HITECH Achieved its Intended Result

According to the analytics arm of the Healthcare Information and Management Systems Society (HIMSS), HIMSS Analytics, the number of hospitals adopting EHRs has increased steadily over the past year. The number of hospitals that have reached Stage 5 and 6 of HIMSS Analytics’ Electronic Medical Record Adoption Model (EMRAM) has increased by more than 80 percent over the five most recent quarters for which data is available.

In addition, the data from HIMSS analytics found that the number of acute-care hospitals that achieved Stage 7 has increased 63 percent. On the other side, the hospitals at Stages 0, 1, 2, and 3 have seen decreases of at least 10 percent. 

“This data suggests that the HITECH portion of the 2009 stimulus law is achieving its intended result of encouraging increased implementation and meaningful use of electronic health records among hospitals,” John Hoyt, executive vice president of HIMSS Analytics, said in a statement. 

“Hospitals are lag indicators of economic conditions. This information indicates that despite the recession, hospitals are continuing to see the value of investing in health IT to improve the quality, safety and effectiveness of patient care.”

HIMSS Analytics says on the contrary, few hospitals in Canada have achieved similar success in the EMRAM scale. It notes Canada does not have an equivalent stimulus program.

“Facilities moving to the upper stages of EMRAM are laying the groundwork for interoperability to occur,” said Hoyt.  “Stage 6 and Stage 7 hospitals are fully prepared for provider-to-provider or facility-to-facility interoperability, as well as increasing the provider or facility’s ability to provide electronic health data reporting to public health and immunization registries to support population health review and syndromic surveillance.”

Original article 

Survey says EHR adoption faster than expected

Erin McCann

Family physicians are adopting electronic health records (EHRs) at a much faster rate than previous data suggested, reaching a nearly 70 percent adoption rate nationwide, new study findings reveal. 

The study, published in the January/February issue of the Annals of Family Medicine, shows EHR adoption by family physicians has doubled since 2005, with researchers estimating that the adoption rate will exceed 80 percent by 2013.  

Findings also reveal a higher percentage of EHR adoption among physicians in comparison to a July 2012 study conducted by the CDC's Center for National Health Statistics, which reported that 55 percent of office-based physicians had adopted EHRs.

EHR adoption rates among family physicians, however, have also been shown to be higher than other office-based specialities. One November study, for example, reported that pediatricians had some of the lowest adoption rates of EHR systems, with a paltry 41 percent indicating they had EHRs.   

[Related: 7 ways meaningful use grew deeper roots in 2012]

Researchers also point to geographical differences in EHR adoption rates. Georgia, Massachusetts, Minnesota, New Hampshire, Oregon and Utah, for example, had significantly higher adoption rates in comparison to states with much lower numbers such as Florida, Illinois, Michigan and Ohio.   

According to study co-author Andrew Bazemore, MD, director of the Robert Graham Center for Policy Studies in Primary Care, report findings offer "some encouragement that we have passed a critical threshold," HealthDay reported.   

Utah family physicians had the highest EHR adoption rates in the country, pegged at nearly 95 percent statewide, according to the study, but Bazemore said, "More work is needed, including better information from all of the states."  

North Dakota ranked lowest among the 50 states, with an overall EHR adoption rate of only 47 percent. 

The study was conducted by researchers at the Association of American Medical Colleges, Georgetown University Medical Center, National Center for Health Statistics, University of Colorado Denver, The Robert Graham Center for Policy Studies in Family Medicine and Primary Care and Medstar Franklin Square Hospital.

mHealth Market to hit $10.2B by 2018

Rene Letourneau, Editor, Healthcare Finance News

The global mHealth market will grow at a compound annual rate of 41.5 percent in the next five years to reach $10.2 billion by 2018, up from $1.3 billion in 2012, according to a recent report from market research firm Transparency Market Research.

The increasing popularity of smartphones and the uptick in chronic diseases are key drivers, said Pawan Kumar, head of ICT and Semiconductor Practices at Transparency Market Research.

[See also: Mobile health initiative expands with global focus.]

“The introduction of newer and improved mobile health applications in the market is helping the healthcare providers to cater (to a higher) number of patients in less time with significant cost saving,” said Kumar. “Faster development of 3G and 4G networks is also expected to fuel the further growth of the market.”

The remote patient monitoring services segment of the mHealth market is growing the most quickly and accounted for about 63 percent of revenue in 2012.

Remote monitoring of patients can help reduce costs significantly by reducing the amount of time the patient spends in the hospital and by lowering the frequency of follow-up visits to the physician, which, according to Kumar, is especially important due to the “shortage of healthcare workers globally.”

