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Is No Flex-IT the Best thing for EHR and Healthcare?

Posted on September 24, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Strategically placed during National Health IT Week, 17 healthcare organizations sent a letter to HHS requesting that the meaningful use reporting period for 2015 be adjusted from 365 days to 90 days. Along with that, the Flex-IT act was introduced to congress in order to legislate this change. It’s always hard to predict what congress will do, but many believe that the Flex-IT act will get tagged on to something else and get passed. We’ll see if that indeed happens.

What everyone I talk to agrees is that the 365 day meaningful use stage 2 reporting period is going to be impossible for hospitals to meet. Sure, a few hospitals might make some herculean effort and meet it, but they’ll be so few and far between that they’ll be a rounding error.

What would it mean to healthcare and meaningful use if almost every hospital opts out of the meaningful use program? This isn’t too hard to imagine. A large portion of the meaningful use money has already been spent and the penalties don’t look that bad when you consider the costs and risks associated with the all or nothing meaningful use program.

If the MU reporting period doesn’t change, I think it spells the death of meaningful use. Sure, the program will subsist for those who have attested, but it will be a defunct program with so few participants that the program will have little impact. Plus, we’ll see a wave of efforts to make sure that those penalties for not being meaningful users of an EHR are removed much like has been done with the SGR fix year after year.

The Flex-IT act would at least keep meaningful use on life support. MU 2 is much harder, but with a change to a 90 day reporting period many will do it to avoid the penalties and get the last bit of EHR incentive money. If we want meaningful use to survive, then the Flex-IT act (or something that does something similar) is going to be essential to its future.

I’m just personally not sure that the Flex-IT act is such a great thing for EHR or the industry. Is it better to keep meaningful use on life support or bite the bullet now and have meaningful use die on the vine.

One might argue that meaningful use has accomplished it’s main goal: adoption of EHR software. It’s dramatically accelerated the adoption of EHR software. Would it be such a bad thing for meaningful use to disappear now? With MU gone, we could return to a more rationale EHR market. I guess this is where I’m torn on whether getting the Flex-IT act passed is a good or a bad idea.

What do you think? Is the Flex-IT act a good idea or should we just fall on the sword now as opposed to prolonging the regulation?

AHA urges agencies to speed up EMR choice expansion

Posted on June 23, 2014 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

In a move that shouldn’t surprise anybody, the American Hospital Association is urging CMS and the ONC to hurry up and finalize new rules which would expand choice for certified EMRs.

The AHA letter argues that its members are on the verge of walking away from Meaningful Use. But if CMS and the ONC speed ahead with with the new proposed rules — which would offer more choice in specific meaningful use requirements they must meet this year — hospitals will be much better equipped to proceed.

Why the rush? Well, for one thing, the letter argues, time is of the essence for hospitals, which have to decide their meaningful use strategy for fiscal 2014. If they must make choices before the new rule is finalized, it could cause them “significant financial and operational harm,” the AHA contends.

Meanwhile, if the agencies don’t push these rules through quickly, “many providers are likely to conclude that they cannot meet meaningful use this year and abandon the program,” wrote Linda Fishman, AHA senior vice president of public policy analysis and development, in a letter to CMS Administrator Marilyn Tavenner and National Coordinator Karen DeSalvo, MD.

The letter also takes on other issues. It asks that CMS and ONC clarify the rules implementation, offer more flexibility in the reporting of clinical quality measures, shorten the MU reporting period for 2015 in analyze lessons learned from Stage 2 before finalizing Stage 3’s start date, according to HealthcareITNews.

The AHA’s letter comes at a challenging time for the meaningful use program generally, which has of late attracted broader attention than it has in the past.

Not only are industry groups pressuring ONC, legislators are too. For example, at a recent health IT conference, U.S. Rep Tom Price, MD, R-GA, argued that meaningful use is “maybe not even doing what needs to be done as it relates to patients and physicians.”

In his remarks, Price argued that meaningful use could be improved by keeping the patient front and center, making sure patients know they own their health data and establishing an interoperability standard.  But he suggests that because the MU program roadmap was laid out in the HITECH Act, it’s not as fluid as it should be and doesn’t accommodate such concerns.

