OIG decides to inquire $15B in meaningful use payments

The Department of Health and Human Services Office of Inspector General will analyze the accuracy of $14.6 billion in meaningful use payments made to hospitals by Medicare between 2011 and 2016. Initially this year, the OIG estimated physicians were wrongfully paid $729 million under meaningful use payments.

Medicare incentive payments were authorized over a 5-year period to hospitals that adopted electronic health record (EHR) technology. From January 1, 2011, through December 31, 2016, the Centers for Medicare and Medicaid Services made Medicare EHR incentive payments to hospitals totaling $14.6 billion, the OIG stated.

The Government Accountability Office recognized wrong incentive payments as the primary risk to the Medicare EHR incentive program. An OIG report described the obstacles that CMS faces in overseeing the Medicare EHR incentive program. In addition, previous OIG reviews of Medicaid EHR incentive payments found that state agencies overpaid hospitals by $66.7 million and would in the future overpay these hospitals an additional $13.2 million, the OIG claimed.

“These overpayments resulted from inaccuracies in the hospitals’ calculations of total incentive payments,” the OIG said. “We will review the hospitals’ incentive payment calculations to identify potential overpayments that the hospitals would have received as a result of the inaccuracies.”

On another front, the OIG will be analyzing the precision of telemedicine payments under Medicare.

Medicare Part B covers expenses for telehealth services on the telehealth list when those services are delivered via an interactive telecommunications system, provided few conditions are met. To support rural access to care, Medicare pays for telehealth services provided through live, interactive videoconferencing between a beneficiary located at a rural originating site and a practitioner situated at a distant site.

 

Kalamazoo County looking for mosquitoes carrying Zika virus

Kalamazoo County is keeping an eye out for mosquitoes known to carry the Zika virus until the end of summer season.

The Kalamazoo County Health & Community Services Department is engaging in a mosquito surveillance program to ensure insects carrying the virus aren’t in West Michigan.

Traps were set at 5 areas throughout the county in June searching for the Asian tiger mosquito, the species most known to carry the virus.

According to a department release, southern Michigan is in the trail of potential migration of the insect. Although, none have been found to this point.

In addition to trapping the mosquitoes, County is identifying what type of insects it is capturing to the Centers for Disease Control and giving citizens information on preventing mosquito bites, diseases and habitat control.

For further information, contact the County Health & Community Services Department-Environmental Health Unite at 269.373.5210.

 

IBT, Scripps Acquire $6.6 Million to Establish Pan-Ebolavirus Vaccine

A collaboration between Integrated BioTherapeutics  (IBT) and The Scripps Research Institute (TSRI)  has been granted a $6.6 million, 5-year grant by the National Institutes of Health’s (NIH) National Institute of Allergy and Infectious Diseases (NIAID) to develop a vaccine that secures against ebolavirus.

"This award will enable us to deal a pressing global public health need, namely a single vaccine that can secure against all ebolaviruses,” stated IBT’s CSO,  M. Javad Aman, Ph.D., who is co-principal investigator for the collaboration. “To meet this challenge, we have assembled a unique team of experts in immunogen design, structural biology, vaccine development, and animal models of filovirus infection.”

Filoviruses, involving Ebolavirus, Sudan ebolavirus, Bundibugyo ebolavirus, and Marburg marburgvirus, cause hemorrhagic fever in humans, and infection is lethal in 40% to 90% of cases. The most recent Ebolavirus outbreak in West Africa was caused by the Zaire ebolavirus (EBOV) and led to 29,000 infections and more than 100,000 deaths. A single glycoprotein reflected on the filovirus surface mediates infection and is the primary target for vaccine development.

Structural differences in surface glycoproteins between viruses mean that current EBOV vaccine development programs are not generally not designed to protect against other filoviruses, but the team at IBT and TSRI has identified broadly neutralizing antibodies that may secure against all ebolaviruses.

The NIAID-funded project will use the EBOV glycoprotein as a foundation for the rational design of pan-Ebolavirus vaccine candidates that can elicit broadly protective immune responses targeting structural sites that are shared between the different viral glycoproteins. The aim is to develop and test immunogens that can be progressed into advanced preclinical studies. IBT says it then projects moving the most promising candidates into the clinic.

