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CMS proposes MU2 extension, MU3 start date of 2017

Less than three weeks ago, I reported from the American Medical Informatics Association Annual Symposium in Washington that officials from the Office of the National Coordinator for Healthcare Information Technology were publicly saying it was unlikely there would be a delay to Stage 2 of Meaningful Use.

In October, noting that the federal rule-making process can be arduous, former national health IT coordinator Dr. Farzad Mostashari said, “I think folks should assume that the timelines stick.” He was speaking to the College of Healthcare Information Management Executives a week after leaving government service.

Today, we find out that they knew something we didn’t. The Centers for Medicare and Medicaid Services proposed extending Stage 2 to 2016 and delaying the start of Stage 3 to 2017.

Per ONC:

Under the revised timeline, Stage 2 will be extended through 2016 and Stage 3 will begin in 2017 for those providers that have completed at least two years in Stage 2. The goal of this change is two-fold: first, to allow CMS and ONC to focus efforts on the successful implementation of the enhanced patient engagement, interoperability and health information exchange requirements in Stage 2; and second, to utilize data from Stage 2 participation to inform policy decisions for Stage 3.

The phased approach to program participation helps providers move from creating information in Stage 1, to exchanging health information in Stage 2, to focusing on improved outcomes in Stage 3. This approach has allowed us to support an aggressive yet smart transition for providers.

 

The delay to Stage 3 was likely. As I exclusively reported in June, ONC’s deputy national coordinator for programs and policy, Judy Murphy, dropped a strong hint that Stage 3 would not start until 2017, saying, “2016 would be a problem.” By pushing back the start of the third stage, we would automatically get an extension to Stage 2, making it a three-year program instead of two.

The start of Stage 2 already had been pushed back a year from the original plan of 2013. From my reading, what CMS is proposing today is not another delay to the beginning of Stage 2. Hospitals that have begun their attestation periods since Oct. 1 may continue and physicians are allowed to start Jan. 1.

CMS said to expect proposed Stage 3 regulations, as well as proposed ONC EHR certification rules for Stage 3, in the fall of 2014.

What strikes me as odd is that this announcement came late on a Friday afternoon. There is no time stamp on the ONC blog post, but CMS’ Travis Broome tweeted this at 4:05 pm EST:

Late Friday is typically when government agencies take steps they don’t want plastered all over the news. I don’t see anything here that is surprising or controversial, and it could be argued that ONC didn’t mislead people with earlier statements because the start dates for Stage 2 are not changing. Did I miss something?

UPDATE: CMS held a webcast about this that started at 1 p.m. EST. That’s still Friday afternoon, but not so late that it looks like they’re trying to bury the news.

 

December 6, 2013 I Written By

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

California HealthCare Foundation CEO Smith stepping down

This comes in late on a Friday, though not as late on the West Coast, where it happened: The California HealthCare Foundation announced that founding President and CEO Mark D. Smith, M.D., will be leaving the influential organization later this year. Over the years, Smith has been a vocal advocate for quality improvement via, among other things, health IT.

I’ve had the pleasure of hearing Smith speak and interviewing him several times over the years, notably at the 2009 American Medical Informatics Association conference and at the 2011 Health 2.0 conference. (Coincidentally or not, both took place at the San Francisco Hilton.) At AMIA 2009, I distinctly remember Smith asking why there wasn’t an Open Table-like service for getting last-minute doctor’s appointments. Not long after that, ZocDoc came along.

Here’s the text of CHCF’s press release:

California HealthCare Foundation President Mark Smith to Step Down

Founding leader of Oakland philanthropy will depart in late 2013

Dr. Mark D. Smith, who has led the California HealthCare Foundation (CHCF) since its founding, plans to step down as president and CEO at the end of year, the foundation announced today.

“It has been a great honor to lead the California HealthCare Foundation in its mission to improve the quality of health care for all Californians,” Smith said. “I leave the foundation knowing it is well positioned to continue this important work.”

