The US has spent several billion dollars on medical records, as part of the HITECH program. The goal of that spend was simple: portable medical records for patients. On our current path, we will have medical records, but without that magic word: “portable.” Ironically, the reason for this is identical to the root-cause of the problems with healthcare.gov
The root-cause of the initial failure of healthcare.gov was a lack of accountability and empowerment. There was no one person who was in charge of the operation, and those who were presumed to be in charge did not have the skill-set or political clout needed to make decisions about the project.
The result was the healthcare.gov train wreck. Thankfully, healthcare.gov was turned around.
That turn-around was the result of decisively fixing these exact issues.
Accountability restored, disaster averted.
You would think that the Obama administration and HHS would have learned the “accountability with empowerment” lesson well, if not for IT projects generally, then at least for projects involving Health IT.
Yet we are repeating this mistake with Meaningful Use. For those who are living in a cave with regards to healthcare reform, Meaningful Use is a set of standards designed to ensure that the money that the federal government spends on Electronic Healthcare Records (EHRs) for doctors results in clinically productive outcomes.
By the end of 2014, more than 6.5 million people were enrolled in health insurance plans through the Affordable Care Act (ACA) Marketplace, also called the “exchanges.” In some cases, this was relatively easy. But for many, the ACA’s first open-enrollment period was a confusing and frustrating time, compounded by a lack of clear, easy-to-understand information about plan options, coverage, and cost.
Of the many hidden gems in the Affordable Care Act, one of my favorites is Physician Compare. This website could end up being a game changer—holding doctors accountable for their care and giving consumers a new way to compare and choose doctors. Or it could end up a dud.
The outcome depends on how brave and resolute the Centers for Medicare and Medicaid Services (CMS) is over the next few years. That’s because the physician lobby has been less than thrilled with Physician Compare, and, for that matter, with every other effort to publically report measures of physician performance and quality.
I’d give CMS a C+ to date. Not bad considering it’s the tough task. The agency has been cautious and deliberate. But after the many problems with Hospital Compare, Nursing Home Compare, Home Health Compare, and Dialysis Facility Compare—not to mention the shadow of healthcare.gov’s initial rollout—that’s understandable. They want, I hope, to get this one right from the get-go. And competition from the private sector looms.
Accenture Tapped to Continue Work on HealthCare.gov
Accenture, the consulting firm that was hired a year ago to fix the troubled HealthCare.Gov insurance exchange, is awarded a five-year, $563 million to continue its work on the federal site. The government hired Accenture Federal Services to repair the online marketplace after dropping its original contractor, CGI Federal.
The long-term contract with Accenture also signals CMS’s acknowledgement that a task as large as HealthCare.Gov is best run with leadership from an experienced, private-sector vendor.
Connecticut HIE Dissolves After Wasting Millions
A former board member for The Health Information Technology Exchange of Connecticut blames management for the failure of the entity, which was tasked to create statewide HIE but dissolved by the legislature last summer. The HITE-CT “wasted” $4.3 million in federal grants over four years “without accomplishing anything,” according to Ellen Andrews, who served as the board’s consumer advocate. State auditors also found deficiencies in state controls, legal problems, and a “need for improvement in management practices and procedures.” The state’s legislature is now developing a new exchange strategy.
Prediction: look for more HIEs to falter this year due to mismanagement and lack of sustainability.
Electronic Prescribing of Controlled Substances on the Rise
Electronic prescribing of controlled substances (EPCS) increased from 1,535 to 52,423 between July 2012 and December 2013, according to a study published in the American Journal of Managed Care. The percentage of pharmacies enabled for EPCS jumped from 13% to 30% during the same period.
The next task: figuring out how to get more than the current one percent of physicians to participate.
ONC Shares Lessons Learned from State HIEs
An ONC report on state HIEs finds that many exchanges lack a critical mass of data and are struggling with data sharing. The case study also found that the technical approaches, services enabled, and use of policy and legislation varied across states; collaboration among HIE participants is critical for success; and states are leveraging a variety of policy and regulatory levers to advance interoperability and data exchange.
CMS Seeks ICD-10 Testers
CMS is seeking approximately 850 volunteers for ICD-10 end-to-end testing in April, according to a CMS bulletin. Volunteers have until January 9to submit applications to participate in the April 26-May 1, 2015 testing week.
Pediatrics Report Increased EHR Use
Seventy-nine percent of pediatricians reported using an EHR in 2012, compared to 58% in 2009, according to a study published in the journal Pediatrics. Only eight percent of physicians say their EHRs include pediatric-specific functionality.
Modernizing Medicine Buys RCM Vendor Aesyntix
EMR developer Modernizing Medicine acquires Aesyntix, a provider of RCM, inventory management, and group purchasing services.
Presumably Modernizing Medicine was most interested in Aesyntix’s RCM component, which may create some concern among Modernizing Medicine’s current RCM partners, which include ADP/AdvancedMD, CareCloud, and Kareo.
On the Healthcare.gov web site I was filling the application – an arduous process that – even when pre-filled from last year, takes 30 – 45 minutes. At the review and sign, I found ONE date that was wrong: the day and month were inadvertently transposed. from 09/08 to 08/09. Since the information will be checked against tax records I thought it best to correct this prior to signing.
I clicked on the “edit” button which brought a box “Do you really want to edit your application”, Yes! That’s why I clicked the button – BOOM! back to “GO”,
So it took almost 45 minutes to go through again, (I do work by the way, so this time consuming process is not OK), but I did it. THEN at review I found I had been so frustrated OR the process accepted the key stroke wrong so I now had 09/03 instead of 09/08.
