Author Archives

cindywilliams

Essential Health Benefits: The Secretary’s Joystick

Dec 1, 2018

By ROBERT F. GRAYBOYES

Beginning in 2014, the Patient Protection and Affordable Care Act (PPACA) hands the Secretary of the U.S. Department of Health and Human Services a joystick – the Essential Health Benefits package – with the potential to rocket small-business health insurance premiums skyward. EHB is the menu of goods and services that must be covered under all exchange-purchased insurance plans and non-grandfathered small-group and individual insurance plans. By vesting one set of hands with control over EHB, small business faces permanent administrative uncertainty. At the same time, the brunt of EHB appears largely to bypass big business, unions, and governments.

EHB, Ban on Limits, Actuarial Value
Beginning in 2014, PPACA (§1302) makes EHB a mandatory feature of most insurance plans purchased by America’s 6 million small businesses and 21 million self-employed individuals. Exceptions initially include businesses with more than 100 employees and those with grandfathered policies. The EHB requirements apply to policies purchased both in exchanges and in non-exchange small-group or individual markets.

In the small-group and individual markets, annual or lifetime coverage limits on all EHB items are forbidden. And plans must have an actuarial value (AV) of at least 60 percent, meaning the plan’s total reimbursements must be at least 60 percent of the total qualifying health care costs incurred.

Section 1302 empowers the Secretary of HHS to define EHB, but gives little specificity beyond requiring that EHB include 10 general categories (e.g., ambulatory patient services) and “the items and services covered within the categories;” the Secretary is to also assure that EHB includes “benefits typically covered” by a “typical employer plan.” The meaning of these words in quotation marks is left to the Secretary (and future Secretaries) to define and redefine. The fluid definitions and concentrated discretion mean uncertainty, which carries a financial cost for small business.Continue reading…

Horses, Camels & Signals

Dec 1, 2018

By MARGALIT GUR-ARIE

On June 8, the HIT Policy Committee at ONC has approved the Workgroup recommendations for Meaningful Use Stage 2. Before diving into the details, it is worth noting that the time crunch for moving from Stage 1 to Stage 2, for those seeking incentives in 2011, was proposed to be resolved by postponing Stage 2 for these early adopters for one year. As I noted before, if you are able to attest and obtain incentives in 2011, go ahead and do that. You will be rewarded by having the opportunity to stay at Stage 1 for 3 consecutive years. The final Stage 2 ruling is not expected to occur until June 2012 and judging by previous experience with Stage 1, the recommendations approved today will be significantly relaxed by the CMS process of proposed rulemaking and public comments. So although analyzing (rejoicing or bemoaning) the various measures on this long list is a bit premature, it may be helpful to look at the general principles embedded in this new stage of Meaningful Use.

Horses

Many of the Meaningful Use more pedestrian measures have remained unchanged, have increased in intensity, or have been moved from menu to core (more on this later). These measures include such items as recording patient demographics, maintaining medications, allergies and problem lists, recording of vitals, running reports, electronic prescribing, incorporating structured lab results, medications reconciliation, using formularies, enabling clinical decision support, reporting to state and federal agencies and ensuring privacy and security of medical records.

ICD-10: Rough Seas Ahead

Dec 1, 2018

By JAAN SIDOROV, MD

Have you heard of “ICD-10?” In addition to the many requirements of the Affordable Care Act, this may turn out to be another big headache for insurers and providers. According to CMS’ web site, under the authority granted to it under the 2003 Health Insurance Portability and Accountability Act (HIPAA), if you want to do business with Medicare or any other health insurer…

“ICD-10 codes must be used on all HIPAA transactions, including outpatient claims with dates of service, and inpatient claims with dates of discharge on and after October 1, 2013. Otherwise, your claims and other transactions may be rejected, and you will need to resubmit them with the ICD-10 codes. This could result in delays and may impact your reimbursements, so it is important to start now to prepare for the changeover to ICD-10 codes.”

Which is why the DMCB paid attention to this “Report from the Field” Health Affairs article “Coding Complexity: US Health Care Gets Ready For The Coming Of ICD-10.”

