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Podcast: UPMC informatics leader Shrestha talks accountable care, business intelligence

Did you happen to catch my InformationWeek Healthcare story about how UPMC believes it has the roadmap in place to achieve true accountable care? Well, here’s the rest of the story.

Last week, Nuance Communications invited me to Pittsburgh for a tour of the Center for Connected Medicine, an impressive, high-tech showcase on the 60th floor of the U.S. Steel Tower. There, I interviewed, among others, Rasu Shrestha, M.D., UPMC’s vice president for medical information technology, medical director of interoperability & imaging informatics and division chief of radiology informatics. Here is that interview.

Podcast details: Interview with Rasu Shrestha, M.D., UPMC vice president for medical information technology, Feb. 7, 2012, at the Center for Connected Medicine, Pittsburgh. MP3, stereo, 128 kbps, 15.6 MB, running time 17:08.

1:10 “Clinical language understanding” and “bringing data to life”
3:05 Analytics beyond patient care
3:55 Computer-assisted coding
6:35 Business intelligence in the context of ACOs
7:45 UPMC striving to be an ACO
8:35 Aggregating data from payer and provider sides of the organization
10:30 Keeping medication lists up to date
11:45 Health information exchange among multiple vendor systems
13:00 What to watch for in the near future from UPMC
14:10 Overcoming cultural barriers to change

 

 

 

February 14, 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.

Podcast: Intel’s Eric Dishman on connected care management

Did you miss Eric Dishman’s keynote address Tuesday at the Medical Group Management Association‘s annual conference in Las Vegas? That’s OK, because I secured a few minutes with Dishman, director of health innovation and policy at Intel, immediately after his talk, and the results are right here.

This podcast, recorded in the somewhat noisy press room at the Las Vegas Convention Center, is a companion piece of sorts to my coverage in MobiHealthNews on Thursday, so I hope you have a chance to check out both.

Podcast details: Intel’s Eric Dishman on connected care management, recorded Oct. 26, 2011, at MGMA annual conference in Las Vegas. MP3, mono, 64 kbps, 5.2 MB. Running time 11:08.

0:30 Virtual care coordination in nontraditional settings
1:05 Overlap/collaboration with Care Innovations joint venture
2:10 Prototype device for monitoring symptoms of Parkinson’s patients
4:00 Home monitoring of “classic” chronic diseases
4:55 Tracking behavioral changes for prevention and early detection
6:05 Realizing the potential of mobile health
6:55 Care coordination and health reform
8:30 ACOs and payment for quality
9:35 Intel’s future providing “strategic blueprints” for healthcare
10:20 How to share ideas with him

October 26, 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.

Podcast: Gartner’s Vi Shaffer on HIE, ACOs and meaningful use

Back in June, I covered the Wisconsin Technology Network’s Digital Healthcare Conference in Madison. That conference featured a panel with Vi Shaffer, research vice president and industry services director for healthcare providers at Gartner, Judy Murphy, vice president of information services at Aurora Health Care in Milwaukee, and Epic Systems CEO Judy Faulkner, based in nearby Verona, Wis.

The panel discussed the question, “Is meaningful use a floor or a ceiling?” as I reported for WTN News. The conference also featured several sessions on how business intelligence and health information exchange can support Accountable Care Organizations.

A month later, I saw Shaffer again at AMDIS Physician-Computer Connection meeting in Ojai, Calif. There, she presented preliminary data from Gartner’s annual survey of CMIOs. After the conference ended, I got a chance to sit down with Shaffer for this podcast. Since the fog and clouds finally lifted on the final day, we decided to record this outdoors at the beautiful Ojai Valley Inn, which is why you will hear some birds and other (human) creatures in the background. We don’t care, it was too nice to sit indoors.

We mostly discussed how HIE can support ACOs, but we also touched on meaningful use and health reform in this lively interview. Enjoy.

Podcast details: Interview with Vi Shaffer, research vice president and industry services director for healthcare providers at Gartner. Recorded July 15, 2011, in Ojai, Calif. MP3, mono, 64 kbps, 7.9 MB. Running time 17:14.