The reality, however, is that there is no simple way to get interoperability; right now, we’re lucky if individual EMRs meet providers’ needs.  Despite the demands from other stakeholders, health IT vendors still have a lot more to gain by creating islands rather than interoperable products.

6 Hospitals’ Meaningful Use Payment Numbers

Posted on May 20, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Becker’s Hospital CIO has posted some really interesting data about the meaningful use payments that hospitals have received. They very smartly looked at the first quarter financial reports for 6 hospitals that disclosed their EHR stimulus payments. Check out the data below:

  1. Community Health Systems (Franklin, Tenn.): $40 million, up from $19 million during the first quarter of 2013
  2. IASIS Healthcare (Franklin, Tenn.): $4 million, down from $5 million during the first quarter of 2013
  3. Tenet Healthcare (Dallas): $9 million, up from $5 million during the first quarter of 2013
  4. Hospital Corporation of America (Nashville, Tenn.): $30 million, down from $39 million during the first quarter of 2013.
  5. LifePoint Hospitals (Brentwood, Tenn.): $14 million, up from $6 million during the first quarter of 2013
  6. Universal Health Services (King of Prussia, Pa.): $430,000, down from $4.7 million during the first quarter of 2013

It’s interesting to see some of them have their payments really fall off. We’ll see how this data plays out over time, but I think it’s another data point that meaningful use stage 2 has issues and we should consider blowing up meaningful use.

4 Hospitals Have Achieved Meaningful Use Stage 2 – Yes…4

Posted on May 7, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Yesterday a presentation was done to the HIT Policy Committee. The slide below certainly paints an interesting picture for meaningful use stage 2. There’s still time, but when you consider hospitals rush to get the EHR incentive money under stage 1 this number doesn’t bode well for MU stage 2.

HITPC_CMS_Update_2014-05-06

Hospital Chief Accused of $800,000 in Meaningful Use Fraud

Posted on February 12, 2014 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Now here’s a case of the type I’ve never seen before, but expect to see more of it going forward given the temptations involved. According to the Dallas Morning News, the top administrator and CFO of a now closed chain of hospitals is facing charges that he defrauded the government of nearly $800,000 in EMR stimulus funds.

The administrator, Joe White, and the doctor who owned the hospitals, Tariq Mahmood, are accused of identity theft and stealing government healthcare funds. Meanwhile, it’s alleged that White falsely certified that Shelby Regional Medical Center in East Texas has met the requirements to receive Meaningful Use funds. Federal authorities assert that White used a computer ID and Social Security number belonging to another employee who had refused to attest at the hospital.

White is also accused of demanding that data be manually inserted from paper records into the incomplete EMR, in an effort to meet Meaningful Use qualifications.

This comes as a follow-up to the catastrophic failure of Mahmood’s six-hospital chain, which came after years of increasing financial chaos, with the hospitals mounting up millions of dollars in debts to vendors and landlords. As the hospitals fell apart financially, inspectors were documenting hundreds of patient care failures, the Dallas Morning News reports.

This came amid questions as to whether White was qualified to run a medical center, given his past record as a RadioShack salesman and a maintenance man.

Survey: CIO Pay Isn’t Keeping Up With Responsibilities

Posted on September 5, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

With EMRs, ICD-10, HIEs and countless additional technical responsibilities being heaped on the head of healthcare CIOs, one would think that they were paid well for their trouble.  And in most cases, they are.  But a new survey suggests that healthcare CIO pay isn’t keeping up as their responsibilities grow, according to Healthcare IT News.

The survey, by retained executive search firm SSI Search, points out that healthcare reform and the HITECH Act of 2009 have but previously unheard-of pressures on CIOs and IT teams to handle major technology changes and new requirements, “arguably some of the greatest changes to impact modern healthcare in America,” SSI said.

According to SSI Search’, which surveyed 178 respondents,, the typical healthcare CIO these days is a well-educated male who has served in the CIO role for 10 years.  Specifically, 82 percent of respondents were male, 97 percent have a college degree and 61 percent have a master’s degree, Healthcare IT News reports.