During his tenure, Smith focused CHCF on catalyzing efforts to improve health care quality, promote greater access, and reduce the cost of care for the state’s most vulnerable and underserved residents. The Oakland-based philanthropy makes grants totaling approximately $37 million annually from a fund of $700 million. CHCF has granted over $500 million since Smith became the founding president and CEO in 1996.

“Mark Smith’s remarkable leadership over the last 16 years has focused the California HealthCare Foundation on a vision to improve the health care system where it matters most: in the clinics, the hospitals, doctors’ offices, and wherever Californians go to find care,” said Ian Morrison, PhD, chair of the CHCF Board of Directors. “While he recognized that the problems in health care are huge, Mark and his team were smart and innovative in targeting the foundation’s resources where they could most make a difference.”

Smith, 61, a physician and expert on state and national health policy, will continue his work as a member of the clinical faculty at the University of California, San Francisco, and as an attending physician at the Positive Health Program for AIDS care at San Francisco General Hospital, where he has practiced since 1992, including during his tenure at CHCF.

Under Smith’s leadership, CHCF focused on improving the way health care is delivered and financed in California through a number of initiatives, including:

Promoting research and policy analysis. From its founding, CHCF has supported sound decisionmaking using evidenced-based research and nonpartisan policy analysis. CHCF has become a prolific publisher on issues of quality, access, and the financing of care covering both the commercial and public sectors.

Promoting transparency. The foundation has made significant investments in supporting transparency in health care delivery through publicly reporting quality data on hospitals, nursing homes, and long term care facilities, and building public websites that allow consumers to compare local facilities and provide health care leaders with benchmarks for improvement.

Improving clinical care. Smith focused attention on innovative ways to improve care delivery, including being an early proponent of using information technology at the point of care, challenging providers to deliver high-quality and cost-effective care, and promoting disruptive innovations like retail clinics and process redesign. He has also championed redefining the scope of work among clinical team members, to help ameliorate the need to train more doctors to do work that lower-cost members of the clinical team can deliver safely and effectively.

Training new leaders. The foundation initiated the CHCF Health Care Leadership Program at UC San Francisco in 2001. The two-year, part-time fellowship has trained 355 clinicians in management and leadership skills required to lead the state’s health care institutions in a rapidly changing and challenging environment. The program’s alumni now occupy leading positions in hospitals, clinics, medical groups, and government throughout the state.

Fostering innovation. The $10 million CHCF Health Innovation Fund helps accelerate innovation in care delivery by investing in new and emerging companies focused on lowering costs and improving access to care. While supporting improvements to the health delivery system, CHCF also has focused on the rise of alternative care delivery models such as retail clinics and the adoption and effective use of information technology.

Modernizing enrollment. CHCF has been a leader in promoting more efficient and consumer-friendly ways for eligible Californians to enroll in public programs. In 1999 the foundation supported the development of the first web-based eligibility and enrollment application in the United States, which it licensed at no cost to the State of California. More recently CHCF led the successful national public-private development of a first-class user experience design to streamline enrollment under the Affordable Care Act (ACA). The foundation has also recently focused on supporting the implementation of the ACA in California, and continues to monitor and report on its progress.

Supporting health care reporting. Recognizing the important role that the media has in promoting improvements in health care, CHCF has devoted significant resources to supporting health care journalism. Since 1998, the foundation has produced California Healthline, a daily digest of news, analysis, and opinion on the state’s health care system. In 2009, the foundation established the CHCF Center for Health Reporting at the USC Annenberg School of Communication and Journalism, which collaborates with media across the state on in-depth, explanatory journalism on critical health care issues.

“Mark has built a strong staff that is set on a steady course, focusing on the medical delivery and financing systems in California, with an emphasis on quality improvement, increasing both access and efficiency, and addressing the unsustainable cost of care to individuals and society,” Morrison said. “The board expects the foundation to continue building on its successes in these areas.”