1:35 ACO as a business model and a fundamental change in the needs of patients (chronic disease)

3:00 Interoperability for care coordination 3:50 Will ACO model be better than disease management as it exists today?

4:50 Nature of proposed rules

7:30 Importance of innovation because “meeting the metrics is average.”

9:05 Is meaningful use a floor or a ceiling? Is an ACO a floor or a ceiling?

10:46 Ambulatory services growing faster than hospital services

12:38 “Oligopolies” in healthcare building interoperability and continuums of care

14:40 How far can you go with interoperability in this changing healthcare climate?

15:19 Targeted panel management rather than population health

August 12, 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.

Berwick political saga is a tragic attack on better healthcare

President Barack Obama has made plenty of mistakes in his first two-plus years in office, but none may be more serious for the future of America than his decision to install Donald M. Berwick, M.D., as a recess appointment to head the Centers for Medicare and Medicaid Services in July 2010.

Berwick really is a great choice to head CMS, but the underhanded nature of the recess appointment has provided fodder for all kinds of uninformed ideologues and assorted nut jobs to attack Obama’s healthcare reform efforts. Just as CMS is gearing up to release widely anticipated proposed regulations for Accountable Care Organizations, we get the sad news that that Berwick’s days are numbered.

After refusing to allow Berwick to testify before the Senate last year, Obama renominated Berwick on Jan. 26. Newly empowered Republicans went on the attack. “The White House’s handling of this nomination—failing to respond to repeated requests for information and circumventing the Senate through a recess appointment—has made Dr. Berwick’s confirmation next to impossible,” the widely respected Sen. Orrin Hatch (R-Utah) said, according to American Medical News.

On March 4, Politico reported that Senate Democrats had given up on the nomination, despite the fact that Berwick had the support of the Medical Group Management Association, the American Hospital Association, the American Public Health Association and, notably, the Republican-leaning American Medical Association and America’s Health Insurance Plans.

How did this happen?

As I wrote last November when Republicans proposed de-funding of the Center for Medicare and Medicaid Innovation, a key element of real reform in the widely misunderstood “healthcare reform” legislation (the main misunderstanding is that insurance is not the same thing as care):

The Patient Protection and Affordable Care Act, widely referred to as “healthcare reform” and mocked by some as a government takeover of healthcare, aka “ObamaCare,” is not popular in Republican circles. That’s no secret.

It’s also well known that, in their drive to repudiate everything Obama, many Republicans, giddy over their victory in last week’s midterm election, have said they want to repeal the PPACA in its entirety, throwing out the baby with the bathwater. (You know, our healthcare system is wonderful the way it is, so we didn’t need any changes in the first place.)

What really got me was the news that some of the more conservative and libertarian elements of the GOP are specifically threatening to pull the $10 billion in funding already authorized for the Center for Medicare and Medicaid Innovation, a CMS program created by the PPACA. This is a center that CMS Administrator Dr. Donald Berwick has called “the jewel in the crown” of the reform bill, and Berwick has unfairly been labeled a socialist, granny-killing pariah by some right-wing zealots who have no idea of his life-saving work at the Institute for Healthcare Improvement.

The new Republican-majority House of Representatives could not make a bigger mistake than defunding the Center for Health Innovation. For years, conservatives have complained of Medicare’s plodding bureaucracy impeding innovation—you know, the very thing the program is intended to foster.

What the PPACA does is allow CMS, via this new innovation center, to try new ideas without having to make sure their experiments are budget-neutral from the start. (The requirement for budget neutrality is why Medicare pay-for-performance and pay-for-prevention initiatives have never really gotten off the ground.) And CMS no longer has to be content with small demonstrations. Instead, the Center for Medicare Innovation is authorized to run wider-scale pilots and then seek congressional appropriations to ramp up any program that proves successful in producing better care for less money.

That’s how you bend the cost curve, a favorite term in policy circles. Killing the Center for Medicare and Medicaid Innovation would just perpetuate the ugly status quo.

