EMR "meaningful use" to be simple and defined by EOY 2009

Let's face it. Many people are anxious while waiting for final rules on the "meaningful use" of Electronic Medical Records (EMR). Happily, the Department of Health and Human Services (HHS) seems to be making progress toward defining "meaningful use", which will determine who qualifies for federal stimulus funding for health IT.

Government Health IT reports that Tony Trenkel, Director of the CMS Office of e-Health Standards and Services, said that HHS was on target to publish its proposed definition of meaningful use by the end of the year at a meeting of the National Council on Vital and Health Statistics in Washington on Thursday. Similarly, Dr. David Blumenthal, national health IT coordinator, echoed those sentiments at AMIA in San Francisco last week.

Meanwhile, the implementation workgroup of the federal Health IT Standards Committee said it would listen to the public sentiment that early standards should be made as simple as possible in order to encourage health IT adoption. Any tightening of requirements would not occur until the publishing ofr the 2013 and 2015 standards for the EMR incentive program.

The definition of "meaningful use" and the publishing of feasible EMR standards are important and necessary for real progress in advancing healthcare information technology (HIT) and, subsequently, healthcare information exchange (HIE).

Stay tuned.

Health Care Reform Legislation Update

Without getting into too much of the excruciating detail, I want to encourage continued vigilance and participation by all parties in this important debate. The outcome will affect us all substantially and will shape, not only our health care, but also our lives in the future as our representatives consider attempting to control over 1/6 of the US economy now primarily in the private sector.

To ease the burden of a planned 21% reimbursement cut for Medicare doctors in 2010, Senate Democrats tried to pass a stand-alone bill that would have wiped out both next year’s cut and all future cuts. Eliminating the cut for one year would cost $10.9 billion. To totally eliminate the fee cuts for all years would cost $245 billion. Such a bill would add close to a quarter-trillion dollars to the deficit. This is precisely the bill Majority Leader Harry Reid brought forward. Senator Reid needed 60 votes, but he garnered only 47 as all Republicans and 13 Democrats voted against cutting off debate. Senate Democrats had hoped to gain physician support for health care reform by providing relief from the cuts. The results should serve as a “wake-up” call to the Democratic leadership that health reform will not be a walk in the park. The strong vote could also embolden moderate Democrats to band together and make “hard votes” on health care reform as well.

In the House, legislative activity for the week came down to passage in the Judiciary Committee of a bill that Democratic sponsors describe as repeal of the health insurer antitrust immunity known as the McCarran-Ferguson Act. The bill more accurately can be described as codifying various court interpretations of the Act, all of which the industry lives with day in and day out. The bill specifically says health insurers can’t hide behind McCarran-Ferguson to price-fix, bid-rig or engage in market allocations with competitors. Insurers can’t do that now, so the bill is much more of a vehicle for some in Congress to further demonize a well thought-out piece of legislation with positive policy underpinnings. Whether this item gets added to a health care reform bill or progresses on its own remains to be seen.

The timing for floor debate on health care reform will likely ebb and flow for several weeks, but the current thinking is that this process may take all of 2009 and possibly into 2010 to complete. There is a real chance that too many variables will get in the way and neither Chamber will get to the floor until December, which, if true, would translate into a January Conference.

The American health care system is not broken, so don't throw it away in the name of change!

85% of Americans have health care benefits and access to the best health care in the world.

15% of Americans are uninsured for a great number of reasons, so of which will never be resolved. Many of these Americans still, however, have access to care.

Our costs are too high. Administrative complexity is too great. Some people in need fall through the cracks.

Should we try to improve the system? YES! Should we throw it all away and cede over $2 Trillion of the economy to ideological control in the Federal government? NO!

"The devil is in the details", and there is a lot not to like in the current House reform bill, H.R. 3200. Don't just take my word for it. Read it and weep.

46.3 million without health insurance in 2008

According to the U.S. Census Bureau, the number of people without health insurance coverage rose from 45.7 million in 2007 to 46.3 million in 2008, while the percentage remained unchanged at 15.4 percent. Among survey findings: The number of people with health insurance increased from 253.4 million in 2007 to 255.1 million in 2008. Between 2007 and 2008, the number of people covered by private health insurance decreased from 202.0 million to 201.0 million, while the number covered by government health insurance climbed from 83.0 million to 87.4 million. The number covered by employment-based health insurance declined from 177.4 million to 176.3 million. The number of uninsured children declined from 8.1 million (11.0 percent) in 2007 to 7.3 million (9.9 percent) in 2008. Both the uninsured rate and number of uninsured children are the lowest since 1987, the first year that comparable health insurance data were collected. Although the uninsured rate for children in poverty declined from 17.6 percent in 2007 to 15.7 percent in 2008, children in poverty were more likely to be uninsured than all children. Source: U.S. Census Bureau, Income, Poverty, and Health Insurance Coverage in the United States: 2008. September 2009. http://www.census.gov/Press-Release/www/releases/archives/income_wealth/014227.html

What are we getting ourselves into?