“There is still a lot of work to be done. While I will assist the board and staff in making a smooth transition to a new leader, I will also continue to look for ways to make our health care system work better for the people of California,” Smith said.

A native of New York City, Smith earned his bachelor’s degree in Afro-American studies at Harvard (1979), his medical doctorate from the University of North Carolina at Chapel Hill (1983), and a master’s in business administration with a concentration in health care administration from the Wharton School at the University of Pennsylvania (1989).

Prior to joining CHCF, Smith was executive vice president at the Henry J. Kaiser Family Foundation. He previously served as associate director of the AIDS Service and assistant professor of medicine and of health policy and management at Johns Hopkins University. He has served on the board of the National Business Group on Health, the performance measurement committee of the National Committee for Quality Assurance, and the editorial board of the Annals of Internal Medicine.

He was elected to the Institute of Medicine (IOM) of the National Academy of Sciences in 2001 and recently completed service as the chair of an IOM committee on “The Learning Health Care System in America,” which issued its report Best Care at Lower Cost in September 2012.

Smith will continue serving as CHCF’s president and CEO until a new leader is in place, which is expected by the end of 2013. The search for Smith’s successor will be conducted by the foundation’s board of directors. Inquiries should be directed to Carol Emmott of Russell Reynolds Associates at cemmott@russellreynolds.com or 415-352-3363.

About the California HealthCare Foundation

The California HealthCare Foundation works as a catalyst to fulfill the promise of better health care for all Californians. We support ideas and innovations that improve quality, increase efficiency, and lower the costs of care.

 

CHCF also released a statement from Board Chair Ian Morrison, Ph.D.:

The Philanthropic Leadership of Dr. Mark D. Smith

Ian Morrison, PhD, MA, Chair of the CHCF Board of Directors

The CHCF board of directors conveys its pride in what has been achieved under Dr. Mark Smith’s extraordinarily creative leadership and reinforces its commitment to the strategy, programs, and initiatives that CHCF has spearheaded over the last 16 years.

 

January 11, 2013

The board of directors of the California HealthCare Foundation has asked me to communicate our pride in what has been achieved under Dr. Mark Smith’s extraordinarily creative leadership and to reinforce our commitment to the strategy, programs, and initiatives that CHCF has spearheaded over the last 16 years.

We recognize and anticipate that our next leader will bring fresh ideas and energy that will take us in new directions. We are also firm in our belief that the California HealthCare Foundation will continue to play a central role at the intersection of the health care delivery system and the policy world that Dr. Smith carved out during his tenure.

We take great pride in the fact that CHCF is a respected resource for objective research, information, data, and analysis on a broad range of health care issues in California; a trusted convener; and a creative helping hand, spurring on innovation in the market and the policy community to benefit the health of all Californians. In reflecting on Dr. Smith’s extraordinary leadership, the board has identified 10 areas where the foundation has had particular impact.

All of these efforts have been shepherded by the foundation’s most powerful asset: its staff. Each board member will attest to the quality of people who work for CHCF: their energy, enthusiasm, expertise, and professionalism are truly impressive.

The consistently high standards of the foundation’s staff, grantees, and partners have resulted in a remarkable body of work that has made important contributions to improving quality, access, and affordability of health care services in California and the nation. This list samples from the many and various ways CHCF has made a difference. Dr. Smith’s leadership signature is evident in all of them and together they reflect the enduring DNA of this organization that we believe will carry on under his successor.

