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CMS clarifies MU2 hardship exemptions

As I reported for MedCity News at HIMSS14 nearly two weeks ago, CMS Administrator Marilyn Tavenner announced plans to provide unspecified flexibility in claims for Meaningful Use Stage 2 hardship exemptions this year. Tavenner then left without speaking to the media.

The news left a lot of people scratching their heads and waiting for some details. Today, CMS issued some clarification, confirming that there would be exemptions for healthcare providers unable to have EHRs certified to 2014 standards in place for the 2014 reporting year. This is particularly important now because Medicare penalties for not achieving Meaningful Use take effect next year, but they are based on the 2014 reporting year (Oct. 1, 2013-Sept. 30, 2014 for hospitals, the 2014 calendar year for physicians and other individual “eligible providers.”)

The guidance confirms that CMS is aware of the problems caused by the slow pace of certification to the new, 2014 standards that Stage 2 requires. As of today, according to the ONC Certified Health IT Products List (CHPL), there are 3,736 ambulatory and 1,200 EHRs and EHR modules certified to 2011 standards, but just 899 total that meet 2014 certification.

Here’s the one-page CMS guidance for hospitals/critical access hospitals and the one for eligible providers.

March 11, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Health Wonk Review, post-HIMSS

While all the health IT reporters like myself were in Florida last week for HIMSS14, plenty of other things were going on in healthcare. David Harlow of HealthBlawg has a roundup of opinions in the latest edition of Health Wonk Review, entitled “In Like a Lion.”

Yes, HIMSS was a big deal, even for non-IT people, as I captured the top mention in a HWR for, I believe, the very first time, with my podcast interview with HIMSS President and CEO Steve Lieber.

(David, per your note, I only suffered superficial injuries this year, with a couple of scrapes on my face. No stitches needed, and no deaths in my family, though my uncle did lose his mother-in-law the day after I returned. I also broke a wine glass in a restaurant, though it was not my glass, it was empty and I was sober. The moral of this story: I need to avoid HIMSS in Orlando, which will be hard, since it’s on a three-year rotation. But next year, the conference is right here in Chicago, and it will be April 12-16 to avoid the dead of winter. The last time it was here, in 2009, I had bronchitis all week. Good times! The following HIMSS will be in Las Vegas, Feb. 29-March 4, 2016.)

Because it was HIMSS week, Harlow featured other IT posts prominently, including one from Lygeia Ricciardi and Adam Dole of the ONC—new national health IT coordinator Dr. Karen DeSalvo said they’re trying to call it “the ONC” instead of just “ONC” these days—about the recently launched Blue Button Connector. Harlow, an attorney, also referenced one of his own posts about HIPAA compliance audits.

Another section of this HWR examines something that I’ve been saying for a long time, that the mainstream media has been not telling the whole story about the Affordable Care Act, a.k.a., Obamacare. Later, Harlow talks about teamwork and collaboration for the purpose of patient safety. Kudos for highlighting those areas.

Click here to read Harlow’s rundown.

March 3, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

HIMSS gossip

ORLANDO, Fla.—Two days of HIMSS14 have come and gone, and I’m not bouncing off the walls just yet. But I did bounce off the pavement Monday night when I tripped exiting a shuttle bus, and have some facial scrapes to show for it. You will see the evidence whenever Health Innovation Media gets around to posting a video interview I conducted Tuesday afternoon.

Health Innovation Media’s Gregg Masters and Dr. Pat Salber have been camped out near the HIMSS press room since Sunday with their video equipment, querying various newsmakers on various health IT topics, and occasionally having guest interviewers. As I walked out of the press room on my way to the exhibit hall, I said hello to former national health IT coordinator Dr. Farzad Mostashari, who looked like he was just hanging around, but was actually waiting to be interviewed. Masters and Salber asked me if I’d be interested in interviewing Mostashari right there on the spot with no preparation, and with just 15 minutes to get down to the show floor.

If you recall, I did a live interview—yes, streamed live on the Web—last year with Athenahealth honcho Jonathan Bush, beers in hand, for the Health Innovation Broadcast Consortium that Masters and Salber were involved in. (I don’t know the status of that project, as there’s nothing new on that site since last July.) So of course I said yes, and I think it went pretty well. Well, there were a couple of hiccups, as in me thinking we needed to wrap up earlier than we actually had to. And then there’s this:

 

Followed by this:

 

Yes, the Twitterverse catches everything.

