Have you seen Epic Systems’ home page today? It’s got quite the Halloween theme.
I have a screen grab in case you miss it, but it’s more fun to see the animations on the page itself. Read more..
Did you miss Eric Dishman’s keynote address Tuesday at the Medical Group Management Association‘s annual conference in Las Vegas? That’s OK, because I secured a few minutes with Dishman, director of health innovation and policy at Intel, immediately after his talk, and the results are right here.
This podcast, recorded in the somewhat noisy press room at the Las Vegas Convention Center, is a companion piece of sorts to my coverage in MobiHealthNews on Thursday, so I hope you have a chance to check out both.
Podcast details: Intel’s Eric Dishman on connected care management, recorded Oct. 26, 2011, at MGMA annual conference in Las Vegas. MP3, mono, 64 kbps, 5.2 MB. Running time 11:08.
0:30 Virtual care coordination in nontraditional settings
1:05 Overlap/collaboration with Care Innovations joint venture
2:10 Prototype device for monitoring symptoms of Parkinson’s patients
4:00 Home monitoring of “classic” chronic diseases
4:55 Tracking behavioral changes for prevention and early detection
6:05 Realizing the potential of mobile health
6:55 Care coordination and health reform
8:30 ACOs and payment for quality
9:35 Intel’s future providing “strategic blueprints” for healthcare
10:20 How to share ideas with him
This is going to be a busy week of conferences and travel. I’m currently in Las Vegas for the Medical Group Management Association‘s annual conference. Tuesday night, I fly to San Antonio for the College of Healthcare Information Management Executives‘ Fall CIO Forum.
In part two of my series from month’s IBM Exchange 2011, my guest is IBM Distinguished Engineer Scott Schumacher. In this lively podcast, Schumacher discusses Watson, disease management and the concept of the “clinical hub,” which envisions bringing together clinical decision support and case management.
As with my previous podcast with IBM’s Lorraine Fernandes, I set my mic too low. I boosted the level during editing, but that introduced more background noise than I’d like. Schumacher mostly comes through nice and clear, though.
0:30 What the IBM Exchange is
1:38 The “clinical hub”
2:30 Population analytics and individual patient analysis
4:20 Applying Watson intelligence and other medical knowledge
5:40 Target customers for clinical hub
7:10 Technical challenges
8:15 Potential for the technology
9:00 Video/image mining
10:00 Plans for testing and deployment
11:35 Mining of clinical notes and patient history
12:30 Incorporation of genomics and predictive treatment plans
As you probably heard, CMS today released a 696-page final rule on accountable care organizations. I wrote a piece for InformationWeek Healthcare that should be posted no later than tomorrow morning, so I’m not going to rehash that. What I will do is show you the various reactions from many interest groups to the rule, particularly the ones that have an IT bent. Unfortunately, there haven’t been too many released so far, and none from the major health IT associations. Now, AMIA and CHIME are gearing up for their annual conferences next week and, let’s face it, the rule is 696 pages long, so I’ll update this page as statements come in.
For the official line, see CMS Admnistrator Don Berwick’s commentary in the New England Journal of Medicine. Notably, he mentions EHRs in the very first paragraph, in which he explains how he delivered accountable care as a Harvard pediatrician.
STATEMENT ON FINAL ACO RULE
President and CEO
American Hospital Association
October 20, 2011
Today’s rules represent the direction in which the hospital field is moving – toward better coordinated patient care across care settings. We commend CMS for listening to the concerns of America’s hospitals. The hospital field is actively working on ways to improve care delivery and the final accountable care organization rule provides hospitals a better path to do so.
In response to the concerns of the AHA and its hospital members, CMS made significant changes to the financial model, provided more flexibility in the assignment of beneficiaries and took a second look at the quality framework. We believe today’s menu of ACO options allows America’s hospitals to create new models of accountable care organizations on which the transformation of health care delivery is so dependent.
The AHA is also encouraged by the historic effort among several federal agencies to achieve the goal of better coordinated care. Specifically the antitrust agencies responded to hospital concerns and reversed their plan to require antitrust preapproval for every ACO applicant and instead provided guidance. We believe removing this barrier was essential to encouraging ACO participation.
Hospital and health system leaders welcome the concept of providing patient care in a more accountable, more coordinated way and know that they will be held increasingly at financial risk in improving outcomes for patients and becoming more efficient in the delivery of services. Hospitals already are engaged in private sector ACO initiatives and the final rule provides an additional avenue for the provision of accountable care.
