HITECH | Hospital EMR and EHR

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

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.

What HIMSS Told Congress

This week, a House subcommittee held a hearing entitled “Is ‘Meaningful Use’ Delivering Meaningful Results?: An Examination of Health Information Technology Standards and Interoperability.” The hearing follows a recent furor over Meaningful Use’s benefits, in which HHS head Kathleen Sebelius was written a stinging letter by a quartet of Congressman arguing that the program might not be pulling its weight.

Lots of interesting discussion took place at the hearing — see a report from the indefatigable HIT blogger and expert Brian Ahier for more background — but for the purposes of this item, I’m focusing on what HIMSS had to say.

HIMSS, which obviously has a massive stake in the topic discussed, is a big Meaningful Use fan. The trade group argues that “Meaningful Use and the Stage 2 regulations allow the healthcare community to continue the necessary steps to ensure health information technology will support the transformation of healthcare delivery in the United States.”

Not surprisingly, HIMSS showed up in full color at the hearing, ready to defend MU and the progress of health IT generally. HIMSS offered Congress seven recommendations as to how to keep the MU train moving, Ahier reports. Here’s my favorites:

Direct the administration to initiate an appropriate study of a nationwide patient data matching strategy with a report back to Congress.

Support harmonization of federal and state privacy laws and regulations to encourage the exchange of health information across health systems, payers, and vendor systems.

Continue to support and sponsor pilot programs addressing the collection, analysis and management of clinical data for quality reporting purposes to assist providers and provider organizations make informed decisions for public health, patient care and business purposes.

Preclude any additional delay in the nationwide implementation of ICD-10, International Classification of Diseases beyond the current October 1, 2014 deadline.

Other than the ICD-10 recommendation, which will probably be battled down to the last millisecond by some groups, I’m betting most readers would consider these to be reasonable steps. But I could be wrong. And I don’t see a lot here on the nitty-gritty of interoperability, which was the focus of the Congressmen’s ire in the first place. Folks, what would you add to/subtract from this list?

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November 16, 2012 I Written By Anne Zieger

Filed Under: Health Information Exchange HIE HITECH Hospital EHR Hospital EMR Hospital Healthcare IT Hospital IT Systems Meaningful Use

Tags:HIMSS Hospital EHR Hospital Electronic Health Records Hospital Electronic Medical Records Hospital EMR Meaningful Use Meaningful Use Stage 2

Hospitals Behind On EMR ROI Measurements

Buying an EMR is one of biggest investments a hospital IT department is likely to make. To date, however, few hospitals are planning for and implementing EMR ROI measures early in the game, according to a new study from Beacon Partners.

Beacon interviewed more than 300 healthcare leaders about the clinical system performance measures they used for their EMR, as well as the resulting ROI. What researchers found out was that most respondents weren’t happy with their organization’s attempts to measure the ROI on their EMR spend — and that many hospitals aren’t directly measuring ROI at all.

According to healthcare leaders who spoke with Beacon, quality management and IT departments, rather than financial executives, generally institute EMR performance measures. All told, 40 percent of respondents said that they were using performance measures, but only 36 percent were satisfied with the extent to which the data was being used to measure the value EMRs brought to their organization, Beacon reports.

The problem may spring from a lack of planning. According to Beacon’s respondents, less than half (48 percent) of performance measures are determined during planning. In fact, 32 percent of providers said that performance measures were implemented in at least one patient care area post-EMR implementation. Fifty-one percent of respondents said that they would have preferred to implement clinical system performance measures earlier than they had done so.

It’s hard to tell what would deter these healthcare execs — mostly leaders with community hospitals — from demanding more results from their EMR investment. My best guess, though, is that adhering to Meaningful Use guidelines has taken up all of their bandwidth, and that CFOs have been mollified by the promise of incentive payments from the feds.

As the Beacon study suggests, though, healthcare leaders aren’t satisfied with this state of affairs. Vendors, expect to get more searching questions about ROI measurement over the next year or two.

Congressmen Want Halt On Meaningful Use Payments

Four congressmen have thrown what could be a monkey wrench into the rollout of Meaningful Use Stage 2 regulations, arguing that Meaningful Use rules are weak and ineffective and that MU incentives have gone awry.

The four have written a letter to HHS head Kathleen Sebelius to recommend that until MU Stage 2 rules require “comprehensive interoperability,” and hospitals can prove they’re capable of exchanging data, the agency shouldn’t hand out incentive payments.

