Health IT Letter – May 2016
I took April off! While I wish it were for vacation, I postponed publishing the April letter to provide the institution a deep dive on the much-awaited MACRA regulations released April 27, 2016. Expect them to affect our clinical journey over the next few years.
Change is afoot for the future state of health care! Critics state it is for the worse; the optimists, for the better. After a thorough review, the final verdict is in. Organizations that silo their data behind the seven most expensive words in business — “We have always done it this way” — are put on notice. These naysayers should heed the words of CMS Acting Administrator Andy Slavitt:
“With respect to some business practices, it’s time to lead, follow or get out of the way. If you want to lead the way with innovations that help consumers, great; if you want to follow by using established standards for data, measurement and technology, also great. If you have a business model that relies on siloing data, not using standards or not allowing data to follow the needs of patients, pick a new business model or pick a new business.”
Clearly, leaders who choose to impede technological benefits to patients are about to be out of a job.
MACRA is here!
What it is: The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) authorized CMS to institute the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM), collectively known as the Quality Payment Program. The goal, CMS officials say, is to continue to support health care quality, efficiency and patient safety by reforming the long-time sustainable growth rate formula that dictates the way physicians and other clinicians are paid. In its place is a new system that rewards value and outcomes. The law also consolidates the current Meaningful Use (MU) (which becomes Advancing Care Information (ACI)), Physician Quality Reporting System, and Value-based Payment Modifier programs into a nationally reportable score for each provider.
CMS states that it is “focused on three core strategies to drive continued progress and improvement.” In summary, these strategies are: (1) clinician compensation to incentivize value of care over quantity of services; (2) delivery of care through clinical practice support, as well as data and feedback reports to guide improvement and enhanced decision-making; and (3) access to data enabling the use of certified EHR technology to support delivery of care.
Why it matters: MACRA is the most significant health care-associated legislation in a generation, particularly as a widely bi-partisan agreement (92-8 in the Senate) compared to the much-debated Affordable Care Act (ACA). MACRA continues CMS’s stated goal of ensuring that “half of all Medicare payments are tied to value by 2018.” Presently, only 20 percent of Medicare payments are tied to value. This is a clear trend that is not going anywhere any tune soon. The Health Care Transformation Task Force has announced a commitment to shift 75 percent of its business to value-based models by 2020. Members of the group include:
- Partners HealthCare, the powerful Boston-based health system that oversees Brigham and Women’s Hospital and Massachusetts General Hospital.
- Ascension, the nation’s largest nonprofit Catholic health system.
- Aetna, a national for-profit insurer.
- Health Care Service Corporation, which operates five state Blue Cross plans.
The group is “committed to rapid, measurable change.” Whether long or short-term, this is how health care will be paid for going forward – through Medicare, private payers, and eventually Medicaid.
With the proposed MACRA rules, there will be clear winners and losers in health care. After the first few years of MIPS scoring, there are no neutral scores. Providers either gain incentives or are assessed for penalties (see “Countdown to MIPS”). Since the legislation is budget-neutral, the penalties (~$833 million) pay for the incentives. All 962 pages have been read, and OCI will provide monthly MACRA updates for the institution to keep abreast of the dynamic and rapidly changing payment landscape in health care to ensure the organization is prepared to weather the challenges.
Virtual health (telemedicine)
In the health care information technology space, telemedicine (aka telehealth or virtual health) is a hot buzzword— almost as hot as the dreaded “digital health” moniker. And yet, one cannot escape the draw of telemedicine — easy access, mobile access, transparent payment, and avoidance of the painful in-office process associated with most health care systems.
