In 2015, Texas Tech University Health Sciences Center El Paso continued a year of turmoil that is embroiling many healthcare establishments across the country. As I mentioned previously, we continue to weather the storm due to the hard work and dedication of all of our faculty and staff. As we move forward into 2016 and beyond, we will focus on clinical quality and the overall cost of care. My belief is that Digital Health (or Health IT) can offer improved ways to measure our practice, analyze our quality and cost, and then optimize practice patterns towards best practice of coordinated patient care we can provide.
The Future of MU (Meaningful Use)
“The reports of my death have been greatly exaggerated.” One hundred twenty (120) years later, that famous quote is very apt when discussing Meaningful Use (MU). When CMS’s acting administrator stated in January of 2016, that “the MU program as we know it is over” thousands of providers and healthcare organizations across the country rejoiced. Editorials and op-ed pieces hailed the downfall of MU and welcomed the release of its shackles. Dr. Karen DeSalvo, the National Coordinator for Health Information Technology, quickly clarified these comments and made it quite clear, “it is being replaced by something better.”
In 2015, Congress replaced the Sustainable Growth Rate, and its long drawn out threat of 21% across the board cuts in Medicare’s physician fees (aka fee for service – FFS). In its place came MACRA – Medicare Access and CHIP Reauthorization Act of 2015. MACRA is made up of MIPS (Merit Based Incentive Payment System) and APM (Alternative Payment Models). Although CMS is still working through the final details of MACRA, to be released in March 2016, the MIPS portion has already been slated to roll Quality (Electronic Clinical Quality Measures – eCQMs), Resource use (Cost), Clinical practice improvement (Patient Centered Medical Home – PCMH) and MU all into one formula. This change, expected to start in 2019, is welcomed and is expected to spur the long heralded transition of fee-for-service (FFS) to value-based care.
What does this mean for you?
Payment formulas and requirements are going to change. This is clear. Irrespective of your leanings across the political divide, consider this – MACRA passed 92-8 in what many have called the most divisive Senate in the long history of Congress. The Journey to Value (J2V) is happening, and we must begin to prepare for it.
How will this happen?
Over the next few years, The Office of Clinical Informatics (OCI) will work with clinical chairs, clinical administrators, faculty, staff and residents to understand the direction CMS is nudging us. Side by side, Clinical Information Systems (CIS) will enable the technology and data tools required to give us insight into our quality measures. There are a host of quality and payment programs presently ongoing across the campus – MU, PQRS, HEDIS, DSRIP, NAIP – just to name a few. All of these are important and a unified message and set of quality measures will be structured so that all departments will understand not only where they are presently, but also where change is needed to ensure our long term survival.
OCI/Digital Health will be directly involved at both the state level in Austin, and on the national stage in Washington DC, to ensure our voice is heard as this change happens. Just as important is your involvement in the drafting and testing of eCQMs as they roll out. Apart from understanding our true costs of care, understanding exactly how we are measured on quality and how clinical practice changes will affect our quality measurement, is the most important mandate for us over the next 2 years (timeline below). “Moving the HealthCare Curve” (attached) provides a very concise overview of how organizations can begin to think about strategic movement and optimization of their process to ensure improved quality and cost containment.
The Triple Aim of Improving the Patient Experience (patient satisfaction), improving the health of populations, and reducing the per capita cost of health care, forms the basis of much of the change in healthcare operations. It is a bumpy ride – strap up!
So What’s New?
EPCS – Many of you received emails and letters from various organizations extoling the virtues of Electronic Prescription of Controlled Substances (EPCS). This system which allows a licensed provider to prescribe controlled substances electronically, such as narcotics , has the potential to eliminate paper triplicate forms, and make the monitoring of narcotics more efficient. Texas law allows it, and New York law mandates it. Two factor authentication, a process whereby multiple sources of personal information verification are used to ensure identity of the prescribing provider, is required to utilize EPCS. UMC will be instituting EPCS on a limited basis in Q4 of 2016. We are currently doing a technical assessment and will have more updates in the summer.
UMC CSI – The University Medical Center El Paso CSI (Cerner) project has been moved back from June 1, 2016 to August 2016. I feel this movement of go-live will help ensure a better process and allow resident transition to go more smoothly during this transition. Thank you to all the faculty and residents who continue to work to ensure this project is a success.
Transmountain Campus – In keeping with the Cerner theme, approximately 70% of all in-patient hospital beds in El Paso are on a Cerner footprint (this does not include the future/new William Beaumont that will also be on Cerner). As we seek to align and optimize ourselves towards to goal of being the best ambulatory and population focused organization in El Paso and West Texas, I believe it is in our best interest to align to a similar data platform. As part of this clinical data alignment, the ambulatory practices at the Transmountain Campus will be using Cerner. The Clinical Information Systems (CIS) team is excited to utilize the various tools within Cerner to provide analytic reports for faculty and administration towards ensuring the Triple Aim.
Digital Health Bytes
- It’s Time To Fix Meaningful Use – read here.
- “Less is More” Is More of the Same – read here.
- The Private Practice Counter-Point – read here and here.
- An Intriguing Look at Healthcare Spending – read here.
Please feel free to contact me with any questions or concerns regarding our EMR, Clinical Information Systems and any issues you have with the direction we are taking in Digital Health.
Ogechika K Alozie MD MPH CPHIMS
Chief Medical Informatics Officer (CMIO)
Office of Clinical Informatics