Why implementing EHR systems still Worried with Danger

The often-mentioned issues to the implementation of electronic health record (EHR) systems aren’t what healthcare providers say they are. Why implementing EHR systems are still filled with risk and danger?

That is the finding of researchers from the institute of Johns Hopkins University’s Bloomberg School of Public Health who observed data from the American Hospital Association (AHA) Annual Survey Information Technology Supplement.

“Several people were saying that the biggest issues for implementing EHR systems were the purchase price and meeting the Meaningful Use requirements,” claims Eric Ford, professor and associate department chair at the Bloomberg School of Public Health. “While those are the most usual uncertainties, that does not essentially mean they are the largest concerns in terms of being actual issues.”

Researchers utilized a novel analytic method—called item response theory (IRT)—to measure the intensity of difficulty that specific issues pose in implementing EHR systems that meet Meaningful Use requirements.

In accordance to Ford, IRT is a collection of modeling techniques for observing item-level data gained to measure variation between respondents.

What IRT disclosed from AHA’s Annual Survey were importantly different results from descriptive statistics in assuming the magnitude of specific EHR implementation issues. Particularly, researchers founded that “gaining physician cooperation” and “ongoing costs of maintaining and upgrading systems” were the most challenging implementation problems for providers, instead of “upfront capital costs” and the “complexity of meeting Meaningful Use criteria within implementation timeline” referred by the survey.

Results of the research were released this week in the American Journal of Managed Care. AHA officials weren’t instantly present to comment on their survey results.

“Various surveys of hospital administrators have sought to recognize hurdles to the Meaningful Use of electronic health record technology. Although, the surveys used often lack the precision to give a list of hurdles ordered from most difficult to least difficult. Rather, surveys tend to report the most usual or famous hurdles to adoption,” states the article. “However this approach is likely to capture how common a problem is among hospitals, it doesn’t explicitly address how difficult a particular challenge is.”

Based on the results of his team, Ford asserts that hospital administrators require spending more time working with their clinical staffs to ensure that the EHRs meet their requirements and that they are rightly trained to make the best use of the systems.

When it comes to getting clinician buy-in, the researchers suggest that doctors and nurses should be brought in at the earliest stage possible of implementing EHR systems.

Moreover, Ford believes the other issue that has been immensely underestimated is the ongoing cost of EHR ownership.

Ford notes that the significance of handling ongoing ownership and operating costs for EHRs is often not completely understood by organizations until after they start their implementations.

“Post-EHR implementation, health systems have to roll out extra functionalities to meet organizational requirements and comply with ever-increasing regulations,” the researchers summarize. Although, public policies that give rewards for implementing more sophisticated EHR functionalities can be tailored to ameliorate these issues, they argue.

 

AHA: ONC interoperability standards advisory requires more specific information

The American Hospital Association is emphasizing the Office of the National Coordinator for Health IT to give more particular data on the features and metrics it has utilized to assess the readiness of standards and implementation specifications in its draft 2017 Interoperability Standards Advisory. ONC interoperability standards advisory requires more specific details.

In accordance to ONC, the advisory is meant to serve as a “coordinated catalog of standards and implementation specifications” to be utilized by industry as a single, public list to meet interoperability requirements focused explicitly on clinical health information technology. Although, AHA would like to see higher detail in how ONC distinguishes mature from emerging standards.

“The consistent utilization of mature standards is necessary to solving the interoperability issues facing our nation,” wrote Ashley Thompson, AHA’s senior vice president for public policy analysis and development, to National Coordinator for Health IT Vindell Washington, MD.

In specific, AHA needs to see ONC prioritize outreach to organizations conducting maturity assessments so that upcoming versions of the ONC Interoperability Standards Advisory (ISA) can involve this reference. The association also suggests that the agency utilize the ISA to make publicly present the feedback it get on the adoption experience of standards and implementation specifications.

Moreover, AHA recommends that the 2017 ONC Interoperability Standards Advisory also involve data on actual standards use in the real world, and not merely adoption.

As an outcome, AHA asserts that the draft 2017 ISA must assess the victorious use of the included standards, not merely adoption, in case to rightly evaluate the capability of a standard to support interoperability.

Additionally, AHA suggests that ONC support the work of private-sector steps that are educating stakeholders about the availability and readiness of the proposed standards, particularly as they pertain to interoperability.

“The majority of the standards involved in the Draft 2017 ISA don’t show whether a test tool is present to determine conformance to the standard or the implementation specification,” claims the letter. “Positive outcomes from conformance testing will add confidence that a standard is all prepared to support the interoperability requirements of providers.”

An ONC spokesman stated that the agency doesn’t respond to written comments, like those from AHA, however it does review them and they will assist to inform the final advisory.