Among the biggest challenges that could potentially weaken market growth are data storage and security, said Kumar.

[See also: FDA issues draft document on mobile app regulations.]

“Multiple device access to healthcare data and applications, on- and off-premises, raises security concerns,” he said. “In the case of mHealth applications, there is a high risk of loss of unprotected confidential data to an unauthenticated user, and physicians are short of time and skills to take care of such security measures.”

Despite the hurdles, Kumar expects the market to continue to trend up.

“We expect that the robust market growth will continue on account of increasing innovation and growing participation of stakeholders,” said Kumar.

“A number of organizations within the provider and mobile technology industries are now sponsoring projects across developing countries like Africa, India and others to explore mHealth opportunities,” he added. “Governments across different countries are playing a vital role in the growth of the mHealth market by initiating policies to support mobile health applications in their respective countries.”

HIMSS: We Expect Continued Focus on Health IT

November 8, 2012  Gabriel Perna, Healthcare Informatics

The Healthcare Information and Management Systems Society (HIMSS) recently released a statement in response to the results of Tuesday’s elections, congratulating President Barack Obama and the other winners of the night. In addition, HIMSS said it anticipates that the Obama administration and congressional members will “continue their focus on health IT.”

HIMSS said congress is likely to examine interoperability, the Meaningful Use program, and IT innovation. It said the House Science, Space, and Technology Committee has already scheduled a hearing on Nov. 14, where HIMSS Board of Directors Chair Willa Fields, RN will present testimony.  Also, “Federal agencies are expected to soon release regulations to address key components of healthcare transformation, including the awaited ‘omnibus’ privacy rule, parameters for health insurance exchanges, and early designs on requirements for Meaningful Use Stage 3,” the organization said in a statement.

Other organizations, such as the American Medical Association (AMA) and the College of Healthcare Information Management Executives (CHIME), have released their own comments on the election.

Scorecard reveals wide disparities in care across the country

NEW YORK – Healthcare access, cost, quality and outcomes can vary greatly from one community to the next, both within states and across states, depending on the performance of the healthcare system available to residents, according to a new report from the Commonwealth Fund Commission on a High Performance Health System.

In the first scorecard measuring how 306 local U.S. areas are doing on key healthcare indicators such as insurance coverage, preventive care, and mortality rates, researchers at The Commonwealth Fund found significant differences between the best- and worst-performing localities. Major U.S. cities also showed wide disparities on many key measures of healthcare, with San Francisco and Seattle ranking among the top 75 local areas in the country, and Houston and Miami ranking in the bottom 75. An interactive map [see below] accompanying the report allows comparison of cities and communities across the country.

The stark differences in healthcare add up to real lives and dollars. According to the scorecard, 66 million people live in the lowest-performing local areas in the country. If all local areas could do as well as the top performers, 30 million more adults and children would have health insurance, 1.3 million more elderly would receive safe or appropriate medications, and Medicare would save billions of dollars on preventable hospitalizations and readmissions.

The report, "Rising to the Challenge: Results from a Scorecard on Local Health System Performance, 2012," and the online interactive map [see below] rank local areas on 43 performance metrics grouped into categories that include access to healthcare, healthcare prevention and treatment, potentially avoidable hospital use and cost and health outcomes. The 43 metrics include potentially preventable deaths before age 75, prevalence of unsafe medication prescribing, the proportion of adults who receive recommended preventive care, and the percentage of uninsured adults.

The report finds there is room to improve everywhere, with no community consistently in the lead on all the factors that were measured. However, there were geographic patterns: Local areas in the Northeast and upper Midwest often ranked at the top, while local areas in the South, particularly the Gulf Coast and southern central states, tended to rank at the bottom on many measures.  Read the full article here.

6 Most In-Demand Skills for HIT Professionals in 2012

by Michelle McNickle | HealthcareITNews

The demand for capable IT specialists is growing, and according to Guillermo Moreno, vice president of recruiting firm Experis Healthcare, certain skills are bound to take the spotlight come 2012. 

“This is an area that’s of interest and concern, given what we’re seeing in the marketplace,” Moreno said. “With the continuation of the build of the information technology movement in healthcare, we are seeing some sizable fractures in the healthcare space around human capital and human talent.” 

With the New Year around the corner, we asked Moreno to look ahead and share with us the top six most in-demand skills for healthcare IT professionals in 2012. 