An approach to health care reform continues to be discussed in the hallowed halls of Congress, and the primary House Bill has >1000 pages of bureaucracy, policy and sweeping changes. The challenge is to be aware of what is being proposed and to speak with an informed voice. Read the Health Care Reform Act (H.R. 3200)! I did, and I'll share some observations in future posts.

Based on a current poll, public opinion does not support health care reform as it is currently being discussed.

Poll:
Do you think the Medicare program for seniors would be better off or worse off if the president and Congress passed health care reform, or don't you think it would make much difference?

42% of people under 65 years of age think that Medicare would be better off, while only 20% of Seniors aged 65+ believe that to be the case. Of the 58%/80% who don't believe things would improve, nearly 30% of those under 65 and almost 40% of those 65+ believe that the Medicare program would be worse off.

Source: Kaiser Family Foundation Health Tracking Poll (conducted August 4-11, 2009)

Factoid: Top 5 Medicare Payments for General Surgeons

In 2007, the top five Medicare physician payments for general surgeons came from:

• Colectomy* ($90.4 million)
• Gall bladder removal ($83.7 million)
• Colonoscopy ($82.2 million)
• Hernia repair, other ($48.5 million)
• Hernia repair, inguinal* ($32.2 million)

*non-laparoscopic/open

Source: Thomson Reuters

Healthcare X Prize Foundation Competition

We are entering an unprecedented season of change for the United States healthcare system. Americans seem to be united by their desire to fundamentally reform our current system into one that delivers on the promise of freedom, equity and best outcomes for best value. In this season of reform, we will see all kinds of ideas presented from all across the political spectrum. Many of these ideas will be prescriptive and don't harness the power of innovation to create the dramatic breakthroughs required to create a next generation health system.

I believe there is a better way.

This belief is founded in the idea that aligned incentives can be a powerful way to spur innovation and seek breakthrough ideas from the most unlikely sources. Many of the reform ideas being put forward may not include some of the best thinking, the collective experience, and the most meaningful ways to truly implement change. To address this issue, the X PRIZE Foundation, along with WellPoint Inc and WellPoint Foundation as sponsors, has introduced a $10M prize for health care innovators to implement a new model of health. The focus of the prize is to increase health care value by 50 percent in a 10,000 person community over a three-year period.

The Healthcare X PRIZE team has released an Initial Prize Design and is actively seeking public comment. They are hoping, and encouraging everyone at every opportunity, to engage in this effort to help design a system of care that can produce dramatic breakthroughs at both an individual vitality and community health level.

Here is your opportunity to contribute:

1. Download the Initial Prize Design
2. Share your comments regarding the prize concept, the measurement framework, and the likelihood of this prize to impact health and healthcare reform.
3. Share the Initial Prize Design document with as many of your health, innovation, design, technology, academic, business, political, and patient friends as you can to provide an opportunity for their participation.

Let's ensure that all of us--and the people we love--can have a health system that aligns health finance, care delivery, and individual incentives in a way that optimizes individual vitality and community health. Together, we can ensure the best ideas are able to come forward in a transparent competition designed to accelerate health innovation. We look forward to your participation.

This purpose of this post is to assist Scott Shreeve, MD, Senior Health Advisor at The X Prize Foundation, in raising awareness of the Healthcare X Prize Foundation competition.

The Impact of Potential Health Care Reform on Health Plans

This week, we're getting an introduction to the direction that the Democrats want to take the health care reform discussion. Consistent with the mandate viewpoint, the House and Senate sponsors seem to be taking an aggressive stance. While the plans are very complex (and assuredly difficult to administer, especially via the tax code), they contain some interesting details.

The primary proposal under consideration contains a universal coverage mandate. Senate Democrats have developed a proposal similar to that of their counterparts in the House, which would require everyone in the U.S. to carry health insurance starting in 2013. Interestingly, the plan provides for an explicit exception for illegal immigrants and people with religious objections. Families making up to four times the poverty level ($88,200 for a family of four) would be eligible for tax credits to help them afford coverage. A penalty for not carrying insurance would be imposed via the tax code. The penalty could be up to 75 percent of the premium for the lowest-cost health plan in the area where the person lives.

The federal government would set minimum benefit standards, including physician services, hospital care and prescription medications. All health plans would have to offer four levels of coverage, ranging from basic coverage to the most comprehensive set of benefits and coverage.

Most companies would be required to offer insurance to full-time employees, or else pay a special tax. The plan proposes tax credits to small businesses with up to 25 employees to lessen the financial burden on employers. However, the plan also calls for an employee "out" privilege, which will allow employees to withdraw from the employer-sponsored plan and seek individual coverage, with the employer still paying a share of the premium.

To learn more about Democratic healthcare reform proposals, read this article from The New York Times.

What does this mean for health plans?

• Probable expansion of the State Children's Health Insurance Program (SCHIP) for coverage of low income families with children.
• Increased administration costs and complexity with new mandated benefit designs, the creation of a national insurance exchange and new regulation of commercial plan marketing.
• Possible "trickle-down" mandates for hospital and physician reimbursement rates putting negative pressure on margins in managed Medicaid.
• Actuarial challenges with higher member turnover, the potential for adverse selection in employer risk pools and the creation of the insurance exchange.
  