In the letter, the congressmen somewhat spitefully quote the recent piece from The New York Times which suggests that EMRs are raising costs by encouraging upcoding. “Perhaps not surprisingly, your EHR incentive program appears to be doing more harm than good,” the letter says. (Oh, snap!)

What do the congressmen want? A) To see CMS suspend all incentive payments until “universal interoperable standards” are promulgated, B) to require higher level of performance from Meaningful Users (upping percentages of, for example, transfers that need to be done electronically) and C) to see HHS “take steps to eliminate the subsidization of business practices that block the exchange of information between providers.”

Of course, the health IT leaders of the world are aghast. HIMSS, for example, has already issued a statement opposing the incentive payment halt.

But there is a nuanced conversation to be had here. While I admit I’ve ridiculed the tone of the congressional letter a bit, I think there’s some merit in the complaints. Interestingly enough, the most substantial complaint (letter “C”) in the missive is discussed the least in the text.

Let’s think about what John rightly calls “Jabba the Hutt” EMR vendors. What incentive do they have to change their business practices and make their products interoperable if the only threat to their business is academic discussions about Blue Buttons, The Direct Project and 17 flavors of HL7?

No, my friends, while I disliked the nasty, hectoring tone of the letter, I think we should take the authors’ objections seriously. We are at an interoperability crossroads and there’s no immediate end in sight.

CA Doctors Say Epic Install Is Creating Massive Turmoil

Not long ago, Contra Costa County, California spent $45 million on an Epic Systems installation designed to tie different sectors of the county health system together. The implementation, which the county dubbed “ccLink” went live on July 1st. The tale that follows here is all second hand, taken from a great piece in an area newspaper, but it’s quite believable, as you’ll see.

To wit, emergency department waits at the county’s hospitals have shot up, with one in 10 patients leaving without being seen due to the backlog. One patient waited 40 hours to get a bed, according to Dr. Brenda Reilly, who spoke to county board of supervisors earlier this week on behalf of doctors working in county facilities.

In addition to live testimony, 15 doctors co-signed a letter to the board pleading for hospital administrators to cut back on physician workload further — some cuts have already been made — as physicians feel they’re unable to keep up and provide adequate care under the circumstances.

“We were not ready for Epic and Epic was not ready for us,” pediatrician Dr. Keith White told the board, according a report in the Contra Costa Times. ”As a result, the providers are struggling to provide safe and effective care…many doctors have left and all are considering leaving.”

This week’s protests follow earlier complaints in August, when nurses at the county’s detention facilities told supervisors that ccLink was jeopardizing patient safety due to the rapid install of the system.

Dr. William Walker, the county’s health services director, told the audience at the hearing that he plans to create teams of medical care providers formed to make the doctors’ paperwork trials easier.

As things stood, however, doctors weren’t mollified, calling ccLink “clunky and time-consuming, designed more for bureaucrats than physicians,” the paper reports.

Given their Epic obstacles, which have seemingly slowed medical care to a crawl, doctors are seeing half or fewer of the patients they’d been seeing.

With those patients seemingly spilling over to the emergency department, the average time a patient spends waiting in the county hospital EDs has gone from three to four hours, arguably as a result of the Epic install issues. It’s hard to argue that the new EMR is at least partly responsible for the logjam.

To be fair, I’ve heard of many an EMR installation which created temporary havoc and pumped up wait times in the ED for a while. But the level of paralysis I’m reading about hear seems to be setting some kind of record.

P.S. A side note: I called the nice young man who wrote the story to give him a backgrounder on Epic and some of the interoperability and just plain functionality problems I’ve gotten wind of elsewhere. He told me he’d gotten tons of calls already! Seems the Epic critics/watchers have their teeth into this one.

Study Suggests Most HIEs Aren’t Sustainable

According to an EHR Intelligence piece, most HIEs spend more than $1 million per year on operational expenses. That number is probably well on the low end for regional HIEs with multiple health system partners. All told, I think we can agree we’re talking about a money pit here.

The question is, and has been for many years, whether those investments offer any financial or clinical payback. After all, you can only lay out that kind of money for so long before there’s no business case for the exchange.

Unfortunately, it looks like the answer may still be “no” in many cases, according to the authors of a study appearing in Perspectives in Health Information Management. Of the 96 HIEs that responded to the researchers’ survey, the “vast majority” didn’t have a business model in place that would sustain itself even into the near future.