Now about that facial injury. I think I just need to avoid Orlando. In 2011, the last time HIMSS met here, I needed six stitches above my right eye after I banged my face against the edge of the bathtub in my hotel room. As I arrived for the 2008 conference here, I turned on my phone after landing and got the message that my grandfather had passed away. Just for good measure, I passed through Orlando on my way back from Europe in 2009. As the flight pulled to the gate, the skies opened up with a violent summer thunderstorm, prompting the airport to close the ramp, preventing the ground crew from unloading bags for nearly an hour. I was stuck in the no-man’s land of U.S. Customs for that whole time, where cell phones are prohibited. It was not until I cleared security, took the airport tram to a different terminal, then hustled to the gate that I knew I would make my connecting flight. So yeah, it’s become a pattern.

Anyway, speaking of Jonathan Bush, he is not at HIMSS14 because he is on sabbatical to write a book and who knows what else? Well, here’s a clue. He was spotted at the Winter Olympics in Sochi, Russia, last week with his more famous brother, Billy, host of “Access Hollywood.” (Hat tip to HIStalk for showing this video at HIStalkapalooza Monday night.)

I also heard that Bush is considering a run for political office of some kind, perhaps because it’s, you know, the family business. Anyone care to confirm this?

I do know for a fact that at least one HIMSS attendee is actually seeking office. That would be Dr. Steven Daviss, CMIO of startup M3 Information, maker of a mental health screening app called My M3. Daviss is running for Democratic Central Committee in Baltimore this year. If he wins, he plans on seeking a seat in the Maryland House of Delegates in 2018, in part because he says there is only one other physician among the state legislature.

Daviss himself is on sabbatical from his job as chairman of psychiatry at the University of Maryland’s Baltimore Washington Medical Center in Glen Burnie, Md.

February 25, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

HIMSS, Continua launch Personal Connected Health Alliance

ORLANDO, Fla.—As HIMSS President and CEO hinted at yesterday in his podcast with me, HIMSS today announced the formation of the Personal Connected Health Alliance, in conjunction with the Continua Health Alliance and the HIMSS-owned mHealth Summit.

This short video from HIMSS explains:

Also, Lieber mentioned that HIMSS has not signed on to a letter from 48 organizations—led by CHIME—to HHS Secretary Kathleen Sebelius, calling for more time and flexibility in meeting Meaningful Use Stage 2 requirements., Lieber said HIMSS declined to sign because the requests were, in his opinion, “very vague.”

Today, the letter, dated Feb. 21, was made public:

February 21, 2014
The Honorable Kathleen Sebelius
Secretary
Department of Health and Human Services
200 Independence Ave., S.W.
Washington, DC 20201

Dear Secretary Sebelius:

The undersigned organizations write to express immediate concerns confronting our respective members’ ability to comply with the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program. We recognize the vital role your department has taken in advancing the adoption of health information technology in the United States and appreciate your willingness to be flexible in extending the start of Stage 3 to 2017. We fear the success of the program is in jeopardy, however, if steps are not taken now to address our shared concerns.

Over the next seven months, more than 5,000 hospitals and 550,000 eligible professionals must adopt the 2014 Edition of Certified Electronic Health Record Technology (CEHRT) and meet a higher threshold of Meaningful Use criteria. Failure to do so will not only result in a loss of incentive payments, but also the imposition of significant penalties. With only a fraction of 2011 Edition products currently certified to 2014 Edition standards, it is clear the pace and scope of change have outstripped the ability of vendors to support providers. This inhibits the ability of providers to manage the transition to the 2014 Edition CEHRT and Stage 2 in a safe and orderly manner.

We are concerned this dynamic will cause providers to either abandon the possibility of meeting Meaningful Use criteria in 2014 or be forced to implement a system much more rapidly than would otherwise be the case. The first choice limits the success of the program to achieve widespread adoption of EHR, while the second is highly disruptive to healthcare operations and could jeopardize patient safety. As you know, our members’ number one priority must be to provide safe and high quality care to patients.

Providers need adequate time to learn how to use the newly deployed technology, including examining staff assignments, workflows, and practice processes. If providers move forward, as dictated by the current policy, our concerns regarding rushed implementations are heightened. Furthermore, we believe the “all or nothing” approach – where missing a single objective by even a small amount results in failure for the program year – compounds our concerns.

For these reasons, our organizations strongly recommend that HHS:
1. Extend the timelines providers have to implement 2014 Edition Certified EHR software and meet the Program requirements (Stages 1 and 2) through 2015;
2. Add flexibility in Meaningful Use requirements to permit as many providers as possible to achieve success in the program.