The AHA strongly supports the goals and principles of the ACO program and delivery system reforms that improve patient care and quality while reducing costs. We will continue to work with CMS and other agencies to remove the substantial legal and regulatory barriers throughout the health care system to clinical integration that still remain.
I understand the American Medical Association had similar impressions, but I haven’t actually seen the AMA’s statement yet. However, the Advanced Medical Technology Association (AdvaMed), which stands to lose if expensive diagnostic tests are reduced, was disappointed:
AdvaMed Statement on
Final Accountable Care Organization Regulation
WASHINGTON , D.C. – Ann-Marie Lynch, executive vice president of the Advanced Medical Technology Association (AdvaMed), released the following statement regarding the Centers for Medicare and Medicaid Services (CMS) final rule on Accountable Care Organizations (ACOs):
“AdvaMed is concerned that CMS failed to address key issues in the final ACO rule that would have advanced patient care, ensured patient access to innovative treatments and technologies, and avoided incentives to stint on care.
“We are also concerned the rule does not address the very real danger of slowing the development of new treatments and cures. The failure to consider how innovative products play an important role in improving patient care threatens medical progress for current and future patients. Without certain design elements, the ACO program may have the effect of limiting treatment options and discouraging physicians from adopting new advancements in care.
“CMS failed to include or even discuss common-sense provisions to support continued medical progress, despite concerns expressed by the life science industry, patient groups, and members of Congress. CMS’ action runs counter to the President’s January 18 Executive Order directing agencies issuing regulations to seek to identify ways to promote innovation and undercuts the President’s goal of fostering a ‘national bioeconomy.’
“We are also disappointed that CMS rolled back rather than revamped the quality measures included in the draft rule. The final rule lacks sufficient measures of patient outcomes to assure quality of care. There are large areas of clinical practice not addressed at all – including cancer, severe arthritis, chronic pain and osteoporosis.
“This rule is a missed opportunity to ensure that the sweeping changes in payment policy established by the Affordable Care Act will support medical progress and assure that patients can receive the care most appropriate for their needs.”
The Association of American Medical Colleges was thrilled that med schools won’t be held to the same standards as everyone else:
AAMC Applauds Final ACO Rule Excluding Medical Education Payments
Washington, October 20, 2011— AAMC (Association of American Medical Colleges) President and CEO Darrell G. Kirch, M.D., issued the following statement today on the Medicare Shared Savings Program “Accountable Care Organizations”(ACO) Final Rule:
“The AAMC is pleased that the ACO final rule excludes indirect medical education payments from the methodology used to assess shared savings under the program. By not including these policy payments in the historical cost analysis, medical schools and teaching hospitals— institutions that often treat the sickest and most vulnerable patients—have a better opportunity to participate in the ACO initiative.
While we are still examining the details of the final rule, the AAMC has always been supportive of new models of care that put patients first and also leverage the benefits of institutions’ educational and research missions to reign in the unsustainable growth in health care costs. We look forward to working with our members, the Center for Medicare and Medicaid Innovation, and the Centers for Medicare and Medicaid Services to help identify ways to partner with the academic medicine community and institutions working to advance meaningful health system innovation.”
The Campaign for Better Care, a coalition of consumer groups interested in quality care for seniors, called the rule a “reasonable compromise”:
Consumer Groups Say New Accountable Care Organization Rule is a Reasonable Compromise, Urge All Parties to Get On-Board to Ensure Patients Will Soon Benefit from Better Coordinated, More Patient-Centered Care
Statement of Campaign for Better Care Leader Debra L. Ness
“The final rule on Accountable Care Organizations (ACOs), released by the U.S. Department of Health and Human Services today, has provisions that will both please and concern various parties. As advocates for consumers, particularly for our oldest and sickest patients who urgently need better-coordinated care, we applaud this effort to incentivize better primary care, increase coordination, and share accountability across providers. We are very pleased that this final rule will require ACOs to adhere to strong patient-centered criteria, use beneficiary experience of care measures to evaluate performance, and ensure full transparency, notification and choice for beneficiaries. These provisions are all essential to realizing the promise of successful ACOs, which patients in this country are counting on.
This new rule is not perfect, but it provides a path away from the broken, dysfunctional health care system we have today toward a system that offers higher quality, better coordinated and more patient-centered care.
We consider it most unfortunate that the provisions requiring beneficiary participation on ACO boards have been tempered. We urge the Department to closely monitor these provisions to ensure that consumers and beneficiaries are engaged in the design, governance and assessment of ACOs in their communities. We will be watching closely to assess whether ACOs operate in the public interest and reflect the needs and perspectives of the communities they serve. Consumers and patients hope and expect that these provisions will be strengthened down the road if needed.