1. ICD-10/5010 expertise. Moreno said with the movement to reach the audit function and compliance right in front of us, the demand in the market place for professionals is at an all-time high. “More and more organizations are beginning to road map themselves in ICD-10 migration,” he said. “Everyone understands what ICD-9 is and what it means to generically migrate to ICD-10, but there are few who have actually made the transition or are in the process of doing so.” Moreno said he’s seeing requests and demands both on the payer and provider side, as well as large government organizations looking for skilled professionals. This includes those with expertise in project management, program management, and coding. “Those are the three pretty major areas for people who understand ICD-10, and frankly, in this country, there isn’t a lot of experience in that space.” 

[See also: ICD-10 stirs controversy among payers.]

2. EMR and EHR implementation. The increased momentum and adoption of electronic health records is prevalent both for ambulatory and inpatient care. But, according to Moreno, with adoption comes voids and needs in the industry. “Some of the major software houses are tailoring their agendas around meaningful use and CPOE and other things that are required,” he said. “This includes quality measures and compliance in the future around payment. So when you look at that and who is in the marketplace today, there’s clearly a higher degree of contracts in place and requirements to deliver against inpatient and outpatient EMRs versus what’s in the marketplace that’s available.” He added that for certain implementation skill sets “there is a higher demand than there is availability.”

3. Applications know-how. “The other piece, both in the payer and provider space, is the development solution space,” said Moreno. This includes applications and data management, as organizations become more mature regarding solutions. “They’re beginning to fill the landscape and [are looking into] a lot of applications required to measure quality and standards,” he said. “So some increase in software development, software management, and application management. Yet, when you look at the marketplace, and in some cases, companies who own the solutions themselves, they’re having difficulty finding those skills.”

4. Security and compliance skills. Both of which go hand-in-hand with where we are today in the industry and where we’re navigating to, said Moreno. “[This is] where information is collected and is required to move from one environment to another,” he continued. “There’s a notion of how do we protect that information and be HIPAA compliant and deal with PHI.” In the past, added Moreno, the industry was focused on introspective security. “And now, there’s a higher increase for skills in the information management security side of the business.”

[See also: Data breaches top of mind for IT decision makers.]

5. Data management talents. Moreno said data management and data security is where he and his team have placed a lot of effort and emphasis. “It’s the complaint side of the business, so it’s important to understand how you manage and protect the information.” This includes putting together the appropriate structure to govern security, he said, and knowing how to protect information and address breaches from a compliance perspective. “Knowing how to have plans in place so you address the potential losses and breach of information and how to be protected in the future,” added Moreno. “It’s going to require some skill sets that aren’t mainstream in healthcare; they are in other industries, so I think we’re going to see a gap for a period then a movement of professionals who have that skill set in other industries, helping to address this need in healthcare.”

6. BI and analytics abilities. Moreno concluded business intelligence and analytics data is a way to “aggregate information in a better way and with better quality.” But he sees the need for these skills as yet to come. “They aren’t necessarily in the marketplace," he said. "There are tools, but they aren’t as robust and mainstream as those the pharmaceutical industry has been using for a long time.” The industry is starting  to see a higher degree of attention on finding newer and more aggressive BI and analytics tools, he added, “which, in turn, will have a higher degree of demand for those professionals."

More Than 100,000 Health Providers Sign Up for Meaningful Use

As of the end of September, more than 100,000 hospitals and physicians had registered for the meaningful use incentive program, according to CMS, Government Health IT reports.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

Of the total 114,644 registrants:

• 88,399 physicians and hospitals signed up for the Medicare incentive program;
• 24,030 physicians and hospitals signed up for the Medicaid incentive program; and
• 2,215 hospitals signed up for both incentive programs.

As of August, 90,000 health care providers had signed up for the meaningful use incentive program.

During the Health IT Policy Committee's meaningful use work group meeting on Tuesday, Robert Tagalicod -- director of CMS' Office of eHealth Standards and Services -- said that as of Sept. 30, CMS had doled out more than $850 million in meaningful use incentive payments, including $357.4 million under the Medicare program and $492.6 million under the Medicaid program.

Since April, 3,722 physicians and 158 hospitals have received Medicare incentive payments for successfully attesting to the meaningful use of EHRs, Government Health IT reports. Health care providers participating in the Medicaid program do not have to attest to meaningful use criteria in their first year in the program, but they receive payments for adopting, implementing or upgrading certified EHRs (Mosquera, Government Health IT, 10/5).

Read more: http://www.ihealthbeat.org/articles/2011/10/6/more-than-100000-health-providers-sign-up-for-meaningful-use.aspx#ixzz1a7R1KXh9