Given that we are well into 2014, immediate attention to these concerns is warranted. This additional time and new flexibility are vitally important to ensure that hospitals and physicians continue moving forward with technology to improve patient care. By making such changes, HHS would be demonstrating needed flexibility to maximize program success, without compromising momentum towards interoperability and care coordination supported by health IT.

We remain committed to the success of the program and look forward to hearing from you on this important matter. Please contact Jeffery Smith, Senior Director of Federal Affairs, CHIME, (jsmith@cio-chime.org) should you have any questions. Thank you for your consideration.

Sincerely,

AMDA-Dedicated to Long Term Care Medicine
American Academy of Allergy, Asthma & Immunology
American Academy of Dermatology Association
American Academy of Family Physicians
American Academy of Home Care Medicine
American Academy of Hospice and Palliative Medicine
American Academy of Neurology
American Academy of Ophthalmology
American Academy of Orthopaedic Surgeons
American Academy of Otolaryngology—Head and Neck Surgery
American Association of Neurological Surgeons / Congress of Neurological Surgeons
American College of Cardiology
American College of Osteopathic Family Physicians
American College of Osteopathic Internists
American College of Osteopathic Surgeons
American College of Physicians
American College of Radiology
American College of Rheumatology
American College of Surgeons
American Health Information Management Association
American Hospital Association
American Medical Association
American Osteopathic Academy of Orthopedics
American Osteopathic Association
American Psychiatric Association
American Society for Clinical Pathology
American Society for Gastrointestinal Endoscopy
American Society for Radiation Oncology
American Society of Anesthesiologists
American Society of Cataract and Refractive Surgery
American Society of Hematology
American Urological Association
America’s Essential Hospitals
Association of American Medical Colleges
Catholic Health Association of the United States
Children’s Hospital Association
College of Healthcare Information Management Executives
Federation of American Hospitals
Heart Rhythm Society
Infectious Diseases Society of America
Medical Group Management Association
National Rural Health Association
North American Spine Society
Premier healthcare alliance
Society for Cardiovascular Angiography and Interventions
Society of Thoracic Surgeons
The Endocrine Society
VHA Inc.

Yes, that is kind of vague, but that’s what you get when you involve four dozen organizations. Will it be effective? As I mentioned yesterday, ONC Chief Medical Officer Jacob Reider, M.D., hinted that there will be news about Stage 2 flexibility, likely Thursday morning at a joint ONC-CMS town hall. Reider made that statement at the CIO Forum, hosted by CHIME.

 

 

February 24, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Podcast: HIMSS CEO Steve Lieber, 2014 edition

It’s time for my annual podcast interview with HIMSS President and CEO Steve Lieber, this time from the Orange County Convention Center in Orlando, Fla., on the day before the official opening of the 2014 HIMSS Conference, rather than in his Chicago office a week or so in advance.

Lieber reiterated HIMSS’ position that the federal government should extend the attestation period for Meaningful Use Stage 2 by one year. I wasn’t there, but today at the CIO Forum, one of the preconference educational symposia, ONC Chief Medical Officer Jacob Reider, M.D., hinted that there will be an announcement on Stage 2 flexibility, possibly Thursday morning at a joint ONC-CMS town hall. That session will feature CMS Administrator Marilyn Tavenner and new national health IT coordinator Karen DeSalvo, M.D. I’ve never heard either of them speak, and now I’m excited to be covering that session.

We also discussed other aspects of healthcare reform, trends in health IT and expectations for HIMSS14. Of note, on Monday morning, HIMSS and two other organizations will announce a new initiative on “personal connected health.”

Near the end, I reference the podcast I did last week with Dr. Ray Dorsey about remote care for Parkinson’s patients. For easy reference, here’s the link.

This is, I believe, the seventh consecutive year I have done a podcast with Lieber at or just before the annual HIMSS conference. Another interview that has become somewhat of a tradition won’t happen this time, as Athenahealth CEO Jonathan Bush is not making the trip to Orlando this year.

 

Podcast details: Interview with HIMSS President and CEO Steve Lieber, Feb. 23, 2014, at HIMSS14 in Orlando, Fla. MP3, stereo, 128 kbps, 36.2 MB. Running time 39:35.