1. The Fruits of Conversion: The Orderly Creation of Two Important Philanthropic Foundations

CHCF was originally tasked with managing the sale of Wellpoint stock following the conversion of Blue Cross of California to for-profit status and transferring 80% of the proceeds to The California Endowment (TCE), our sister foundation. The founding CHCF board and staff under Dr. Smith’s leadership managed the process smoothly and created the endowment for TCE, which today has assets of $3.2 billion and annual giving in excess of $165 million. CHCF’s 20% of the proceeds amounted to almost half a billion dollars at the time, and Dr. Smith led the process of developing a complementary strategy and grants program. The result was the creation of two important health care philanthropies in the state: The California Endowment, which focuses on community-level initiatives to improve access and public health, and the California HealthCare Foundation, which focuses on policy and practice change in health care financing and delivery.

2. A Market Savvy, Policy-Relevant, Innovative, and Trusted Philanthropy

We are proud of our position as a trusted convener of health care stakeholders from the worlds of policy and industry. We value our reputation as an organization that simultaneously understands market dynamics and the intricacies of policy at federal, state, and local levels. Dr. Smith and the staff have built the capacity to navigate through this difficult terrain, but most importantly, to identify creative ways to intervene and play a catalytic role. Our board has strongly supported the identification of unique points of leverage on market-makers and policymakers alike to help improve quality, access, and affordability of health care for all Californians.

3. Support for New Leaders

Early in CHCF’s history, in collaboration with the University of California, San Francisco, CHCF conceived of a professional development program for clinical leaders in the state, particularly those serving in safety-net institutions. The purpose was to provide young clinicians with the leadership skills they would need to head their organizations in the future. The program currently has 355 alumni across the state and the board recently announced the foundation’s support for two new classes. The program has been emulated by other foundations and institutions in California, resulting in a total of more than 2,000 graduates across the state. Any meeting of California health care leaders is likely to include graduates of these programs, and many of them have become important grantees, partners, and champions for constructive change across California’s health care system.

4. The Adoption and Effective Use of Health IT

CHCF has always been known as a pioneer in the promotion of health information technology as an important tool to improve the quality, safety, and efficiency of care delivery. Some may point to our investments in the creation of the Santa Barbara County Care Data Exchange as taking a large risk (as we explored in a self-reflective 2007 Health Affairs special section). But as a board, we have been consistent in our support for investment and improvement in the use of new information technology in health care. And indeed we firmly believe that Santa Barbara was a catalyst for the significant federal HITECH investment that has followed.

While CHCF has had a long and important interest in promoting health IT to improve clinical care, we have also made special contributions in the seemingly arcane area of enrollment modernization. Building on Mark Smith’s and Vice President of Programs Sam Karp’s combined belief, interest, and expertise in the area, CHCF created important tools, technologies, and policy processes to help automate and modernize enrollment in public programs such as Medi-Cal and Healthy Families. Health-e-App and One-e-App not only enabled thousands of Californians to secure the coverage they were eligible for, but these pioneering efforts laid critical groundwork and built expertise in online enrollment and user experience design that has informed policy and practice related to implementing the Affordable Care Act in California and nationally.

5. Technical Assistance for the Safety Net

Much of CHCF’s work has involved deep engagement with public hospitals, community health centers, and county-organized health systems to improve quality, access, and affordability, particularly for patients with chronic conditions. Through a wide range of projects and initiatives, CHCF has supported chronic disease registries, electronic health records, telehealth adoption, quality improvement activities, and measuring and improving patient experience in institutions that lack the resources, capacity, or time to invest in delivery system transformation. These programs have helped improve access to care for specialty services for the underserved and the quality of care for patients with chronic illness, as well as improve the efficiency, service level, and throughput of overstretched safety-net providers.

6. The California Health Care Almanac and Information Services

CHCF plays an active role in monitoring the functioning and improving the transparency of health care policy and practice in California. Through a wide range of sponsored studies, custom reports, and news services under the broad rubric of the California Health Care Almanac, California Healthline, and iHealthBeat, the foundation keeps health care leaders informed about what is happening, what is important, and what lies ahead. The consistent quality and timeliness of this work has created a resource base that is relied upon by managers, policymakers, consultants, and academics, in the state and across the country.