That commentary drew five responses on the site, four of which were negative. And every last one of the negative comments were written anonymously. The only commenter to list a name also happened to be the lone supportive response.

I am in no way surprised. Politically motivated lies abound about Berwick, and few of the critics want to be held accountable for misleading the public.

The week before last, I was somewhat critical of the Lucidicus Project and Jared M. Rhoads, who hosted the most recent Health Wonk Review. He did a fine job hosting HWR, but in scanning some earlier posts on the Lucidicus site—hewing closely to confused, angry, misguided ideology of the tea party—I noticed something that got my blood boiling.

On Jan. 27, Rhoads wrote that Berwick was “on a one-way path,” a path that leads to socialism and a government takeover of healthcare. “Without free-market solutions on the table, the one-way march to an NHS-like system will continue. Berwick has just one solution in mind for the problems created by government: more government.”

He also wrote, “Berwick is openly enamored of the U.K.’s National Health Service (NHS) model, in which the government essentially makes decisions for people about the care that they receive, and in which patients can be penalized for attempting to pay for additional care out of their own pockets. The system is characterized by bureaucracy, rationing, and redistribution of wealth and resources.”

At least give Rhoads credit for not cowardly hiding behind a cloak of anonymity.

Yes, it is true that Berwick has publicly spoken of his admiration for the NHS, but it was more about the British decision to make quality improvement a key element of healthcare than it was about a desire to bring an entirely government-run system to the United States. In my post about that edition of HWR, I asked if Berwick hadn’t done more to prevent needless deaths and adverse events than pretty much anyone else alive today.

That’s the same question I asked in an e-mail to the anti-reform (read “crackpot”) group called Docs4PatientCare. Why do I say crackpot? The Atlanta-based organization contacted me last fall with links to a series of videos, including one from group representative Scott Barbour, M.D. According to the original pitch to me, “Utilizing quotes from Dr. Berwick, Dr. Barbour exposed that, ‘He is not interested in better health care. He is only concerned about implementing his socialist agenda.’”

In another video, Docs4PatientCare Vice President Fred Shessel, M.D., said of Berwick, “This is a man who has made a career out of socializing medicine and rationing care for the very young, the very old and the very sick. It is a backdoor power grab. It is dragging our country down the road to socialism and we should resist it.”

I responded to this pitch with a short question: “Berwick isn’t interested in better care? Do you know anything about his work at IHI?” I never got a response. Docs4PatientCare seemingly was trying to hoodwink media that don’t know any better and/or care more about politics than facts.

Here are the facts, from another piece I wrote last year:

A longtime champion of patient safety, Berwick co-founded the Institute of Healthcare Improvement in 1989 and led it until he became CMS administrator by virtue of a controversial “recess appointment” in July 2010, preventing the Senate from questioning him about his views. At IHI, Berwick created and championed the 100,000 Lives Campaign, an effort to prevent that many deaths in an 18-month period by getting thousands of U.S. hospitals to follow simple, preventive safety measures voluntarily. The program later turned its focus to nonlethal adverse events and became the 5 Million Lives Campaign. Berwick is a pediatrician who also holds a master’s degree in public policy.

In kicking off the 100,000 Lives Campaign in December 2004, Berwick made the following audacious challenge to American hospitals: “I think we should save 100,000 lives. I think we should do that by June 14, 2006. 9 a.m.” At that appointed hour 18 months later, he announced that the campaign had prevented 122,300 unnecessary deaths. Berwick was careful not to make IT a prerequisite for participating in either campaign, but he’s come to see the benefits of EMRs and clinical decision support. Now, as head of CMS, he effectively leads the “meaningful use” incentive program. Though the Stage 1 rules were mostly done by the time he took the reins, you can be sure Berwick will be pushing for true quality improvement in subsequent stages of meaningful use.

The key word in the above passage is “voluntary.” There were no mandates when the private-sector IHI encouraged hospitals to do what is right for patients.

Months later, Berwick has indeed been pushing for true quality improvement in meaningful use. I’ll have more on that later in the week.

March 14, 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.