0:40 “It’s time to execute.”
1:40 Challenges for small hospitals and small practices
3:10 New ONC EHR certification proposal and continued questions about Meaningful Use Stage 2
5:00 Prioritizing with multiple healthcare reform initiatives underway, including proposed SGR repeal
6:30 Surviving ICD-10 transition
7:35 HIMSS’ position on MU2 timelines
9:05 Remember “macro objective” of Meaningful Use
10:00 Letter to HHS from organizations not including HIMSS calling for what he says are “very vague” changes to MU2 criteria
11:40 Things in MU2 causing providers fits
13:05 Fewer EHR vendors certified for 2014, but more HIMSS exhibitors
15:00 What this means for providers who bought products certified to 2011 standards
17:20 Progress on Meaningful Use so far
21:00 Looking toward Stage 3
22:42 What healthcare.gov struggles might mean for health IT
25:35 Other aspects of the Affordable Care Act being lost in the public debate
27:10 Political considerations related to health IT
29:40 Patient engagement and new HIMSS exhibitors
32:20 Why healthcare spending and provider shortage forecasts don’t account for efficiency gains made from technology and innovation
35:10 Demographic challenges for healthcare
35:45 Shift from hospitals to ambulatory and home care and consolidation of provider organizations

February 23, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Podcast: Telehealth for Parkinson’s care

Two months ago, I interviewed neurologist Ray Dorsey, M.D., co-director of the Center for Human Experimental Therapeutics at the University of Rochester, for a story I wrote based on a study he led. He had a lot of interesting things to say and, unlike so many other physicians, was aware of multiple system atrophy, the disease that killed my dad in 2012, so I decided to have him on for a podcast to describe how he is using off-the-shelf telehealth technology to expand access to care, improve patient satisfaction and reduce costs.

The study focused on Parkinson’s disease, as does a new study Dorsey is leading through http://connect.parkinson.org, but Dorsey sees this technology as promising for treating autism and Alzheimer’s disease as well.

We, of course, discussed cross-state licensure holding back wider use of remote care, a subject that is very much in the news right now. In fact, Health Data Management just published a story I wrote about, in part, the launch of the Alliance for Connected Care. This group, headed by three former senators and including CVS Caremark, Walgreens, Verizon Communications, WellPoint, Welch Allyn, Cardinal Health and telehealth companies HealthSpot, Teladoc, Doctor on Demand, MDLive and GE-Intel Care Innovations, is advocating for regulatory changes to expand remote care.


Podcast details: Interview with University of Rochester neurologist Ray Dorsey, M.D. MP3, mono, 128 kbps, 16.3 MB. Running time 17:54.

1:30         Telehealth to expand access to care for people with chronic diseases

2:00         Shocking numbers about Medicare beneficiaries with Parkinson’s who don’t have a regular neurologist

2:45         Lack of reimbursement for telehealth even though it costs substantially less than in-person visits

3:38         Incentives to provide care in “high-cost, relatively unsafe environments”

3:58         Insurers “are never going to lead the way” in terms of innovation

4:40         Previous study funded by PatientsLikeMe, the Verizon Foundation and Medtronic funded his study

5:40         Findings of that study, and advantages of remote care

6:25         Telehealth to increase access to care, improve patient satisfaction and reduce costs

6:50         New study on “virtual house calls” about to launch in collaboration with Patient-Centered Outcomes Research Institute (PCORI)

7:37         Low-cost, off-the-shelf technology

9:45         Registering for PCORI study

10:40       Cross-state licensure issues, including new Alliance for Connected Care

12:10       Parameters and goals for new Connect.Parkinson study

13:35       How technology is creating care opportunities for “anyone, anywhere”

14:10       Dealing with the newly insured and with special-needs patients

15:50       Savings from preventing falls and other dangerous conditions

16:10       Enrollment for Connect.Parkinson

16:42       About the Center for Human Experimental Therapeutics

 

February 19, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Happy birthday, HITECH, and pre-HIMSS humor

Today is the fifth anniversary of the American Reinvestment and Recovery Act being signed into law, which also means today is the fifth anniversary of the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was rolled into the $831 billion stimulus bill. HITECH introduced “meaningful use” into the lexicon, and for that, it has had a lasting effect.

Through the end of 2013, the program had paid out more than $19 billion in Medicare and Medicaid incentives for EHR usage, and healthcare is still a mess. However, all of that money is for Stage 1, and the goal for the first stage was mostly to get technology in place. Stage 2, which is just getting started, is about interoperability and data capture, while Stage 3, which will not start before 2017, will be focused on actually improving outcomes. It is not until the third stage where we are supposed to see real gains in healthcare quality, though we should start seeing some efficiency improvements in Stage 2.

Penalties for not achieving Meaningful Use kick in next year, though that could change. According to Medscape, the new bill to repeal the much-reviled Medicare sustainable growth rate calls for bringing Meaningful Use, the Physician Quality Reporting System (PQRS) and Medicare’s value-based payment modifier under a proposed new program called the Merit-Based Incentive Payment System (MIPS). This program would eliminate Meaningful Use penalties after 2017, but would base incentives and penalties on more factors than just EHR usage.