 

AHA inquires Congress for modernization of rules on inducements, collusion

As hospitals and physicians growingly shift toward value-based care and take on risk in contracts, they require working together more closely.

Although, the regulatory structure in the organization has not been changed over the years to support that stage of collaboration. Present regulations are structured to stop collusion between vendors or to make sure that agencies do not offer incentives to referring clinicians to admit sufferers for care.

The way contributors presently are paid doesn’t support hospitals and physician practices in enforcing the shared electronic health record (EHR) infrastructures that are required to support coordinated care, the American Hospital Association (AHA) points out in a new report.

“Public and private payers are utilizing the financial incentives to drive behavior to acquire quality results, clinical efficiencies and cost savings—the objective of value-based models,” in accordance to AHA. “At the similar time, the legal framework controlling how, if at all, hospitals can share the threats and rewards has remained static.”

In the latest report, AHA calls for the modification of laws ruling financial collaboration to enable hospitals to subsidize start-up IT prices for the proposed physicians, to bring regulations into the line with present market realities.

3 primary laws managing fraud and abuse in the healthcare industry—The Anti-Kickback Statute, Stark Law and Civil Monetary Penalty Laws—have become significant impediments to collaboration, in accordance to AHA. These rules were made to stop financial relationships between contributors, seeking to make sure that several kinds of contributors performed sufferer care in separate, distinct and uncoordinated ways, with each contributor being paid separately deployed on services given, the report claims.

Existing laws assumed that any shared financial incentive was suspect. Now, latest alternative payment models have modernized and advanced “just because Congress authorized and the HHS Secretary has repeatedly released waivers of the abuse and fraud laws,” the hospital association asserts.

In specific, the Stark Law has become growingly unessential and an important impediment to valued-based care that Congress, Medicare, Medicaid and commercial insurers are supporting, in accordance to the report. “The threat of overutilization, which drove the passage of the Stark Law, is highly or completely eradicated in alternative payment models.”

Moreover, present oversight of compensation arrangements is for an outmoded network where physicians were self-employed, hospitals were separate entities and the payment system treated them as functioning in distinct silos. “It micromanages the situations in which a compensation arrangement is allowed, the amount paid and the way in which compensation is calculated,” in accordance to AHA.

This outmoded network also impacts the health IT initiatives to support value-based care, the association asserts.

AHA further inquires for adjustments to several other regulatory hurdles covering care teams. Those restrictions involve utilizing non-physician practitioners; offering care coordination when a sufferer leaves the hospital; helping sufferers with discharge planning; and prohibiting some kinds of financial assistance to sufferers, like transportation vouchers or in-kind contributions like a meal scale.

AHA: Commercial ACO Tax Ruling hinders Value-Based Care Models

In a letter to the IRS, AHA elaborated that the recent decision to disqualify a commercial ACO from charitable tax exempt status could discourage value-based care for other contributors.

By stripping commercial accountable care organizations (ACOs) of their charitable tax exempt status, the IRS could be threatening the future of value-based care and care coordination, in accordance to the American Hospital Association (AHA).

In a letter addressed to IRS Commissioner John Koskinen, the AHA described that the recent ruling against upholding tax-exempt status for an unnamed ACO was unfounded. Non-Medicare ACOs promote better healthcare for different communities like Medicare Shared Savings Program (MSSP) ACOs and, therefore, deserve a nonprofit, tax-exempt designation.

“We’re seriously concerned that the IRS has adopted a ruling position that means nonprofit hospitals threat losing their tax exemption if they pursue a modern approach to clinically integrated health care that holds the largest promise for improving outcomes and reducing costs,” wrote Melinda Reid Hatton, the AHA’s Senior Vice President and General Counsel.

AHA: MACRA Alternative Payment Model Incentives Require Modifications

CMS should make Alternative Payment Model incentives that make it convenient for contributors to become qualified rather than raising hurdles, AHA argued.

The MACRA Alternative Payment Model incentives should be executed in a way that offers the best chance for physicians to become qualified participants, the American Hospital Association discussed in a letter to CMS this week

MACRA gives incentives for physicians who indicate high-level participation in Alternative Payment Models. AHA claimed that it supports accelerating the utilization and the establishment of alternative payment models and delivery models to reward more effective and coordinated care for sufferers.

Various hospitals, health systems and payers are getting initiatives that better aligning provider incentives to acquire the Triple Aim of making better the sufferer experience of care, improving the health of populations and decreasing the price of care. One way contributors are meeting the aims of the Triple Aim is by making accountable care organizations (ACOs). They are also bundling facilities and payments for episodes of care and establishing latest incentives to involve physicians in making better the efficiency and quality, AHA noted. Although, the healthcare field is yet experiencing a learning curve.