7. CHCF Center for Health Reporting

CHCF recognized with concern that the ongoing transformation in media was undermining the economic viability of quality journalism in the health care field. The foundation created the CHCF Center for Health Reporting at the USC Annenberg School for Communication and Journalism to support high-quality reporting in partnership with media outlets in the state. The results can be seen in the number of stories produced in state and local media and their impact on the policy discourse on important topics, including the performance of Denti-Cal plans, the public conversation on end-of-life issues, and variation in the quality of care delivered across the state.

8. CHCF Health Innovation Fund

CHCF has committed $10 million over three years to invest in new ventures that have the potential to reduce the cost of care or improve access for the neediest Californians. The fund is off to an exciting start with several important investments in promising start-ups that we hope will create lasting value and improvement in health care delivery in areas such as telehealth access to specialists, better asthma management, and more efficient pharmacy services for rural and safety-net institutions. The fund is at an early stage, but we are excited by the prospects for this program-related investment (PRI) vehicle to innovate in areas of greatest need that the market might have overlooked without our help.

9. End-of-Life Care

End-of-life care has become a focus of the foundation because of the wide gap between the way Californians say they want to spend their last days and the highly medicalized way that many of them die. The foundation has supported greater clarity in end-of-life wishes through use of POLST (Physician Orders for Life Sustaining Treatment) forms across the state. Major progress has been made in making this a standard of care. Similarly, CHCF grants and initiatives have enabled every public hospital in the state to establish palliative care programs over the last five years. CHCF remains committed to raising awareness of Californians’ wishes for the care they receive at the end of life and in supporting care choices that are consistent with those wishes.

10. Supporting Improvement in the Medi-Cal Program and the Implementation of the ACA

CHCF has joined with other foundations and has worked with policymakers and state agencies and departments to provide instrumental technical support for many dimensions of the Medi-Cal program and the implementation of the Affordable Care Act, including:

  • Informing the development of enabling legislation for the state-based health benefits exchange
  • Providing technical support on the development of Medi-Cal waivers
  • Developing performance standards for Medi-Cal beneficiaries with disabilities and monitoring and evaluating their transition into Medi-Cal managed care
  • Informing California’s implementation of coverage expansion and insurance market reform, health IT deployment, and quality improvement initiatives

This important work continues.

Over the course of the next year, there will be many opportunities to toast Mark Smith’s legacy and contributions, and also time to warmly welcome a new leader. As we embark on this journey, the CHCF board of directors is proud of CHCF’s past and confident in its future. With the board’s strong encouragement and support, Mark Smith and his team have created an important institution that will continue to serve Californians in the decades ahead, building on a rich legacy of creativity and innovation, as evidenced in these efforts we highlight today.

January 11, 2013 I Written By

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

Technology changes faster than you think

How much do things change in seven-plus years? Perhaps more than you think.

According to Wikipedia, the following happened in April 2005:

  • Google doubles the storage space of its Gmail service to two gigabytes.
  • Pope John Paul II passes away at the age of 84.
  • A group of at least 40 Iraqi insurgents attacks Baghdad’s Abu Ghraib prison, using car bombs, grenades, and small arms. At least 20 American soldiers and 12 Iraqi prisoners are injured, but the US Army says it has put down the assault.
  • American newscaster Peter Jennings states that he has lung cancer and will begin chemotherapy.
  • Sinn Féin leader Gerry Adams appeals to the IRA to stop violence.
  • Eric Rudolph agrees to plead guilty to four bombings including the 1996 Centennial Olympic Park bombing in exchange for four life sentences.
  • Prince Charles marries Camilla Parker Bowles
  • Adobe Systems buys Macromedia for $3.4 billion.
  • Victims and families observe 168 seconds of silence on the 10th anniversary of the Oklahoma City bombing.
  • YouTube is founded and launched.
  • Pope Benedict XVI is formally installed as pope of the Catholic Church in an inaugural mass.
  • Venezuelan president Hugo Chávez ends military cooperation with USA, claiming that US Army training officers in the country have been agitating unrest against him.
  • The new Airbus A380 performs its maiden flight, in Toulouse, France.