NOT wanting to go back to the very beginning AGAIN, I called the help desk, thinking this would save time. The agent was supportive and pleasant, but basically REFILLED the ENTIRE form again!!!!!!!
I’m back. I’m recovering right now from trauma related to the Affordable Care Act. I’m OK, but probably a few months until fully recovered.
Some would think that since I no longer accept money from insurance companies, the Affordable Care Act would have less of an effect on me. Those folks may be right in how it directly impacts my practice (since I don’t know the actual impact on other doctors, it’s not easy to compare), but there has been a significant impact. I’ve got plenty of ACA stories.
But that’s not what I am going to discuss in this post.
My personal adventures with this law are far more interesting from the other side of the insurance card: the health care consumer (AKA patient). It has been quite a ride — one that has not yet reached its destination.
CHAPTER 1: December 9, 2013
Being the adventurous guy I am, I thought I’d give the Healthcare.gov website a whirl. Expecting the worst, I set aside a lot of time for the experience. It was actually quite a bit easier than advertised. My family is as follows:
Me – Age 51, healthy
Wife – Around my age, but actual age disclosed only for legal reasons.
Child 1: Son, 21 years. College grad but living at home for now.
Child 2: Daughter, 20 years. In college
Child 3: Son, 18 years at time of application. In college. Birthday later in December.
Child 4: Daughter, 14 years.
I submitted the information about whether any of us smoke (no), any of us are pregnant (no), and how much money we earn (not much, as I am starting a new business). I immediately got the following eligibility notice.
Last Thursday, HHS released the final enrollment stats for health exchange enrollment for 2014. Here’s what we learned:
8.1 million enrolled in a plan in the Health Insurance Marketplace. 3.8 million (47% of total) since the end of February including 1.2 million in the much-watched 18-34 age cohort.
54% are female; 28% are between the ages of 18-34; 63% are White, 17% Black, 11% Hispanic, 8% Asian/other.
20% chose a bronze plan, 65% chose silver, 9% gold, 5% platinum and 2% catastrophic. Note: At the silver level, individuals who earn less than 250% of the federal poverty level — ($29,175 for an individual, or $59,625 for a family of four) — are eligible for assistance for out-of-pocket costs. 85% who picked an exchange plan qualified for a subsidy: 82% in the 14 state-run exchanges and 86% in the federally-run exchange.
Young adults 18-34 were 83% of those applying for the catastrophic coverage.
I am reading Creativity, Inc. right now by Ed Catmull, the president of Pixar Animation and Disney Animation.
One particular quote by Catmull that has stuck with me personally over the last few days is this:
“At some point, every Pixar movie sucks.”
Which got me thinking – are we in the “suck” part of transforming healthcare right now?
In my opinion, all roads lead to yes. Still, I don’t want to dwell on the suck part, I want to focus on how one of the world’s most innovative companies, Pixar, transforms their “ugly babies” (mediocre ideas) into something magical (a la Toy Story 2 or my personal favorite, Up) – and how the healthcare industry can learn fromPixar’s “Braintrust” model.
Forget that it’s cliché – celebrate failure
One of the key things that make the Braintrust at Pixar unique is the fact that candor and honesty are truly placed on a pedestal. More so, failure is celebrated to a certain degree in the culture Catmull outlines.
He writes, “If you aren’t experiencing failure, then you’re making a far worse mistake: You are being driven by the desire to avoid it.”
Which leads me to something failure related that many in the healthcare industry have debated – whether the government did the right thing by incentiving providers to adopt electronic health records (EHRs). I think many would agree that the answer to that is no.
Instead of touting the percentage of organizations reaching certain stages of meaningful use attestation, would the government’s honest admittance of a certain degree of failure provide a chance to successfully redirect efforts?
I think yes.
Yet, due to the risk adverse nature of the healthcare industry and the engrained fear of failure in all of us, we (not just government) are all too often guilty of pushing forward with similar mediocre ideas merely to see them through when they may have been better served by being put to rest.
A few observations from my travels and conversations in the marketplace:
About half of the enrollments are coming from people who were previously insured and half are not. When I try to gauge this, I go to carriers who had high market share before Obamacare and have maintained that through the first open enrollment. Some carriers have said only a small percentage of their enrollments had coverage before but health plans only would know who they insured before.
By sticking to the high market share carriers who have maintained a stable market share and knowing how many of their customers are repeat buyers, it’s possible to get a better sense for the overall market. Other conventional polls have suggested the repeat buyers are closer to two-thirds of the exchange enrollees.
The number of those in the key 18-34 demographic group improved only slightly during the last month of open enrollment so the average age is still high. The actuaries I talk to think this issue of average age is made to be far more important than it should be. It is better to have a young group than an old group. But remember, the youngest people pay one-third of the premium that older people pay.
The real issue is are we getting a large enough group to get the proper cross section of healthy and sick?
The bigger concern continues to be the relatively small number of previously uninsured people who have signed up compared to the size of the eligible group. The recent report released by Express Scripts reporting on very costly pharmacy claim experience from January and February enrollees is far more concerning than the average age.
A considerable amount of taxpayer money is spent on federal IT projects, but in contrast to the aspirations of Obama in his early years in the Senate, it is not spent responsibly.
According to the Standish Group report, from 2003 to 2012 only 6% of the federal IT projects with over 10 million dollars of labor cost were successful.
52% of them were either delayed, went over budget or did not meet user expectations. The remaining 41% of the IT projects were abandoned or started from scratch. Perhaps most troubling is that healthcare.gov is just a one example among many.