"A novel aspect of the program will be the use of state-of-the-art imaging and computational approaches,” stated co-principal investigator Erica Ollmann Saphire, Ph.D., at TSRI.  “This design work will help us craft a vaccine to steer the immune response in the right directions."

"We’re excited to participate in this collaboration and to test novel immunogen design strategies for their ability to focus antibody responses to conserved epitopes on ebolaviruses,” added William Schief, Ph.D., who is also a TSRI co-principal investigator for the program. “This’ll be a fantastic test for structure-based vaccine design, and it may give us insights on how to make vaccines for other more variable viruses.”

The collaboration will also include investigators at the Albert Einstein College of Medicine (Bronx, NY) the US Army Medical Research Institute of Infectious Diseases (USAMIID; Frederick, MD), the Public Health Agency of Canada (Winnipeg, Manitoba), and the Sanford Burnham Prebys Medical Discovery Institute in La Jolla, CA.

IBT is concentrated on the discovery and development of vaccines and therapeutics for emerging bacterial and viral infectious diseases, including pan-filovirus immunotherapeutics and vaccines. The firm works closely with U.S. government agencies including the NIAID, National Cancer Institute, Department of Defense, and USAMRIID.

Just previous month, IBT reported that its partnership with the Albert Einstein College of Medicine received Phase II of a small business technology transfer (STTR) grant from the NIAID to continue the development of bispecific antibodies targeting multiple broadly neutralizing epitopes on filovirus glycoproteins. During Phase I of the program the partners generated a lead candidate that was shown to provide protection against Ebolavirus and Sudan ebolavirus, and neutralize all ebolaviruses. Phase II of the project will encompass antibody manufacture in CHO cells and evaluation in nonhuman primates.

In May, IBT reported publication in the journal Cell of nonhuman primate studies demonstrating the ability of an antibody candidate designated CA45 to block cells from infection by EBOV, Sudan ebolavirus, and Bundibugyo ebolavirus.

 

Drchrono evolves FHIR support into its electronic health record

EHR vendor drchrono has declared that its electronic health record (EHR), practice management and revenue cycle products now support the Fast Healthcare Interoperability Resources specification.

With FHIR, drchrono claimed that it’s enabling ten million sufferers to access to their healthcare information through the FHIR API through the company’s inpatient electronic health record.

The new application programming interface is developed to support the Precision Medicine Sync for Science Initiative and fulfills one of the requirements of Meaningful Use Stage 3 to enable a patient electronic health record API, the vendor stated.

Drchrono’s Patient API also offers users the ability to control their own data and share the data with others throughout the continuum of care. Any developer through the personal health record FHIR API can build applications on top of drchrono so researchers and other physicians with the patient’s approval can view that person’s data.

Most developers know what APIs are, they know the modern technology stacks, but they do not necessarily know what HL7 or X12 are, the company stated.

FHIR, on the other hand, enables developers to move into healthcare and start building new apps as quickly as possible using concepts from other modern technology practices, he said.

The healthcare system increasingly needs a patient to play more of a part to ensure they are getting the right care in the right setting at the right time.

“Increasingly, more of our healthcare system’s burden is on sufferers, when it comes to higher deductibles, the requirement for second opinions, the need to understand what preventive services are available to them,” said Aneesh Chopra, the former U.S. CTO and CEO of CareJourney. “That shift to more responsibility is concurrent with the need to have more information so you can get better at that step.”

 

Hospitals can anticipate financial burden from new EHRs installs

Hospitals installing new EHRs or electronic health record systems should anticipate a sizable cash drain as the procedure disrupts business and adds technology and training expense, Moody's Investors Service claimed in a report this week.

During the first year of new EHRs installations, the median decline in operating cash flow for hospital systems is 10 percent with a 6 percent falloff in days cash on hand, Moody's said after examining system installs over the past several years. EHR installations can cost anywhere from several million dollars for a small, stand-alone hospital to a half-billion dollars for larger systems.

Moody's discovered in looking at 39 recent launches that the installs can disrupt billing and patient throughput.