And smartphones were not exactly common in healthcare. How do I know this? I just unearthed the following program from AMIA’s 2005 Spring Congress:

Yes, indeed, that’s a Pocket PC, a personal digital assistant without a phone. Microsoft dropped the name in 2006 in favor of Windows Mobile. A year after that, Apple introduced the iPhone, and the rest is history.

I’m about to go on a long-overdue vacation for the rest of the year, including a week of staycation to catch up on everything I’ve neglected at home in this difficult year. You probably will see my byline in MobiHealthNews and InformationWeek Healthcare next week, but I won’t be on the job. I have a couple of pieces of multimedia I’ve put off for months, and I may get around to processing and posting them before the end of 2012. If not, I’ll see you in January.

December 13, 2012 I Written By

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

Hyperbole doesn’t work in health IT

I’m still rather slammed with work, but I might as well take a few minutes to post on a Friday afternoon to call out someone else who’s pumping up the health IT hype beyond reasonable levels.

A publicist for UnitedHealth Group wanted me to attend yesterday and today’s New York eHealth Collaborative Digital Health Conference in New York City. Never mind the fact that I live in Chicago and the invite came in two days ago. To be fair, though, I was offered phone interviews. I declined based on the second paragraph in the e-mail:

This event is the first and only national summit dedicated specifically to advancing the role of health information technology (HIT). Hundreds of leading stakeholders and thought leaders from across the HIT space will gather under the same roof to discuss the latest technologies, achievements and challenges impacting the industry. HHS Chief Technology Officer Todd Park is the keynote speaker.

This is the first and only national summit dedicated specifically to advancing the role of health information technology, huh? Other than HIMSS, AHIMA, AMIA, AMDIS, CHIME, ANIA-CARING, iHT2, Health Connect Partners, HL7 and a few more, that is absolutely a true statement. Let’s not leave out the dearly departed TEPR, either.

I hope others didn’t fall for that ridiculous statement.

December 2, 2011 I Written By

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

Reactions to final ACO rule

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.

From the private sector, the American Hospital Association liked the flexibility in the final rule, as evidenced by this statement:

STATEMENT ON FINAL ACO RULE

Rich Umbdenstock
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, 2011AAMC (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.”

 

October 20, 2011 I Written By

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

Clinical informatics certified as medical subspecialty

I just got word from AMIA that the American Board of Medical Specialties has officially accepted clinical informatics as a medical subspecialty. I’ll have more in a story for InformationWeek by tomorrow morning. I don’t have a link to the press release yet, but here’s the text:

 

FOR IMMEDIATE RELEASE

 

Clinical Informatics Becomes a Board-certified Medical Subspecialty Following ABMS Vote

AMIA to offer prep courses for clinicians who sit for Board Exam

Sept. 22, 2011, Washington, DC—Today, AMIA—the association for informatics professionals—announces the success of a multi-year initiative to elevate clinical informatics to an American Board of Medical Specialties (ABMS) subspecialty certified by an examination administered by the American Board of Preventive Medicine and available to physicians who have primary specialty certification through the American Board of Medical Specialties. Joining such subspecialties as pediatric anesthesiology, medical toxicology, sports medicine, geriatrics medicine, and cardiovascular disease, clinical informatics (CI) certification will be based on a rigorous set of core competencies, heavily influenced by publications on the subject that were developed by AMIA and its members, many of whom have pioneered the field and supported CI’s new status as an ABMS-recognized area of clinical expertise. The goal for the first board exam is to have it available in Fall 2012, with the first certificates awarded early in 2013. To prepare physicians who wish to sit for this examination, AMIA is developing preparatory materials both as online and in-person courses starting Spring 2012.