AHA: MACRA Alternative Payment Model Incentives Require Modifications

CMS should make Alternative Payment Model incentives that make it convenient for contributors to become qualified rather than raising hurdles, AHA argued.

The MACRA Alternative Payment Model incentives should be executed in a way that offers the best chance for physicians to become qualified participants, the American Hospital Association discussed in a letter to CMS this week

MACRA gives incentives for physicians who indicate high-level participation in Alternative Payment Models. AHA claimed that it supports accelerating the utilization and the establishment of alternative payment models and delivery models to reward more effective and coordinated care for sufferers.

Various hospitals, health systems and payers are getting initiatives that better aligning provider incentives to acquire the Triple Aim of making better the sufferer experience of care, improving the health of populations and decreasing the price of care. One way contributors are meeting the aims of the Triple Aim is by making accountable care organizations (ACOs). They are also bundling facilities and payments for episodes of care and establishing latest incentives to involve physicians in making better the efficiency and quality, AHA noted. Although, the healthcare field is yet experiencing a learning curve.

“Instead of the growth made to date, the field as a whole is yet learning how to efficiently transform care delivery,” AHA stated.

Just a restricted number of APMs have been launched to the healthcare field so far. “Existing models haven’t gave participation opportunities evenly across physician specialties, AHA stated. As an outcome, a number of physicians might be utilizing APMs for the 1^st time.

AHA was disappointed that CMS has gave “a narrow definition of financial risk when recognizing advanced APMs, which count for intentions of the MACRA bonus payment.” CMS proposes to explain financial threat for monetary losses to need participants to take on downside risk. “This approach fails to identify the significant up-front contribution that must be made by contributors who establish and implement APMs,” AHA stated.

Contributors who engage in APMs are requited invest much time and resources to establish the clinical and operational infrastructures essential to better manage sufferer care. Forming an ACO is expensive. The estimated start-up prices for a small ACO are $11.6 million, AHA stated. For a medium ACO, the startup price is $26.1 million.

 

AHA Finds Four Changes to MIPS as Part of MACRA executions

Among the several suggestions the American Hospital Association (AHA) has made regarding MACRA implementation, it is particularly seeking 4 broad changes to the Merit-based Incentive Payment System (MIPS) with hospital-based physicians in mind.

In written testimony submitted to the House of Representatives Committee on Ways and Means, AHA spelled its 4 suggestions for MIPS implementation.

First, it suggests that MIPS measures align with national priority areas, specifically those involves in the 2015 report by the National Academy of Medicine.

Second, it has called on the Centers for Medicare & Medicaid Services (CMS) to establish a MIPS participation choice for hospital-based physicians.

Third, the agency has sought rigorous risk adjustment to ensure that physicians treating sufferers with complex health conditions are capable to perform well under MIPS.

Fourth, AHA has suggested that CMS align meaningful use needs for both physicians and hospitals in light of the replacement of meaningful use under MIPS with the advancing care information performance category.

AHA looks to collaborate with docs

The American Hospital Association, which lobbied to stop physicians from owning hospitals, has created a new organization to represent doctors who now are owned by hospitals. 

The AHA kicked off its Physician Leadership Forum at a breakfast meeting in San Diego today at the AHA's Leadership Summit. The organization will represent the interests of physicians who are working closely with hospitals on new models of care delivery. Specifically, the new organization will focus its energy on four objectives: education and leadership; physician advocacy and policy development; quality and patient safety; and partnerships with other healthcare organizations.

Information about the new group is available at www.ahaphysicianforum.org.

"The AHA's initiative is particularly timely," said Dr. William Jessee, president and CEO of the Medical Group Management Association. "We see more and more of our members becoming members of hospitals and integrated delivery systems. The forum will help meet the needs of physicians in AHA member organizations."

The MGMA is a partner organization of the new Physician Leadership Forum, and Jessee spoke at the kick-off breakfast.

Other external partners of the new group include the American Board of Medical Specialties, the Accreditation Council on Graduate Medical Education, the American Medical Association, the Joint Commission and the Society for Hospital Medicine.

A 20-member advisory board will oversee the new group chaired by Dr. Mike Rock, the chief medical officer, at the Mayo Clinic. Other notable members of the all-physician advisory board include Dr. Jonathan Perlin, president of the clinical and physician services group at HCA, and Dr. Glenn Steele Jr., president and CEO of Geisinger Health System.

Dr. John Combes, AHA senior vice president, said the intent of the new organization is not to compete with the AMA or organized medicine. Combes also spoke at today's breakfast.

"We are not representing physicians' interests to Congress," Combes told Modern Healthcare. Rather, the new group "provides an avenue for physicians to affect AHA policy."

The AHA along with the Federation of American Hospitals successfully lobbied to have severe restrictions on physician-owned hospitals added to the Patient Protection and Affordable Care Act.