"Implementing new EHRs or electronic medical record systems carries significant financial risk for hospitals because the systems are vital to the provision of care and billing," the report said.

Though disruptive in the first year of execution, the damage to operating performance commonly dissipates after the first year as staff and clinicians become proficient in the technology, Moody's said.

An EHR is the electronic nervous system of a hospital or clinic, allowing staff to onboard patients, track care, view clinical workflow and bill for services. It also increasingly contains information that can help systems and hospitals gather information useful toward meeting new payment models.

Vanderbilt University Medical Center in Nashville has been preparing for more than a year for the Nov. 2 launch of its new Epic EHR across the entire academic health system.

Vanderbilt decides to have 1,000 third-party consultants and trainers on hand in the first week to minimize disruptions and help employees through the switch, Vanderbilt EHR project leader Dr. Kevin Johnson said in a May interview. He likened the transition to "changing a jet engine in midflight."

Vanderbilt has budgeted $214 million for the conversion.

UMass Memorial Health Care is going live with its own Epic rollout later this year. Already, the preparation is hitting the bottom line of the Worcester, Mass.-based system.

 

Survey: Physicians are not ready for Quality Payment Program

A recent survey of 1,000 physicians discovered that most respondents aren’t ready for the Quality Payment Program (QPP).

The survey, conducted by the American Medical Association and KPMG, indicates that respondents give mixed views on their comfort level with the program, the proposed rules of which were recently issued for review by the industry.

Physicians this year are measuring and reporting certain quality measures while also indicating proficient use of electronic health records (EHRs) in the MIPS program that is part of MACRA. Physicians can acquire extra points and thus receive higher reimbursement rates beginning in the year of 2019.

Instead of entering the MIPS program, physicians can be part of an Advanced Alternative Payment Model, which will need them to take on risk and receive a 5 percent bonus for meeting certain thresholds that reward doctors for delivering high-quality and cost-efficient care.

In the AMA survey, 70% of respondents report they have started preparations to meet QPP requirements, and about 90% of those believe they will meet the 2017 reporting requirements.

Although, the survey discovered that just 51% were somewhat knowledgeable about MACRA and the Quality Payment Program, and only 8 percent reported that they were very knowledgeable about QPP.

Prior reporting experience through the PQRS and EHR meaningful use programs appears to have contributed to readiness for QPP, survey results demonstrated. However, only one in four physicians say they are well-prepared for QPP.

“Although, even those who feel prepared do not completely understand the financial ramifications of the program,” in accordance with the AMA and KPMG, which conducted the study for the AMA. “In short, they may be prepared to ‘check the box’ of reporting requirements but they lack the long-term strategic financial vision to succeed in 2018 and beyond.” Survey findings are available here.

 

Hacking of Medical devices increasing as a next huge threat

Medical devices, involving those that are implanted within patients, are increasingly likely to be targeted by hackers and could pose a nightmare scenario if providers do not take measures to improve their defenses.

“The issue with security is that hackers always follow the path of least resistance,” claims Sam Rehman, the chief technology officer at security vendor Arxan, which serves multiple industries and has a large footprint in healthcare.

Like several other security vendors, Rehman says providers require conducting a comprehensive risk assessment and fixing vulnerabilities. In healthcare, medical devices security is a hot topic and for great reason, because providers mostly have hundreds if not thousands of devices in their facilities.

But providers also require increasing security levels for devices that are implanted in patients, and that is because several of those devices have wireless capabilities that enable hackers to interfere with them, Rehman says.

For instance, physicians can utilize hand-held medical devices to wirelessly collect data and even update an implant, for example to change device settings on insulin pumps, pacemakers and other devices. Although, a hacker in a hospital can do the same thing, which represents a potential risk to patient safety, Rehman cautions.

Many hackers might not need to intentionally cause harm, but others will do what someone pays them to do, which could involve causing injury to patients. Rehman says monetary motivation, particularly through blackmail, could rise as a potential risk.

Such hacking could involve efforts to affect the share price of a device manufacturer. Rehman says stock price manipulation could provide another financial motive for hacking. For imstance, if one person can make money by paying another person to cause harm, the instigator can make money when a company’s stock price falls.