The Disease Management Care Blog was reminded that “International Classification of Disease” or “ICD” is an alphanumeric billing system used to specify and describe diseases and treatments. Originally developed in 1763, it was adopted by the World Health Organization in 1948 for use in public health reporting. It was later used by physicians, hospitals and health insurers to specify diagnosis coding and payment levels. For example, persons with “diabetes” may think they saw a doctor for that particular disease, but as far as their insurer goes, they were really seen for “250.”Continue reading…

It Looks Like the Head of HIMSS Likes Us

Dec 1, 2018

By JONATHAN BUSH

The headline said that the chief of HIMSS sees “seismic shifts” in the health IT landscape.

I sure hope so because I’m betting on it.

As many of our employees know, HIMSS is a massively important leader in our space, and their annual conference—this year it was held in Orlando and set an attendance record of over 30,000 people and 1,000 vendors—is our chance to feel small and uninvited. It is a club of large vendors and large buyers. Very large deals, you might say ‘seismic’ deals, requiring long-term multimillion dollar commitments in EHR and practice management systems, go down at the HIMSS conventions.

Obviously, our consistent criticism has been that the balance sheet impact of such investments is not sustainable by any health care institution for long, BUT ALSO, the information that comes from such investment…well…sucks.

It doesn’t suck because the IT departments that buy and run these EHR andpractice management systems are bad (they may or may not be, I have no idea, but that isn’t the problem). It isn’t because the systems being purchased don’t work as advertised (I have no idea if they do, but I assume the answer is ‘yes’).

The Super Mobile Doctor Uses Smartphones and Tablets in Patient Care

Dec 1, 2018

By JANE SARASOHN-KAHN

Physicians who have adopted smartphones and tablet devices access online resources for health more than less mobile physicians. Furthermore, these “Super Mobile” doctors are using mobile platforms at the point of care.

Physicians adoption and use of mobile platforms in health will continue to grow, according to a survey from Quantia Communications, an online physician community. This poll was taken among 3,798 physician members of QuantiaMD’s community in May 2011. Thus, the sample is taken from the community’s 125,000 physicians who are already digitally-savvy doctors. QuantiaMD calls physicians with both mobile and tablet devices “Super Mobile” physicians.

The most common mobile devices among the Super Mobile doctors in QuantiaMD are iPhones, used by 59%; iPads, used by 29%; and, Android smartphones, used by 20% of the physicians surveyed. Blackberry devices are used by 14% of the doctors in the poll.

Just under one-half of these doctors plan to purchase a mobile device in 2011, notably an iPhone, an iPad, or an Android.

The Effectiveness of Online Health Intervention Programs

Dec 1, 2018

By GLENN LAFFEL, MD

In recent posts on Web-based and mobile behavioral intervention programs, we reviewed evidence suggesting that social support, in one form or another, can improve participants’ adherence and engagement with the program. That didn’t always mean however, that participants achieved better outcomes as a result. In one study for example, an online community increased engagement with and utilization of a Web-based activity program, but it did not increase participants’ actual activity levels.

Another study, slightly older than the ones reviewed above, did show that a Web-based program improved outcomes. In this case, the intervention was an online videogame known as Re-Mission. Since I haven’t touched previously on outcome studies for automated lifestyle intervention tools or videogames as an example of such programs, I’ll do that here.

Re-Mission is intended improve medication compliance in teens and young adults with a history of cancer. In the game, players control a nanobot within a 3-dimensional body of a young person that has cancer. Play involves destroying cancer cells and managing chemotherapy-related adverse effects like vomiting and bacterial infections by using antiemetics and antibiotics. The game purports to help users understand their disease and its treatment and improve their sense of self-efficacy: they can take control of their disease.

Do Kaiser Cardiologists Need More Pharmacist Consults to Keep Their Patients Alive?

Dec 1, 2018

By AL LEWIS

A study by a team consisting mostly of Kaiser clinical pharmacists published in Pharmacotherapy[1] finds that a very inexpensive pharmacist consult for cardiac patients reduces the cardiac death rate by more than 80% and — even though it’s a cardiac-specific drug regimen consult — also reduces the non-cardiac death rate by more than 95% vs. what Kaiser’s doctors achieved with usual care. Plus, even though it increases drug use, it earns a 56:1 ROI while reducing drug costs.