What’s worse, there’s little evidence that things are due to change anytime soon, the authors write: “The last decade has seen significant progress in HIE technologies and substantial investments in HIT adoption, yet the lack of evidence on the value delivered by such efforts remains a major hurdle in making a strong case for both adoption and investment at the local level.”

Even more troubling is the apparently lack of insight into this state of affairs by HIE leaders, the authors assert. When asked how they measured ROI, the authors apparently got very squishy answers, such as that they “believed” their HIE was showing positive ROI without having any metrics to make this case.

I don’t know about you, readers, but I’ve been following health data exchanges of various kinds since the early 1990s, and this is just depressing. If the government’s strategy in doling out some HITECH dollars to HIEs was to help build the core of the Nationwide Health Information Network, I think it’s pretty much proving to be a bust.

No, I’ll come out and say it: I think the government ought to pour massive funding into building out the NHIN and just get it over with without waiting for the politics and competing priorities of healthcare to gum up the works. At this point, I doubt anything else CAN work.

Hospital EHR Incentive Makes the Rich Richer

A few months back, Anne Zieger did a post discussing AHA’s comments that the Meaningful Use schedule is too ambitious that started me thinking about what’s really happening with the EHR incentive money.

Think about the hospitals that were best positioned to get access to the EHR incentive money. In most cases, they were the hospitals that were rich enough to implement IT and EHR well before the EHR incentive money even existed. I’d love to see a survey of hospitals that started their EHR implementation after the announcement of the EHR incentive money. Yes, I’m being generous. I’m not even taking into account the arduous EHR selection process that can often go on for years. If you added in that time frame, I wouldn’t be surprised if no hospitals selected and implemented an EHR post EHR incentive money.

Remember that most enterprise software projects in a hospital take multiple years to accomplish. Most hospital EHR implementations are an enterprise software project on steroids. That means that those hospitals that were already well down the path of EHR adoption are those that got paid the EHR incentive money. Those hospitals that could really use the EHR incentive money are still sitting there trying to figure out how they’re going to implement an EHR.

I’m sure there are plenty of cases where the EHR incentive money hastened EHR implementations that would have taken much longer. I know a number of hospitals that had EHR somewhere on their list of IT projects. No doubt the EHR incentive money bumped up the priority of that project.

I can’t help but see the irony of Obama having an EHR incentive program that makes the rich hospitals richer.

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July 10, 2012 I Written By John

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

Filed Under: Healthcare CIO HITECH Hospital CIO Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital Healthcare IT Meaningful Use

Tags:ARRA EHR Adoption EHR Incentive EHR Selection HITECH Hospital EHR Hospital EHR Adoption Hospital EMR Hospital Enterprise Software Projects

$5 Billion Paid Out In Meaningful Use Incentives: Now What?

So, the latest data from CMS reports that Medicare and Medicaid have paid out $5 billion in incentive payments. Sorry to be one of those annoying “glass half empty” folks, but I’m not terribly impressed.

In fact, I keep wondering whether I’m the only person who has grown more and more skeptical about Meaningful Use as it continues to pay out bonuses. I’m more concerned about what happens next, when hospitals which were sped into EMR use truly take stock of what they’ve bought and why.

According to CMS, the total number of hospitals registered for incentive payments is 3,569, a substantial percentage of the facilities in the U.S. While the math gets tricky, the bulk of those hospitals seem to have shared in the $3.34 billion paid out to the industry by CMS. (The rest has gone to eligible professionals, largely physicians.)

Some hospitals have gotten large incentive checks, but few seem to have gotten anywhere near what it’s going to cost them to install, integrate and maintain their EMRs over the next five to ten years, much less cope with the productivity hits some will face. That may be ok, but it’s worth repeating: let’s not confuse these incentives with financing.

Despite this reality, hospitals seem to be barreling ahead — grimly, with teeth clenched perhaps — but ahead nonetheless. If they’re not sure of what to do with their Epic and Cerner and Allscripts gear, other than meet government requirements, it wouldn’t surprise me. Revolutions usually don’t happen on somebody else’s timeline.

Doctors, meanwhile, seem to be taking a bit of a pause on the whole “race to EMRs” thing. The same CMS data indicates that the number of eligible professionals registering for incentives was down in 12 percent in April from March numbers. More specifically, a whopping 36 percent fewer professionals signed up for the Medicaid program, though that was offset by a 13 percent increase in Medicare enrollment by professionals.

Personally, I don’t think we’re at a tipping point yet when it comes to acceptance of Meaningful Use, despite the dollars providers are spending to company. How about you?