Total compensation for these CIOs ranged widely, from less than $125,000 to more than $724,000 per year, Healthcare IT News notes.  But that compensation didn’t track closely with the level of responsibility these CIOs are taking on, the study found. Thirty-eight percent of CIOs reported having an increase in compensation of 10 percent or less over the past four years, SSI concluded.

It’s not that we should feel sorry for these CIOs who, after all, make far more  than most average Americans. But it’s worth noting that their already overloaded plate is having even more piled on it these days.  Whether it’s reflected directly in their compensation or not, CIOs deserve acknowledgement that their very tough job is getting tougher.

For what it’s worth, CIOs seem more or less content with their pay, with more than half reporting that their current compensation is “good – in line with expectations.”

Critical Access, Small Hospitals Lagging In Meaningful Use

Posted on August 14, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Many critical access hospitals and other smaller hospitals are falling behind on Meaningful Use and may be at risk for being slapped with Medicare reimbursement penalties in 2015, according to a study reported in Health Data Management.

The study, which appeared in the journal Health Affairs, was conducted by Mathematica Policy Research and the American Hospital Association.  Its bottom line conclusion was that smaller and rural hospitals were less likely than other hospitals to have met Stage 1 criteria, and that very few had all of the IT systems in place needed to reach Stage 2, HDM reports.

The researchers noted that between 2011 and 2012, the percentage of hospitals with at least 200 beds getting Meaningful Use almost doubled, but that those with less than 100 beds had a lower rate of Meaningful Use compliance. Meanwhile, the proportion of critical access hospitals that received a Meaningful Use payment in 2012 fell slightly from the previous year.

The study also concluded that teaching hospitals had a higher rate of Meaningful Use compliance than non-teaching hospitals, and that a small percentage of government-owned and non-profit hospitals received MU incentive payments compared with for-profit facilities.

According to Health Data Management, the study isolated three challenges faced by critical access and smaller hospitals:

* Low patient volume complicates long-range planning and limits ability to maintain adequate cash flow,

* The hospitals may not be able to offer competitive salaries for skilled information technology professionals, and

* Smaller hospitals may have difficulty finding a suitable I.T. vendor.

It’s not lost on the ONC that these hospitals face significant disadvantages in getting their Meaningful Use program rolling. About a year ago, the agency rolled out a campaign intended to get 1,000 critical access and small rural hospitals meaningfully using certified EMR technology by the end of 2014. To get things rolling, ONC is spending up to $30 million for Regional Extension Centers targeting these facilities.

But as I see it, funding more REC activity is far from enough. The plain fact is that mounting a Meaningful Use program is time consuming and expensive, so much so that some smaller hospitals simply make it happen without help. Maybe the time has come for the feds to offer grants outright to hospitals struggling with these challenges.

Feds Plan EMR Certification For Specialty Facilities

Posted on August 13, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Federal HIT leaders are planning to set up a voluntary program for testing and certification of EMRs used by behavioral health, long-term care and post-acute care, according to a story in Modern Healthcare. 

As things currently stand, they’re off the hook, as ARRA doesn’t require long-term or behavioral health facilities to buy certified EMRs.

These plans came to light last week at a webinar held by outgoing ONC head Farzad Mostashari, who said that his office is working on what the scope of such a program should be, MH reports. The webinar was held to discuss government officials’ reaction to public comments on how to improve interoperability.

In its original request for input, federal regulators noted that 4 in 10 hospitals were sending lab and radiology information to outside providers, though only one in four were  exchanging medication lists and clinical summaries, Modern Healthcare said.

Meanwhile, only 6 percent of long-term acute-care hospitals, 4 percent of rehab hospitals and 2 percent of psychiatric hospitals had even a basic EMR, the feds reported.

Launching these specialty-focused options seems like a logical next step for the certification program, and a long-delayed one at that. EMR certification has been a fact of life for several years, since then-ONC chief David Brailer kicked off the formation of the CCHIT.

Over the long haul, however, such new certification options may not be worth much unless they’re better matched to provider needs. My colleague John, for one, thinks the certification will have to change to actually offer value to doctors and healthcare organizations.