On a lighter note, MMRGlobal, the controversial PHR vendor that has been aggressive in defending its many patents but that also has, like every other vendor of untethered PHRs, had trouble landing many customers, has signed on actress and cancer survivor Fran Drescher as a spokesperson. There’s a video on the company’s Facebook page, with a teaser to “Watch For MMRGlobal on TV!” Draw your own conclusions.

On an even lighter note, digital media producer Gregg Masters has started the #HIMSSPickupLines hashtag on Twitter. A few samples:

 


 


 

Have fun.

February 17, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Loudmouth patients, in their own words

The video from the Digital Health Summit session, “Loudmouth Patients: Making Noise and Making Change,” that I moderated in January has been posted. It was a lively, fascinating discussion involving: empowered patient Hugo Campos; Donna Cryer, CEO of the Global Liver Institute (and a liver transplant recipient herself); and Greg Matthews, group director of  interactive and social media at WCG.

Unfortunately, one long-winded questioner from the audience took up all the Q&A time (and I initially mistook her for Bettina Experton of Humetrix), so some things went unanswered. If you have any questions for the participants, post them in the comments below and I will attempt to get the panelists to answer.

This discussion took place Jan. 8 at the Digital Health Summit at International CES in Las Vegas.

In case you missed it, here are some post-session interviews with Campos, Matthews and myself.

February 13, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

OpenNotes, changing roles in health IT and a Friday, um, funny

I’ve just had two new stories published on the US News & World Report Hospital of Tomorrow site: “OpenNotes Helps Keep Patients Informed and Engaged” and “The Evolution of Health IT Continues.” The latter is subtitled, “New roles signal new realities and priorities as hospital information technology changes,” and goes in depth and the changes underway in hospital HIS and HIM departments in response to various healthcare reform imperatives. I’d appreciate your feedback here, on the U.S. News pages and on Twitter.

Since it’s Friday, I’ll share something offbeat. I’ll let you decide if it’s a good idea or a gimmick. Nestlé Fitness has created the “Tweeting Bra,” with a Bluetooth-enabled sensor that sends a tweet every time the wearer unhooks the undergarment, reminding women daily of the importance of breast self-exams. Here’s a video, in Greek with English subtitles.

 

If you want more information, here’s a short interview with the keeper of the Tweeting Bra, Maria Bakodimus, a Greek celebrity. It’s only in Greek, without subtitles, but it does show the sensors in more detail.

If you want to get one, well, sorry.

 


It was a one-off prototype created for Breast Cancer Awareness Month in October.

February 7, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

More accolades for Topol as ‘connected health’ gains

I’m convinced that Dr. Eric Topol is one of those rare people, like Dr. John Halamka, who can function on minimal sleep, perhaps four hours a night. He just gets that much done.

Yesterday, AT&T named Topol chief medical advisor. As such, the company says, Topol will “impact the design, development and delivery” of connected health products and services for the AT&T ForHealth business. This is on top of his appointment last year as editor-in-chief of Medscape, his many speaking engagements and TV appearances and, lest we forget, his day job as cardiologist, geneticist and chief academic officer at Scripps Health in San Diego and leader of the Scripps Translational Science Institute.

Topol will not, however, be replacing Dr. Geeta Nayyar, who was full-time CMIO at AT&T until September.

This news comes a couple weeks after CBS News ran a segment on the possible demise of the stethoscope at the hands of the portable ultrasound.

 

This is not the first time we have heard this idea. Yes, it was Topol who dropped his stethoscope in the trash on stage at TEDMED 2009 and suggested that the handheld ultrasound should become the standard of care by the time the 200th anniversary of the stethoscope rolled around in 2016.

Given how slowly medicine moves, I wouldn’t bet on the stethoscope being extinct in the next two years; the cost of the GE Healthcare Vscan ultrasound, the one Topol demonstrated in 2009, hasn’t really budged since then. A new one will still set you back $7,900. I can’t see primary care physicians shelling out that kind of cash when the old technology is $200 or less.

Meanwhile, this week we get more evidence that “connected health” may be winning the terminology battle over mobile, wireless and digital health. The February edition of Health Affairs examines this field, which the policy journal says encompasses telemedicine, telehealth and mobile health. On the other hand, the lead author of one of the overview articles is Dr. Joseph Kvedar, founder and director of the Center for Connected Health at Partners HealthCare in Boston. He is the champion of the term, and possibly the creator of it.

 

 

February 4, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.