“It is entirely appropriate and timely to certify clinical informatics as a specialized area of training and expertise in an era when more and more clinicians are turning to data-driven, computer-assisted clinical decision support to provide care for their patients,” said AMIA’s Board of Directors Chair Nancy M. Lorenzi, PhD, of Vanderbilt University Medical Center. “Clinical informatics blends medical and informatics knowledge to support and optimize healthcare delivery.”

In 2005, AMIA took note that demand for formal training and certification in clinical informatics (CI) was growing among physicians. Two years later, with support from the Robert Wood Johnson Foundation, AMIA launched a process to define the core content of the CI specialty and the training requirements for proposed CI fellowships (that would be accredited by the Accreditation Council of Graduate Medical Education). In 2009, the American Board of Preventive Medicine (ABPM) agreed to sponsor an application for a CI specialty examination, and a year later submitted a formal application to the American Board of Medical Specialties (ABMS) to consider the creation of a new specialty certification. Once submitted, the ABPM proposal attracted support from the American Board of Pathology, which will cosponsor the subspecialty with the ABPM.  Subsequently, several other medical boards expressed interest in joining as formal co-sponsors

The role of the clinical informatician is to use his/her knowledge of patient care in combination with an understanding of informatics concepts, methods, and tools to:

  • assess information and knowledge-based needs of healthcare professionals and patients.
  • characterize, evaluate, and refine clinical processes.
  • develop, implement, and refine clinical decision support systems, and
  • lead or participate in the procurement, customization, development, implementation, management, evaluation, and continuous improvement of clinical information systems, such as electronic health records and order-entry systems.

“Establishment of the clinical informatics medical subspecialty is consistent with the current emphasis on broadening and professionalizing the health information technology workforce,” said AMIA President and CEO Edward H. Shortliffe, MD, PhD. “With the need over the next decade for 50,000 informatics professionals in the health sector with various levels of expertise, this focus on physician expertise in clinical informatics is clearly a step in the right direction. The CI exam will encourage more medical schools to build informatics into their training programs and to begin addressing real-world information management needs of physicians in virtually every work environment.”

About AMIA
AMIA is the center of action for 4,000 informatics professionals from more than 65 countries. As the voice of the nation’s top biomedical and health informatics professionals, AMIA and its members play a leading role in assessing the affect of health innovations on health policy, and advancing the field of informatics. AMIA actively supports five domains in informatics: translational bioinformatics, clinical research informatics, clinical informatics, consumer health informatics, and public health informatics.

About ABMS

ABMS Member Boards certify physicians in more than 150 specialties and subspecialties. To see a full list of current specialty and subspecialty certificates offered by ABMS Member Boards, including the American Boards of Preventive Medicine and Pathology, visit www.abms.org/Who_We_Help/Physicians/specialties.aspx

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UPDATE, 8:50 pm CDT: Here’s the link to AMIA’s press release.

UPDATE, Sept. 23: Here’s my story for InformationWeek.

September 22, 2011 I Written By

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

An easy link to many of my health IT stories

One of these days, I’m going to build a page with all my professional information and a collection of stories I’ve written over the years. In the meantime, I recently discovered a decent source for tracking some of my work, a service called uFollow.

My page on this site, which I did not build myself, contains links to pretty much every story I’ve written for InformationWeek, going back to the beginning of the year. It also includes links for the five posts I did for the BNET Healthcare Blog in 2009 (which earned me the whopping sum of $250 total). But there’s nothing else currently there, even though my bio references the work I did for three Fierce Markets titles in 2009-10. I’ve asked uFollow either to update the feeds to include my work for titles like MobiHealthNews, Healthcare IT News, Health Data Management and others, or tell me how I can update the page myself. Stay tuned.