A scenario similar to this has already occurred. Previously this year, the Food and Drug Administration confirmed cybersecurity vulnerabilities in St. Jude Medical’s implantable cardiac devices and its Merlin@home transmitter. The vulnerabilities were originally declared by an investment group that threatened to make money by selling its stock short.

St. Jude Medical devices, the FDA stated, could be hacked by outsiders, leading to injury or death, and St. Jude’s share price quickly dropped by 10% as the company scrambled to make fixes. “If someone can make money, this absolutely will happen,” Rehman assumes.

 

Seven Regional HIEs complete data exchange contracts

Seven regional HIEs or health information exchanges in the upper Midwest are increasing the number of patient records they are sharing through a collaborative that spans 5 states.

Since last fall, the HIEs have been working to complete technical connections, as well as settling on suitable legal agreements to permit data exchange, executives claim.

Additionally, the participating agencies are working to implement a virtual integrated record that would enable physicians outside of the 5 states covered by the HIEs to access patient records. The virtual access initiative gives a model that could be replicated by other HIEs to more immensely share information that clinicians require in the course of treatment.

Participating Seven regional HIEs include:

• Indiana Health Information Exchange, Indianapolis.


• Michiana Health Information Network, South Bend, Ind.


• HealthLINC, Bloomington, Ind.


• East Tennessee Health Information Exchange, Nashville.


• The Kentucky Health Information Exchange, Frankfort.


• The Health Collaborative, Cincinnati.


• Great Lakes Health Connect, Grand Rapids, Mich.

Last October, the HIEs agreed to exchange patient data among themselves. The initiative, termed as the Heartland Project, got a $270,000 grant from the Department of Health and Human Services, with funds being shared among all seven entities; in addition, the money is assisting to develop a governance structure for the Heartland Project.

This past fall, Great Lakes Health Connect, a health information exchange in the State of Michigan since the year of 2010, was the last HIE to join the project. Since the month of April, Great Lakes has got 10,057 admit/discharge/transfer messages and has sent 57,690 such messages to partnering HIEs.

“Heartland Project is seven regional HIEs working among ourselves with the aim of broadening beyond our regions when patients go outside these areas,” says Doug Dietzman, executive director at Great Lakes Health Connect.

With the utilization of the virtual integrated patient record, if a Michigan resident receives care in another state, an admit/discharge/transfer message is transmitted to Great Lakes Health Connect, which then notifies the patient’s primary care physician. This enables better continuity of care and better communication among clinicians

With all participating seven regional HIEs now live on the system, the exchanges now are developing a query process for Continuity of Care Documents, with hopes that CCDs can be exchanged by year-end.

The new 7-HIE data exchange service has been named the Patient-Centered Data Home, which will enable data to be forwarded to a physician to support a complete medical record, Dietzman says.

As technical work progressed in recent months to link the HIEs, so did work to establish policies and methods governing the actual exchange of data across the region. It took 3 or 4 months of work to develop a trust framework for how information will be shared and how participants will manage the information once they have it, Dietzman says.

One big challenge was handling identities, which was managed by running admit/discharge/transfer messages through a master patient index (MPI), and each HIE has its own technology vendors, so they also have their own MPIs and a unique identifier for each patient.

The long-term intent of Heartland Project is to be a model for other HIE initiatives, Dietzman says, but how to do that is not yet clear, he appreciates. But the ultimate aim is quite bigger—to tie all HIEs at some point across the nation.

 

The use of electronic health records interrupts the doctor-patient connection

The utilization of electronic health records during the patient encounters has the potential to negatively affect the doctor-patient connection, in accordance with a study that used a qualitative analysis of comments from hospital- and office-based physicians.

Researchers at the institute of Brown University and Healthcentric Advisors conducted the analysis of comments, which were submitted in response to a Rhode Island Health Information Technology Survey, conducted in 2014 by the state’s Department of Health—744 doctors gave feedback about their EHR use and how it impacts the doctor-patient connection.

“We were actually struck by the difference between how the inpatient physicians view their EHRs and how it affects their actions, in contrast with those in the office space,” claims Rebekah Gardner, MD, an associate professor of medicine at Brown University’s Warren Alpert Medical School and a senior medical scientist with Healthcentric Advisors. Result of the research was recently published in the Journal of Innovation in Health Informatics.

