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Video: Farzad Mostashari on patient engagement, ‘physician ACOs’

As I alluded to earlier, I was leaving the press room one afternoon at HIMSS14, and there I see former national health IT coordinator Dr. Farzad Mostashari hanging around Gregg Masters and Dr. Pat Salber of Health Innovation Media. It turns out, Masters and Salber had just pulled Mostashari aside to do an interview on video, but they didn’t have anyone to interview him on camera, so they asked me right there on the spot to be the interviewer. Here is the result.

Mostashari, now a visiting fellow at the Engelberg Center for Health Care Reform at the Brookings Institute in Washington, discussed how the years of searching for a business model to coordinate care and engage patients is finally starting to pay off. Always the champion of the little guy in healthcare, Mostashari also brought up the notion of physician-led ACOs, or, as he called it, the “Davids going up against the Goliaths.”

 

I had pretty much no preparation for this interview. It probably shows. I still think it worked out well.

Here’s a link to Salber’s post about the interview because I don’t want to steal page views. :)

March 14, 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.

Late news, literally: A new national HIT coordinator

Karen DeSalvo, M.D.

 

I’m a little late to the party reporting on the naming of a new national health IT coordinator, Karen DeSalvo, M.D. HHS Secretary Kathleen Sebelius announced DeSalvo’s appointment on Dec. 19, two days after I boarded a plane out of the country for a much-needed vacation. I vowed not to respond to any work-related e-mail while away, and I stayed true to my word, so now I play catch-up.

I honestly know nothing of DeSalvo’s work as health commissioner of the City of New Orleans and senior health policy advisor to Mayor Mitchell Landrieu, even though I visited New Orleans twice in the early rebuilding stages after Hurricane Katrina in 2006 and 2007 to report on the state of the healthcare infrastructure. At the time, Ray Nagin was mayor, though Landrieu was Louisiana lieutenant gove

rnor and his sister, Mary, was and still is a U.S. senator representing the Pelican State.

During my visits, I met with several state and local healthcare officials, but never came across DeSalvo. She is the first national coordinator I did not know prior to taking over ONC, so I guess I’ll be doing some catch-up. From her biography, I see her background is in public health, much like her predecessor, Farzad Mostashari, M.D. That signals to me that there will be a continued strong focus on using IT to improve population health, one of the original 2004 goals of the first national coordinator, David Brailer, M.D.

While Stage 1 of Meaningful Use has been about installing EHRs, we should start to see connectivity and interoperability to help manage populations in Stage 2, which is just getting started, with an eye toward producing measurable outcomes in Stage 3, which probably won’t begin before 2017.

DeSalvo remains in New Orleans at the moment. She takes over at ONC Jan. 13. Acting national coordinator Jacob Reider, M.D., will go back to being ONC’s chief medical officer.

December 30, 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.

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.

Top 10 things wrong with Fox News smear job on EHRs

Today, FoxNews.com published a hit job on health IT and EHRs in the guise of another hit job on Obamacare. I found out about it courtesy of this tweet:

First off, it’s clear that Mostashari feels unshackled from having to watch his words now that he’s no longer national health IT coordinator. Secondly, he’s right. This story contains so many errors and misleading statements that it’s almost funny. Let’s count down the top 10.

10. “Under a George W. Bush-era executive order, all Americans should have access to their medical records by the end of 2014, part of a concept referred to as e-health. President Obama then made electronic medical records (EMRs) central to the success of the Affordable Care Act”

When Bush issued the executive order in 2004 that created the Office of the National Coordinator for Health Information Technology, he set as a goal interoperable EMRs for “most” Americans. The “all” part came after Barack Obama took office in 2009.

9. Though Obama did reiterate the 2014 goal and up the stakes by saying “all Americans,” nobody realistically thought it could happen. After all, the HITECH Act, which created Meaningful Use, didn’t pass until March 2009 and Meaningful Use didn’t even start until 2011. Before the HITECH Act, ONC barely had any funding anyway. For five years, Congress failed to pass much in the way of health IT legislation, even though a federal EHR incentive program had bipartisan support, symbolized by an unlikely alliance between Newt Gingrich and Hillary Clinton.