In the end, we see this rule as a reasonable compromise. The Department was enormously responsive to the comments that were filed and in particular, to concerns raised by providers. It is time now for all parties to come together to create successful ACOs that deliver care that is truly patient-centered, that improves quality and care coordination, and that lowers costs. This new model of care deserves to be tested along with the numerous other innovations that have and will be promoted by the CMS Innovation Center. Patients and consumers have no time to waste.
The stakes are too high to ignore the promise that ACOs offer to improve care and bring us better value for our health care dollars. We must not let opponents of reform use any remaining differences to block the progress Americans so urgently need. Transformation is never easy, but the cost of failure to patients, families and the country is simply too high.”
AARP called the rule a “good first step” in improving quality and lowering Medicare costs:
AARP Statement on New HHS Programs Designed to Improve Coordination and Quality of Patient Care in Medicare
WASHINGTON—AARP Legislative Policy Director David Certner released a statement following today’s announcement that the Department of Health and Human Services (HHS) has issued a final rule introducing two new programs—the Medicare Shared Savings Program and the Advance Payment model—to help providers better coordinate patient care and use health care dollars more wisely through accountable care organizations (ACOs). Both programs create incentives for health care providers to work together to treat an individual patient across care settings – including doctors’ offices, hospitals, and long-term care facilities. Certner’s statement follows:
“Accountable care organizations have the potential to improve the quality and lower the cost of health care for all patients. By working across the spectrum of providers to ensure that patients get the right care at the right time and in the right setting, accountable care organizations have shown great promise in positively changing the way we deliver care.
“The programs announced today can benefit people in Medicare by encouraging providers to work together to better coordinate patient care, which can lead to fewer hospital readmissions and lower Medicare costs. AARP believes today’s announcement is a good first step and we welcome the chance to further review these programs.”
From the Department of Procrastination comes part one of a two-part podcast series from last month’s IBM Exchange 2011, an event the vendor put on to display its wares in health information exchange. The two-day conference took place in Chicago, home of the former Initiate Systems, which IBM acquired in early 2010. Here, I talk with Lorraine Fernandes, global healthcare ambassador for IBM (yes, that’s really her title), about how HIE enables healthcare reform and improved public and population health. (In part two, which I’ll post later this week, I discuss Watson with IBM’s Scott Schumacher.)
As usual, I had a minor technical glitch. Since it was a local event, I schlepped my bag downtown and set up a mixing board with two mics. I didn’t notice until the very end that I had my mic set way too low. I tried to fix that during editing, but raising the level just introduces more background noise. Ah, at least Lorraine’s words are clear.
Podcast details: Interview with IBM Global Healthcare Ambassador Lorraine Fernandes, recorded Sept. 14, 2011, in Chicago. MP3, stereo, 128 kbps, 22.0 MB. Running time 23:50.
1:00 Global problem of public health
1:45 Renewed focus on population health
3:00 Early successes and a search for better models
4:00 Private HIE in competitive U.S. markets
5:00 “Lowest common denominator” of EHR
6:30 Barriers to HIE
7:00 Building trust with consumers
11:30 Engaging people in the healthcare system
12:30 HIE for care coordination
13:30 Planning and executing ACO plans
15:15 Experiments in healthcare reform
16:00 Explaining healthcare innovations to the general public
18:05 Home monitoring for preventing hospital readmissions
19:45 IBM analytics, including Watson
21:10 Addressing continued physician resistance
22:30 Healthcare and American competitiveness
Editor’s note: This was written for a national publication, but rejected because it was too localized. I have permission to post it here. Don’t get used to me writing a lot of news stories for this blog.
Healthcare business process services firm Anthelio Healthcare Solutions will open a “center of excellence” in or near Detroit, a move that could bring thousands of IT-related jobs to an economically depressed area. The Dallas-based company, formerly known as PHNS, also announced that it is working with community colleges across Michigan to develop and hire in-state talent.
“This is mostly about private industry stepping up,” Anthelio Chairman and CEO Richard S. Garnick said. “These are not part-time or short-term jobs,” Garnick said. He added that the company did not receive any government assistance or subsidies for this expansion.
“We want to create jobs for Americans and leverage our existing capabilities,” Garnick said.
The 50,000-square-foot center of excellence will serve as a “physical location that clusters skills and expertise,” Garnick explained. Anthelio has not chosen the actual site yet, but Garnick said the company has narrowed its options to two, one in Detroit proper and one in an unspecified suburb.