Formally defined, telemedicine is the use of medical information exchanged between one site and another via electronic communications to improve a patient’s clinical health status (American Telemedicine Association). Since this is essentially the delivery of health care services (synchronous or asynchronous) through non-physical means, I personally prefer the term virtual health. This can range from software applications and services using two-way video to email, smart phones, wireless tools and other forms of telecommunications technology. The virtual health market is growing with a slight uptick in telemedicine solutions/services adoption from 57.7 percent in 2015 to 61.3 percent in 2016. This is in-line with a global market valued at approximately 14 billion U.S. dollars in 2014. It is expected to reach approximately 35 billion U.S. dollars by 2020, growing at slightly over 14 percent between 2015 and 2020. This impact will be felt locally as the Department of Veterans Affairs (VA) wants to have same-day medical and mental health services at every VA center by the end of 2016.
How this will affect you: As Texas Tech University Health Sciences Center El Paso enters this health care space, we need an organized approach. The policy, process, tools, carts and software needed to ensure that we can remain competitive as health care evolves are part of a larger investment already occurring in many health care institutions and in their information technology infrastructure — particularly video and voice. To this end, and in-line with many organizations using a hub and spoke model, Clinical Information Systems (CIS), the Office of Clinical Informatics (OCI) and IT are embarking on a process. We will collaborate with clinical and administrative stakeholders to create a centralized backbone and infrastructure in order to align payment mechanisms (e.g., CMS, NAIP and private funding), implement technological tools (e.g., carts or tablets) and develop software (global EMR connectivity). All this will enable any clinical or research department to utilize virtual health tools as opportunities arise. We expect to have a virtual health roadmap by the end of the year.
So what (else) is new?
UMC CSI — The University Medical Center El Paso CSI (Cerner) project is ongoing with registration and clinical scenarios testing activities. Faculty and residents continue to work with UMC on this project, which will put UMC on a single clinical records platform. The “go-live” is projected for August 2016. Thank you to all of the faculty and residents whose hard work has ensured a successful project.
Transmountain Campus — The TM Cerner project has completed the present state assessment phase. Thank you to all of the clinical departments that kindly and excitedly gave time to outline how we use and can improve our present EMR on our new campus. We expect to have our own test Cerner environment up and running soon, which will allow us to test the integration with various other systems. More updates will be presented as we progress towards the grand opening of our new clinic on the northwest side of the city.
Analytics — In the new and rapidly changing world of health care and its digital transformation, our institution will require a gold standard of business intelligence and analytics tools in order to align clinical measures and provide all members of the organization with coherent dashboards/scoreboards. This gives visibility to clinical and business data without having to be in IT or be a Ph.D. researcher — centralize the data, but decentralize the reporting.
The data crunch has replaced the gut check as the key source for decision-making. OCI is committed to ensuring we have tools that are more powerful than Microsoft’s cumbersome old standby, Excel, and that most of our organization runs on an easier-to-use platform than any business intelligence product from GE, IBM, SAP or Oracle. The mandate is clear — that anyone in this institution should be able to input their data, be it billing, expense or patient data, and quickly spit out beautiful, interactive charts showing trends in time, geography and nearly anything else one desires. This opens up the possibilities for everyone – from IT to clinicians, administrators and researchers.
The data revolution is upon us and with time, we will be in the midst of its transformation.
OCI Updates – CMS had been attested to for the Physician Quality Reporting System (PQRS) and Meaningful Use (MU) for program year 2015. We successfully reported 98 percent of providers meet the CMS quality measures for MU. Job well done to our clinical departments!
CIS Updates – In an effort to improve the patient portal, the CIS group will be engaging clinics over the next few months to re-assess patient engagement strategies and learn new ways to enhance the patient portal as well as target improvements to the EMR.
Digital health bites
- What does HIPAA really mean for care coordination? Read here.
- Apple is coming for you. Read here.
- A deep dive on the ‘overwhelmingly complex’ MACRA proposed rule. Read here and here.
- Telehealth pros and cons.
Please feel free to contact me with any questions or comments regarding our role in the digital transformation of health care.
Ogechika K. Alozie, M.D., M.P.H., CPHIMS
Chief Medical Informatics Officer (CMIO)
Office of Clinical Informatics