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June 11, 2012 I Written By Anne Zieger

Filed Under: Community Hospitals EMR Financing EMR ROI HITECH Hospital EHR Hospital EHR Company Hospital EMR

Tags:Allscripts Cerner Epic HITECH Hospital EHR Hospital Electronic Health Records Hospital Electronic Medical Records Hospital EMR Meaningful Use

GAO Wants To See Tougher Meaningful Use Audits

Here’s some scary news. A new report from the Government Accountability Office (GAO), the federal government’s watchdog agency, has recommended that the MU program do more to verify that providers actually qualify for incentive payments. Given that CMS already plans to begin auditing already-certified providers after they get their incentives, we could be looking at some disasters in the making.

The GAO, which conducted a review of the first year of Meaningful Use, looked at both the Medicare and Medicaid EMR incentive programs. It analyzed Medicare MU attestation data from last year, as well as looking at the verification processes used by Medicaid programs in four states and interviewing subject matter experts.

Along the way, the study picked up some interesting data points. For example, the agency found that 80 percent of hospitals and 72 percent of eligible professionals decided not to report on at least one mandatory MU measure, a loophole allowed by the program. (Hospitals can dodge up to three measures, and professionals six, if the measures aren’t relevant to their clinical practice or patient population.)

The bottom line is that the GAO recommends that CMS increase the number of prepayment verifications it does; set up timelines which will speed the process of evaluating audit effectiveness; offer states the option of having CMS collect MU data for both Medicare and Medicaid; and (the big one) collect additional MU verification information from providers from Medicare providers seeking the MU bucks.

As it is, CMS plans to start a “post payment audit” program this year which sounds as if it could involve clawbacks of already approved moneys. It’s hardly a new trick for CMS, which already does this already happens when our friends the Recovery Audit Contractors think you’ve made Medicare claims mistakes.

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May 18, 2012 I Written By Anne Zieger

Filed Under: HITECH Hospital EMR Meaningful Use

Tags:CMS GAO Government Accountability Office Hospital EHR Hospital Electronic Health Records Hospital Electronic Medical Records Hospital EMR Meaningful Use Audits Medicaid Medicare MU Measures

EMR Gap Grows Between Large, Small Hospitals

Meaningful Use incentives may have boosted EMR adoption dramatically, but the incentive program has had an uneven effect on the industry, new research suggests.

According to a new study published in the journal Health Affairs, the EMR adoption gap between small- and large-hospitals is substantial and growing. The study drew on responses by executives from 2,646 hospitals, or about 58 percent of all acute care hospitals in the country.

First, the good news. Researchers found that hospitals with EMRs grew from 15 percent in 2010 and 26.6 percent in 2011. They also found that the number of hospitals with a “comprehensive system” rose from 3.6 percent to 8.7 percent, according to a piece in Information Week.

The not-so-good news, however, is that not all hospitals are joining the party at the same rate. The study reported that 15 percent EMR adoption gap seen in 2010 has grown to almost 22 percent last year.

And the problem doesn’t end there. As Chantal Worzala, director of policy at the American Hospital Association and co-author, told the magazine, it’s clear that smaller hospitals’ problems may get worse over time.

As hospitals struggle to move through MU stage one and move into Stage 2 compliance, smaller hospitals are likely to get further and further behind, as they don’t have the infrastructure or staff to allow for high-volume exchange of clinical data.

So, what should happen next? Researchers had a couple of suggestions for policy-makers:

* Consider lowering the MU Stage 2 bar for smaller, rural and nonteaching hospitals
* Create a special program designed to bring hospitals with little health IT in place on board with an EMR

Short of buying systems for half the country’s hospitals, though, I don’t think the government can do much to eliminate this adoption gap. With hospitals short of IT staff, facing a tight budget and running on a narrow or non-existent margin, moderate incentives and pressure alone won’t do the trick. Readers, what solutions would you suggest?

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

What HIMSS Told Congress

Hospitals Behind On EMR ROI Measurements

Congressmen Want Halt On Meaningful Use Payments

CA Doctors Say Epic Install Is Creating Massive Turmoil

Study Suggests Most HIEs Aren’t Sustainable

Hospital EHR Incentive Makes the Rich Richer

$5 Billion Paid Out In Meaningful Use Incentives: Now What?

GAO Wants To See Tougher Meaningful Use Audits

EMR Gap Grows Between Large, Small Hospitals

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