8. “Doctors, practitioners and hospitals, though, have been enriching themselves with the incentives to install electronic medical records systems that are either not inter-operable or highly limited in their crossover with other providers.”

Meaningful Use was never intended for enrichment, or even to cover the full cost of an EHR system.

7. While systems mostly are not interoperable yet, that wasn’t the intent of Stage 1 of Meaningful Use. Stage 1 was meant to get systems installed. Stage 2, which has barely started for the early adopters among hospitals and won’t start for 2 1/2 months for physicians, is about interoperability. That’s where the savings and efficiencies are supposed to come from.

6. We’re years away from knowing whether Meaningful Use program did its job, though I don’t fault members of Congress such as Sen. John Thune (R-S.D.) for putting pressure on the administration to demand more for the big taxpayer outlay.

5. “‘The electronic medical records system has been funded to hospitals at more than $1 billion per month. Apparently little or none of that money went to the enrollment process which is where the bottle neck for signing up to ObamaCare’s insurance exchanges appears to be,’ Robert Lorsch, a Los Angeles-based IT entrepreneur and chief executive of online medical records provider MMRGlobal, told Fox News.”

The money wasn’t supposed to go to the insurance enrollment process. The Meaningful Use incentive program was from the HITECH Act, part of the 2009 American Recovery and Reinvestment Act. The Patient Protection and Affordable Care Act, a.k.a. Obamacare, came a year later. Again, someone is confusing insurance and care. They are not the same thing.

4. “Lorsch, at MMRGlobal, offered the U.S. government what it describes as a user-friendly personal health record system for one dollar per month per family – a fraction of what it has cost the taxpayer so far.”

MMRGlobal’s product is an untethered personal health record. No untethered PHR anywhere is “user-friendly,” which is why adoption has been anemic. Without data from organizational EHRs, PHRs are worthless. Besides, the direct-to-consumer approach in healthcare has failed over and over, since people are used to having someone else — usually an insurance company — pick up the tab.

3. For that matter, MMRGlobal is a bad example to use as an alternative to EHRs. (The Fox story is correct in saying that other vendors do have close ties to the Obama administration, though the former Cerner executive’s name is Nancy-Ann DeParle, not “Nance.”) I could be wrong, but I haven’t seen a whole lot of evidence that MMRGlobal isn’t much more than a patent troll.

2. “But this process could have been easier if a nine-year, government-backed effort to set up a system of electronic medical records had gotten off the ground. Instead of setting up their medical ID for the first time, would-be customers would have their records already on file.”

Actually, as I wrote in a story just published in Healthcare IT News, we could have had national patient identifiers 15 years ago, as called for by the 1996 HIPAA statute. But Congress voted in 1998 not to fund implementation of a national patient ID and President Bill Clinton signed that into law. Since then, interoperability and patient matching have been mighty struggles.

1. “‘Plus, unlike under ObamaCare, the patient would be in control of their health information and, most importantly, their privacy,’ Lorsch said.”

Where in Obamacare does the patient lose control of health information? Less than a month ago, I was in Washington listening to HHS Office for Civil Rights Director Leon Rodriguez say, ““There is a clear right [in the HIPAA privacy rule] not only of patient access, but patient control over everything in their records.” This may come as news to some people, but patients own and control the information. They might not know it, but the language is pretty clear.

Already, the Fox story has been reposted in a number of blogs shared all over the Internet, so it’s being accepted as fact in some quarters. If you want the truth, you sometimes have to do the work yourself.

October 15, 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.

Podcast: A quick chat with Farzad Mostashari

Friday is the last day on the job for departing national health IT coordinator Dr. Farzad Mostashari, who is stepping down after four years with the Office of the National Coordinator for Health Information Technology, including the last two years as head of ONC.