The implication: Kaiser’s doctors need Kaiser’s pharmacists to prevent their cardiac patients from dying, in general, but especially from non-cardiac causes…and that Kaiser is losing huge amounts of money if they don’t do this.

However, the study’s conclusions violate every “rule of plausibility” and are invalid. This study, unless its invalidity becomes more widely recognized, could also be used to justify expanded reimbursements for clinical pharmacist consults. Clinical pharmacists may or may not deserve expanded reimbursement, but justification for that reimbursement cannot be made based on studies like this one.

Quite a number of findings deserve mention. First, not getting the $1/patient-day of clinical pharmacist support given to the study group had apparently cost 30% of the retrospective control group patients their lives, vs. 3% of the intervention group.

GAO: FDA Can’t Monitor Device Recalls

Dec 1, 2018

By MERRILL GOOZNER

The Government Accountability Office has weighed in on the failure of the Food and Drug Administration to properly monitor medical device recalls. Its review of the 3,510 recalls between 2005 and 2009 — 40 percent of which were cardiovascular radiological or orthopedic devices — found:

Several gaps in the medical device recall process limited firms’ and FDA’s abilities to ensure that the highest-risk recalls were implemented in an effective and timely manner. For many high-risk recalls, firms faced challenges, such as locating specific devices or device users, and thus could not correct or remove all devices.

“The gist of this report is that the FDA can’t tell if recalls of high-risk devices were carried out successfully because it lacks criteria for assessing device recalls and doesn’t routinely review recall data,” said Sen. Charles Grassley, R-Ia., who along with Sen. Herb Kohl, D-Wis., called for the report. “Recalls are typically voluntary, and patients would be better served if the FDA took a thorough approach to post-market surveillance of medical devices.”

TMI, Dude!

Dec 1, 2018

By LISA SUENNEN

If you are a baseball fan like I am, it is not unusual for you to spend time with your fellow sports fanatics comparing statistics. A player’s batting average, on base percentage, runs batted in, earned run average, home run stats and how those compare to their team mates’ stats–all fair game for friendly conversation. The personal analysis of players’ worth doesn’t stop there, as each of them has their height, weight, age and home town displayed on the screen as they step up to bat. Can you imagine if every time you went to work a big Jumbotron screen with all your vital statistics followed you around for all to see. “Look, there’s Lisa on deck. Man, she really is that short.”

Well, you might be horrified to think that the intimate descriptive details of your being might be published and used to compare your value to others, but there is a growing cadre of people who willingly do exactly that despite the complete impossibility that they will ever be found sliding into home plate. In case you have missed it, there is a burgeoning movement built around “self-knowledge through numbers” generally known as “the Quantified Self.” The term Quantified Self refers to the actions that thousands and thousands of over-achievers, narcissists and the insecure are actively undertaking every day, aided by a giant leap forward in sensor and wireless technology, to measure, track and report their vital statistics in the pursuit of living forever, or at least until the Houston Astros win the 2011 World Series in a sweep. FYI if you’re not a baseball fan–that’s going to happen about 3 weeks after hell freezes over.

In a recent article in The Healthcare Blog, Scott Peppet writes:

Human instrumentation is booming. FitBit can track the number of steps you take a day, how many miles you’ve walked, calories burned, your minutes asleep, and the number of times you woke up during the night. BodyMedia’s armbands are similar, as is the Philips DirectLife device. You can track your running habits with RunKeeper, your weight with a WiFi Withings scale that will Tweet to your friends, your moods on MoodJam or what makes you happy on TrackYourHappiness. Get even more obsessive about your sleep with Zeo, or about your baby’s sleep (or other biological) habits with TrixieTracker. Track your web browsing, your electric use (or here), your spending, your driving, how much you discard or recycle, your movements and location, your pulse, your illness symptoms, what music you listen to, your meditations, your Tweeting patterns. And, of course, publish it all — plus anything else you care to track manually (or on your smartphone) — on Daytum or mycrocosm or me-trics or elsewhere.