Researchers discovered that hospital-based physicians commented most frequently that they spend less time with sufferers because they have to spend more time on computers for documentation. By contrast, office-based physicians commented most frequently on EHRs worsening the quality of the doctor-patient connection.

“However hospital-based physicians report benefits ranging from better information access to improved patient education and communication, unintended negative consequences are more frequent themes,” the researchers wrote.

The research discovered other responses differed across settings. “When comparing themes across settings, hospital-based physicians more frequently comment on the use of EHRs to feel more prepared for the clinical encounter, while office-based physicians more frequently comment on alteration of workflow and the depersonalization of relationships.”

At the similar time, the authors point out that comments from physicians that were “generally positive and comments that detailed the sufferer’s perspective comprised the least commonly observed themes for both (hospital and office) settings.”

In accordance with the Gardner, the study demonstrates the requirement for different solutions to make better how EHRs are used in inpatient versus office-based settings, given the different ways in which doctors in those environments perform their jobs.

She points out those hospital-based physicians frequently use computers situated outside of patient rooms, while office-based physicians increasingly bring laptops into exam rooms.

Outpatient doctors “will be documenting and going through the EHR while they are sitting there talking to the sufferer, so it is literally sitting there between them, distracting the physician from making eye contact and taking their attention away from the patient,” states Gardner, who suggests that doctors “honor the golden minute” when they first enter an exam room—not turning on their computer, giving patients their undivided attention and engaging them in conversation to develop doctor-patient connection.

She also suggests that after the computer is turned on, physicians should turn the screen in such a way that patients can view it. Doctors should “narrate” what they are doing in the EHR to be more inclusive of the documentation process, in accordance with Gardner.

On the other hand, Gardner claims inpatient physicians “who take care of patients on hospital floors, in the ICU and ER, when they are in the room with a patient, the computer often is not there—they are going outside of the room and documenting later.” As an outcome, researchers report that when doctors use computers for EHR documentation in inpatient settings, it limits time spent directly interacting with patients.

“With our inpatient findings, it actually speaks to the volume of documentation that is required and clunky EHR user interfaces,” states Gardner, who calls for making these interfaces more intuitive as well as decreasing the documentation burden on physicians.

Gardner and her colleagues appreciate that one of the limitations of the survey is that it was administered in a single state. Although, they contend that the large sample size, high response rate, range of represented specialties and array of EHR vendors might reduce this limitation.

 

CHIME provides new certification program for industry executives

The College of Healthcare Information Management Executives (CHIME) is launching a new certification program that seeks to appreciate the expertise of executives who work for companies that give products or services to the healthcare industry.

The Ann Arbor, Mich.-based professional organization has initiated the CHIME Foundation Certified Healthcare Executive program (CFCHE) for information technology experts who are not CIOs, but are at a senior level and have other achievements in the HIT industry.

Experts who may seek the new designation may be consultants, implementers, sales representatives or in other roles, claims Keith Fraidenburg, executive vice president and COO at CHIME.

CHIME considers the new designation will facilitate interactions within the healthcare IT industry, he states. For instance, when a CIO or other technology professional discusses technology with a person with a CFCHE designation, the CIO will know the other person has passed a tough exam and has studied the challenges confronting CIOs, other healthcare leaders and payers, along with other IT experts outside a healthcare organization, Fraidenburg says.

CHIME has experience developing professional designations for the healthcare IT industry. In the year of 2009 it started a new certification program for IT executives called the Certified Healthcare CIO (CHCIO) program. Currently, more than 350 CHIME members have studied for and acquired the CHCIO title. Becoming a CHCIO is a demonstration of knowledge, skill and competency earned over various years and is the CIO equivalent of being a “black belt,” Fraidenburg asserts.

For CHIME’s newest program, after an individual has registered to participate in the CFCHE certification program, a candidate will get an extensive list of reading materials, and will take a sample exam that is not like the real exam but written in the similar way as the CIO exam to ascertain where the candidate did well and where he or she requires improving.