I was in Washington two weeks ago and stopped by the HHS headquarters for ONC’s Consumer Health IT Summit, the opening event of National Health IT Week, and got a few minutes with Mostashari. (I suppose that was good timing, because I imagine the government shutdown that took effect this week would have canceled the summit and even prevented me from entering the Humphrey Building.) I had the recorder rolling for a brief chat, which lasted less than 15 minutes before Mostashari’s handlers ushered him out to his next appointment. But I did get something.

The interview actually goes on a bit longer than what’s on this track, moving on to a discussion about Food and Drug Administration guidance on mobile medical apps. (You can read about that in this story I wrote for MobiHealthNews.) As it turned out, the FDA issued its final recommendations Sept. 23, which also happened to be the same day new HIPAA regulations—modifications called for in the HITECH Act—took effect.

I might get another chance to talk to Mostashari at the College of Healthcare Information Management Executives Fall CIO Forum at the end of next week, after he officially leaves government service and is allowed to discuss his future plans and perhaps be more candid about his tenure; CHIME has confirmed to me that he will keep his speaking slot. For now, enjoy this short interview.

Podcast details: Interview with outgoing national health IT coordinator Dr. Farzad Mostashari, Sept. 16, 2013. MP3, stereo, 128 kbps, 7.1 MB. Running time 7:44.
0:00 Why he’s leaving
1:20 Different “tribes” of health IT
2:25 Balancing competing interests and the pace of change
4:30 Difficulty of culture change
5:35 Patient control of data and confusion about HIPAA

 

October 2, 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.

I was wrong: Muntz to leave ONC

On Sept. 17, I predicted that Principal Deputy National Coordinator David Muntz would lead the Office of the National Coordinator for Health Information Technology at least on an interim or acting basis when National Coordinator Dr. Farzad Mostashari departs at the end of next week.

I was wrong.

Last night, Muntz announced his resignation in an e-mail to ONC staff:

From: Muntz, David (OS/ONC)
Sent: Wednesday, September 25, 2013 8:47 PM
Subject: Farewell to my federal family and friends

It is with a great deal of gratitude and sadness I have tendered my resignation as Principal Deputy National Coordinator for Health IT.   All of the ONC staff and, for that matter, all of the federal staff with whom I worked, have been more than patient and generous as I entered the world of federal public service.

The goals and objectives of our diverse and important activities helped me understand and accept the challenges, and then embrace them.  I was sustained by the spirit and talent that I encountered every step along the way.  You’ve heard me say on several occasions that I’ve never seen such a group of dedicated leaders and staff.  It is heartwarming and head-pleasing to have worked with all of the federal staff and to represent the providers and patients in the private and public sector who are pulling and pushing us toward a very promising future where the collective efforts will benefit the nation and the world.  The people and the progress are awe inspiring.  It’s been a privilege to have played any role in such a truly transformative era, much less a leadership role in all the successes we have achieved both inside and outside ONC.

I look forward to continuing to support HHS’ vision of achieving interoperability and better engaging patients from the private sector.  With many wonderful memories and much gratitude, David

David S. Muntz, CHCIO, FCHIME, LCHIME, FHIMSS

Principal Deputy

HHS/Office of the National Coordinator

Also last night, Mostashari announced that Dr. Jacob Reider, director of the ONC Office of the Chief Medical Officer, will serve as acting national coordinator and Lisa Lewis, currently deputy national coordinator for operations, will be acting principal deputy, effective Oct. 4. Joy Pritts will remain as chief privacy officer and political appointee, Mostashari noted.

Mostashari also said that Muntz informed him “several weeks ago of his decision to return to the private sector to work more closely on the front-lines of medicine.”

I shall not make any further predictions about next full-time coordinator.

September 26, 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.

At the very least, expect Muntz to be acting national coodinator

I don’t have any inside knowledge about whom the White House might be considering to replace Dr. Farzad Mostashari when he steps down from his post as national health IT coordinator on Oct. 5, but I get the sense Principal Deputy National Coordinator David Muntz will at least be acting head of the Office of the National Coordinator for Health Information Technology. What makes me think this?