There will be some consolidation of services from Anthelio offices in Detroit and Flint, Mich., but most of the people working at the center of excellence will be new hires, Garnick said, and the company would keep the existing locations open. The two current Michigan offices help Anthelio support major clients McLaren Health Care Corp. in Flint, and Nashville, Tenn.-based Vanguard Health Systems, owner of Detroit Medical Center.
Garnick did not indicate exactly how many employees Anthelio was looking for, but said it was in the thousands. “We are hiring people as we speak,” Garnick said. He added that Anthelio will support tuition reimbursement for new employees who are completing health IT training in programs of three to six months at community colleges. Current Anthelio employees also are eligible for tuition assistance.
The company is looking for expertise in health information management, computer-assisted coding, business process improvement, and other back-end healthcare functions, according to the CEO. “We have a broad set of needs, he said.
Last week, Anthelio announced a partnership with speech recognition technology vendor MedQuist Holdings to improve clinical documentation for healthcare providers and promote computer-assisted coding. The Michigan center for excellence will handle some of this work, according to Garnick, as well as analytics-related activities with another Anthelio partner, OptumInsight, a subsidiary of UnitedHealth Group that was formerly known as Ingenix.
Much of the ramp-up is intended to prepare clients for the October 2013 transition from ICD-9 to ICD-10 coding. Garnick likened the change to the scope of preparations IT departments made for Y2K more than a decade ago, with one major difference. “It doesn’t end on Jan. 1, 2000,” Garnick noted. “This will be the new platform for reimbursement for healthcare.
In the latest edition of Health Wonk Review, hosted by Chris Fleming on the estimable Health Affairs blog, there’s not much in the way of a fun theme, but that’s OK. It’s still full of some good perspectives, including more than the usual share of health IT.
My post that aggregated a bunch of tweets from the Health 2.0 Conference made the biweekly blog carnival, as did a much longer-form way of covering the event, David Harlow’s series of video interviews. Harlow got 18 different people on camera, including HHS gurus Todd Park and Dr. Farzad Mostashari.
Elsewhere, patient advocate Jessie Gruman, president and founder of the Center for Advancing Health, took on mobile apps as a means of changing patient behavior, Tom Lynch of the Workers’ Comp Insider blog discussed predictive modeling in healthcare claims administration and Healthcare Economist blog author Jason Shafrin wonders why patients don’t seem to care much about healthcare quality.
In particular, I invite you to share Shafrin’s short post, if for nothing more than a conversation starter.
How’s this for a deterrent against unauthorized snooping into patient EHRs? Australian Health Minister Nicola Roxon recently proposed whopping fines of A$13,200 for individuals and A$66,000 for companies that illegally access patient records. The Aussie dollar is nearly on par with the greenback these days, so the numbers are virtually equal when you convert to U.S. currency. That’s a lot of money.
Now, Australia doesn’t actually have much in the way of EHRs just yet, so this is somewhat speculative, but I think those numbers will get people’s attention. At least it will make records clerks think twice before peering at the records of people like Hugh Jackman or Nicole Kidman, right? The celebrity snooping at UCLA Health System cost the organization $865,000 in a legal settlement, and two employees were convicted of crimes, but I’m not aware of an individual being fined more than $2,000.
Would the threat of automatic big-dollar fines prevent unauthorized peeking at EHRs, or are lawsuits like the one the HHS Office for Civil Rights filed against UCLA more of a deterrent?
Dr. Harry Greenspun, who leads health IT efforts at the Deloitte Center for Health Solutions, was among the passengers who survived a scare on board American Eagle flight 4305 late last Wednesday. According to news accounts, a 20-year-old Saudi man on the flight from New York’s JFK Airport to Indianapolis tried to open one of the plane’s doors while in midair.
Several other passengers reportedly stopped the man and escorted him back into his seat for the duration of the flight. Upon landing, police detained the suspect. Greenspun, who was headed to Indianapolis on business, was interviewed by a local TV news station, according to the Daily Mail. (Why a British paper? I found out about this myself from the British-born Matthew Holt, mack daddy of The Health Care Blog and the health 2.0 movement.)
Out of curiosity, I checked the stats for flight 4305. It was on an Embraer ERJ-145 regional jet, a 50-seater. As a regular customer of American Airlines and its American Eagle affiliate, I know that Eagle has just a single flight attendant on planes with no more than 50 seats, as federal law allows. That’s not a lot of eyes to keep track of everything going on in the cabin. Good thing the other passengers were alert.
Dr. Greenspun, we’re glad you’re safe.