What do you think, readers?  Do you think certification programs for EMRs are a waste of time, or do you see them doing anything meaningful to improve care?

AHA, AMA Seek More Flexible Meaningful Use Requirements

Posted on July 30, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

The American Hospital Association and the American Medical Association have sent a joint letter to HHS Secretary Kathleen Sebelius asking for more flexibility in the requirements for the Meaningful Use program, iHealthBeat reports.

The two trade groups, which called the program’s requirements “overly burdensome,” argue that as the current Meaningful Use program is structured, it’s too hard for some providers to keep up. “[W]e believe that the best way to move the program forward and ensure that no providers, particularly small and rural ones, are left behind is to realign the meaningful use program’s current requirements to ensure a safe, orderly transition to Stage 2,” the letter adds.

The letter makes four recommendations to improve the Meaningful Use program for providers, iHealthBeat notes:

* Let providers meet Stage 1 requirements using either a 2011- or 2014-certified EMR

* Set up a 90-day reporting period for the first year of each new stage of the program, applicable to all providers;

* Give providers increased flexibility to meet Stage 2 Meaningful Use requirements

* Extend each stage of the Meaningful Use  program to a minimum term of three years for all providers

The AHA submitted also submitted testimony to the Senate Finance Committee last week asking legislators to give providers more flexibility within the Meaningful Use program.

As things stand, unless current requirements for electronic clinical quality measures are changed, “clinicians [will be] spending extensive amounts of time working for the EHRs” rather than having the EMRs work for them, the trade group suggested.

As part of its testimony, the AHA presented case studies drawn from four separate hospitals. Based on the issues arising at these hospitals, the group recommended several changes to MU, including using fewer, better-tested electronic quality reporting measures, starting with Stage 2, and making EMRs and electronic clinical quality measure reporting tools more flexible to align data capture with the nuances of workflow.

Again, With More Gusto: Could Meaningful Use Incentives Be Slashed?

Posted on March 15, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As readers of this publication know, your editor has previously held forth on the issue of whether Meaningful Use incentive funds could be cut in the current rush to snip budgets.

With the sequester seemingly moving forward, though, and continued budget-cutting fights underway, it seems a good time to address the matter again.  So I’ll plow on, partly in response to a nicely-detailed editorial by Tom Sullivan, editor of Government Health IT.

In his editorial, Sullivan notes that 40 percent of its readers expect health IT’s bipartsan support to continue, while 25 percent argue that opposition to health IT spending is brewing on the Hill. (Another 36 percent of his readers argued that health IT momentum would continue whether or not government keeps on doling out incentive funds.)

But are his readers right about the political climate?  To get more insight, Sullivan speaks to some authorities on the subject of health IT spending, including Scott Lundstrom, group vice president of consultancy for IDC’s Health Insights Unit.

In his comments, Lundstrom points out that while there’s probably enough support for health IT capabilities — notably improved processes and quality and controlling healthcare costs — there’s a catch.  He suggests that funds from HITECH which pay for the incentives, $10 billion of which still haven’t been disbursed, are a tempting target for budget shrinkers, possibly under the mantle of clawing back stimulus funding.

Lundstrom’s on to something there. Given that the stimulus was not a bipartisan project, it does seem to me that health IT fans may finally have something to worry about. That’s especially true given the letter four congressmen wrote to HHS in September arguing for a halt in Meaningful Use disbursements until better interoperability was achieved.

I’m not a political junkie and have no access to Capitol Hill chatter on this subject. But as a supporter of Meaningful Use payouts generally — if not every detail of their execution — I’m troubled by Lundstrom’s analysis, as I do think the lack of progress on  interoperability to date gives MU foes a toehold.

Cutbacks on EMR incentives would probably do little to stop the automation of hospitals.  But I think it’s fairly clear that market momentum would not push the reluctant small group practices which are still health IT challenged to pick up costly, confusing, hard to use EMRs without some reward for their efforts.  It’s that sector we should be worrying about if the budget cutters’ eye turns to that $10 million incentive reserve.