Here is the lineup for tomorrow’s press conference at the U.S. Capitol marking National Health IT Week:

  • Sen. Sheldon Whitehouse (D-R.I.)
  • Rep. Mike Honda (D-Calif.)
  • ONC Principal Deputy National Coordinator David Muntz
  • Former Wyoming Gov. Jim Geringer
  • Incoming Director of the Department of Health for the District of Columbia Dr. Joxel Garcia

Mostashari isn’t speaking. Muntz is. The transition is underway.

By the way, I had a chance to interview Mostashari yesterday. Stay tuned for details.

September 17, 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.

I sense a delay in MU2

I have no evidence to back this up, but I have a sneaking suspicion that the feds are giving serious thought to delaying some of the timelines in Stage 2 of Meaningful Use.

The pushback has been building for some time, and advanced in the past couple of weeks with the opinions of three important industry associations.

The American Association of Family Physicians called for a one-year delay and proposed separating providers into “three distinct cohorts,” depending on what year they first met Meaningful Use standards. HIMSS wants the attestation period for the first year of MU2 extended to April 2015 for hospitals and June 2015 for physicians and other “eligible professionals.” The MGMA asked CMS not to penalize physicians who reach Stage 1 but can’t make it to Stage 2 when penalties are due to start in 2015.

All cited the short timelines for vendors to get their products ready and certified for Stage 2.

And then there was the big news this month, the resignation of national health IT coordinator Dr. Farzad Mostashari, seemingly without warning. I can’t take credit for this idea, but an industry insider I spoke with this week suggested Mostashari may have wanted out because he didn’t want to be in charge of a watered-down or delayed program. Again, I have no evidence to support the idea, but it sounds absolutely plausible.

I welcome your thoughts on this matter.

August 22, 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.

Breaking news: Mostashari to leave ONC

National health IT coordinator Dr. Farzad Mostashari will leave the Office of the National Coordinator for Health Information Technology at an unspecified time this fall.

From Twitter:


Government Health IT reports this morning that HHS Secretary Kathleen Sebelius broke the news in a letter to agency staff.

“During this time of great accomplishment, Farzad has been an important advisor to me and many of us across the Department. His expertise, enthusiasm and commitment to innovation and health IT will surely be missed,” Sebelius wrote, according to Government Health IT. “In the short term, he will continue to serve in this role while a search is underway for a replacement.”

The fourth national coordinator since the position was created in 2004, Mostashari has been in his current job since April 2011. Prior to joining ONC in 2009, he led the Primary Care Information Project for the New York City Department of Health and Mental Hygiene.

UPDATE, 10:46 am CDT: I have the full memo from Sebelius.

Hello Colleagues,

I am writing to share the news that Dr. Farzad Mostashari has advised me he will be stepping down as National Coordinator for Health Information Technology this fall.

Farzad has been a leader in the Office of the National Coordinator for Health Information Technology (ONC) for the last four years.  Farzad joined the office in 2009 as Principal Deputy National Coordinator and took over as the National Coordinator in 2011.  During his tenure, ONC has been at the forefront of designing and implementing a number of initiatives to promote the adoption of health IT among health care providers.  Farzad has seen through the successful design and implementation of ONC’s HITECH programs, which provide health IT training and guidance to communities and providers; linked the meaningful use of electronic health records to population health goals; and laid a strong foundation for increasing the interoperability of health records—all while ensuring the ultimate focus remains on patients and their families.  This critical work has not only brought about important improvements in the business of health care, but also has helped providers better coordinate care, which can improve patients’ health while saving money at the same time.

During this time of great accomplishment, Farzad has been an important advisor to me and many of us across the Department.  His expertise, enthusiasm and commitment to innovation and health IT will surely be  missed.  In the short term, he will continue to serve in this role while a search is underway for a replacement. Please join me in wishing Farzad all the best in his future endeavors.

Kathleen Sebelius

 

 

August 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.