Since I’m talking about myself here, I’ll let you know that I’m making plans for a lot of conference coverage this fall. I’ll be attending the Health 2.0 conference in San Francisco in a couple of weeks, bravely wading into the back yard of the same Silicon Valley community I roundly dissed in July and have since taken a couple more swings at.

Next month, I’m expecting to be at the MGMA annual conference in Las Vegas. Last year was the first time in 10 years I missed that one, but I’m planning a return. Later that week, I’ll either be at TEDMED in San Diego or the CHIME Fall CIO Forum in San Antonio, a decision I’ll make in the next few days. Unfortunately, AMIA’s annual symposium is the same week on the east coast, so, regrettably, I’ll have to skip that one.

The first week of November, I’m scheduled to moderate a couple of panels at the Institute for Health Technology Transformation’s Health IT Summit in Beverly Hills, Calif. There may be one more speaking/moderating gig that month, but I’m not ready to announce it yet.

Publicists, you might be salivating now that you have an idea about my schedule this fall. Don’t worry, I won’t have time for all the vendor meetings you are going to propose, and I’m more than happy to ignore all but the very best pitches. I may even come to you to request a meeting if I think it would help me pay the bills, since I’m usually covering my own travel expenses. However, I know that especially at something like Health 2.0, there will be a lot of vaporware, hype and companies with no business model among the many good, solid ideas. I have a very good B.S. detector, honed over a 19-year career, and I’m not afraid to use it. Consider yourselves warned. :)

September 13, 2011 I Written By

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

Conference overload, meet conference overlap

Normally this time of year, I’m making plans to attend the many fall conferences in health IT and related industries. This year, my decisions are harder. You see, it seems like everyone decided to schedule their events during the last week of October:

AMIA 2011, Oct. 23-26, Washington

MGMA Annual Conference, Oct. 23-26, Las Vegas

TEDMED 2011 Oct. 25-28, San Diego

CHIME11 Fall CIO Forum, Oct. 26-28, Austin, Texas

Just for kicks, I’m scheduled to participate in the Institute for Health Technology Transformation’s Health IT Summit, Nov. 2-3 in Beverly Hills, Calif.

All are worthwhile, and all will be great places to find relevant stories for this blog and my various media clients. It probably makes most sense to go west, hitting MGMA and TEDMED, then spending the weekend in California before IHT2. But AMIA and CHIME always produce quality stories for me and supply me with leads which could pay off months later.

If you were in my shoes, which would you choose?

September 1, 2011 I Written By

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

AMIA scuttlebutt

I’m on my way home from the AMIA annual conference, which actually doesn’t end until tomorrow. I’ve got just a couple of short items to share. First of all, I was not the only person to notice that ONC’s Chuck Friedman was wearing a tie with elephants on it. He said it’s from Thailand, a place that actually has elephants, and in no way is meant to be a political statement. In fact, he said he had to get ethics clearance from HHS to wear it to work.
Also, I heard legendary medical informaticist Clem McDonald ask a session moderator if recorded sessions would be available for purchase on DVD. Someone like Clem McDonald shouldn’t have to pay for that. Just saying.

November 16, 2010 I Written By

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

Bellagio follow-up in ‘Health Affairs’

There’s been a lot of work done in the field of global e-health since the Rockefeller Foundation‘s series of conferences in Bellagio, Italy, in July and August 2008. I had the distinct honor of attending for the third of four weeks, which focused on electronic health records and on mobile healthcare, two subjects that even more up my alley now then they were a year and a half ago.

I’ve had intermittent contact with some of the participants in those conferences since then, most recently at the AMIA annual symposium last month, and I’ve tried to report on progress from those meetings toward applying information technology to addressing health issues in developing countries. A wider audience will get a chance to read more about some of the projects in an upcoming issue of Health Affairs.

From what I understand, in mid-February, Health Affairs will publish nine papers on global e-health issues related to the work done at and as a result of Bellagio. I’m not privy to any further details, though.

December 6, 2009 I Written By

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