In the opinion of G2 Management Group, health plans should seek even more efficiencies in their business processes. With administrative costs, benefit costs and reimbursement rates all likely to rise, the plans that can remove cost from the system will be best prepared to thrive. Contact us today to discuss how to mitigate the effect of health care reform on your health plan's bottom line.

Open Source BI: Is it ready for prime time? (Intro)

Business Intelligence (BI) is the use of an organization's disparate data to provide meaningful information and analysis to employees, customers, regulators, and partners for more effective decision making. Business intelligence solutions gather information together, organize it, measure it, give people access to it, and share information changes.

The use and importance of business intelligence software tools is demonstrated by the size of the BI software market. The US Business Intelligence market is currently about $6 billion with an annual growth rate of approximately 12.5%.

Several commercial software vendors occupy the BI marketplace. The market leaders, in terms of market share, include IBM Cognos, SAP Business Objects, Oracle Hyperion, MicroStrategy and SAS among several smaller firms.

Each of these firms offers a proprietary software solution to the business intelligence needs of organizations. While the software implementations are unique to each vendor, the concepts and functions accomplished by each are common to all. These common functions are also addressed by an open, community-based approach called Open Source Projects. Open Source Projects rely on the free, technical contributions and development of participating individuals and companies around the world. Pentaho, JasperSoft and Talend, to a more limited degree, are examples of commercialized Open Source Projects. The resulting products developed are freely distributed to any entity. As the capabilities of Open Source BI projects continue to increase, the value of commercial, proprietary solutions is challenged. The commercial BI software vendors, therefore, protect their products by questioning the viability and readiness of Open Source BI software for use in commercial applications.

Because of the relatively recent advent of commercial, Open Source software and the competing interests of proprietary software companies, much uncertainty and misinformation exists in the software marketplace regarding the viability and usefulness of commercial open source software applications.

In subsequent posts, I plan to examine the issues and considerations regarding Open Source BI and to ultimately answer the questions: Is Open Source BI software ready for business?

Do You Know Where Your Sensitive Data Is? Really?

Now, more than ever, healthcare covered entities such as Health Plans, Physicians and Hospitals must understand where PHI exists, who has access to it and with whom they are sharing it. If your organization can't confidently answer those questions, you may want to consider Sensitive Data Management technology.

G2 Management Group, LLC works with an advanced data technology firm who has developed the first integrated data security solution that discovers, protects and monitors sensitive data at rest and in motion throughout the enterprise without negatively impacting productivity.

In additional to understanding where sensitive data resides and where it goes, healthcare organizations often need to distribute or share data for studies, public health analysis, disease management and other projects. Where PHI needs to be distributed, data obfuscation or de-identification is necessary, especially to comply with privacy standards and good security practice.

Traditional approaches, such as encryption, often reduce the intrinsic business value of the data. Some Sensitive Data Management tools can mask, encrypt or obfuscate the data depending on the level of security required. Unlike data masking, hashing and scrambling, obfuscation removes the sensitive nature of the data while retaining its intrinsic business value. For example, an obfuscated social security number (SSN) will still look and feel like an SSN to the data consumer. An obfuscated street address will still look like a real mailing address.

Sensitive Data Management tools can help you to achieve compliance with HIPAA privacy and security standards and realize the following benefits:

• Generate desensitized data that looks and acts like real data
• Allow use of desensitized production data for testing
• Maintain referential integrity between multiple source systems over time
• Reduce reliance on endpoint security needs when data is lost via a stolen laptop, USB key, CDs, emailed files, etc.
• Produce consistent, repeatable obfuscation across multiple data extracts and multiple source systems
• Provide ability to access original source system data
• Provide audit trail to demonstrate data validity

Contact us to discover where your sensitive data really is and how to ensure that it is protected.

Tapping the brakes on Healthcare Costs using Supply Efficiency Scoring

Have you considered how healthcare economics seem to be at odds with classic free market performance trends? Why is it that increased supply leads to increased utilization? In Healthcare Law, Christopher C. Gallager cites John Wennberg, of Dartmouth, who offered critical testimony on the connection between the availability of health care providers and utilization...with health care, supply drives demand. This leads to "unwarranted care," which leads in turn to higher costs for everyone in the health care system.

One example of this dynamic may be found in the artificial demand brought on by the practice of investment in medical technology, in this case imaging and diagnostic services, to generate revenue for the healthcare practitioner/practice. In HealthLeadersMedia Industry Survey 2009, 59% of non-rural practices plan to add an ancillary service to increase revenue in the next three years.

Supply Efficiency Scoring is a strategic reimbursement innovation for imaging and diagnostic services that promises to slow the growth of healthcare costs by eliminating artificial demand without disrupting free market activity or applying administrative review techniques.

In my opinion, Supply Efficiency Scoring has the potential to be an effective, measured innovation in cost control that should be considered by health plans with fee-for-service contracts for imaging and diagnostic services.

You may be interested to help validate this concept by participating in a demonstration project. For more information, read the entire article or contact G2 Management Group directly.