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Health Management Technology News
  March 25, 2014
In this issue:

► Electronic health record sharing evolving

► CMS: Expect an 'array of adjustments' in revised renal ACO demonstration rules

► AF healthcare messaging service now fully implemented

► Doctors say Obamacare rule will stick them with unpaid bills

► Hospital mergers raise price concerns

► On the ramifications of high-tech, big-data medical care

Electronic health record sharing evolving

In response to the conundrum raised by Dr. Joel Saland in the Business Outlook Executive’s Desk published March 10, “Electronic health records rife with flaws,” it is important to note the ongoing development of New Mexico Health Information Exchange (NMHIC), the state-designated health information exchange (HIE).

LCF Research is currently in the process of developing a robust HIE that physicians and other health-care providers could use in an efficient and effective manner to share health information, which can assist in managing their patients despite having disparate electronic health records (EHRs). With the appropriate secure interfaces, NMHIC allows exchange of protected health information between different electronic health records.

The HIE can consolidate a patient’s health information from a variety of different EHRs, allowing the health-care provider to view that patient’s diagnosis, medications, immunizations, allergies, procedures, lab, X-ray and even specialty consultations, derived from each health-care organization even when they have different EHR systems.

Read the full Albuquerque Journal article here ► 

Return to the table of contents ► 

CMS: Expect an 'array of adjustments' in revised renal ACO demonstration rules

When no one comes to the party, it may be time to rewrite the invitation.

In this case, the Centers for Medicare & Medicaid Services’ Innovation Center is getting ready to re-launch its request for application, or RFA, for the Comprehensive ESRD Care Model demonstration. The Innovative Center’s leader Patrick Conway, MD, MSc, said he hopes that the changes they made, based on criticisms from the renal community, would bring more dialysis providers to the table.

“We have done the work,” said Conway, who gave the Louis Diamond Lecture during the Renal Physicians Association annual meeting here. “Hopefully in the next month we will get it out.” The lecture was part of a four-day program marking the RPA’s 40th anniversary. Conway, a pediatrician with a long employment history at CMS and other agencies looking at improving outcomes, took over for nephrologist Barry Straube as CMO for CMS in August 2011.

CMS pulled the plug on the Accountable Care Organization-type demonstration’s January launch after numerous extensions for applications failed to produce the 10-12 viable candidates the agency was seeking. The project puts dialysis providers and nephrologists in charge of coordinating care for ESRD patients (who are pre-selected by CMS from the provider’s service area). These partnerships between providers and nephrologists would include other specialists and local hospitals to form an ESRD Seamless Care Organization, or ESCO, to help coordinate care for the enrolled ESRD patients.

But dialysis providers have complained that the rules of the demonstration place too much risk and expense in their hands, while questioning the likelihood about potential rewards. If costs of care are reduced—based on what Medicare had historically paid for caring for patients enrolled in the demonstration—the ESCO and Medicare would share in the savings.

Read the full Nephrology News and Issues article here ► 

Return to the table of contents ► 

AF healthcare messaging service now fully implemented

The Air Force has recently completed implementation of its secure healthcare-messaging system, MiCare, to all 76 of its medical treatment facilities worldwide.

As of March 1, more than 360,000 Air Force healthcare beneficiaries and 2,300 providers have signed up for this service, which allows the patient and provider to communicate on a secure network regarding non-urgent healthcare concerns.

The MiCare network also allows beneficiaries to view their healthcare record, make appointments, fill prescriptions and allows providers to push important preventative care updates to the members.

Overall, Airmen, their families and beneficiaries using MiCare can expect a decrease in trips to the military treatment facility (MTF) and more personal communication with their healthcare team.

"At the beginning of MiCare's deployment, MTFs were instructed to have 25 percent of beneficiaries empaneled by three months and 50 percent within a year," said Maria Faison, a Nurse Informatics, MiCare project manager with the Air Force Medical Operations Agency. "However, we have had many MTFs surpass this goal within a couple months because the portal's processes are now updated to allow users to E-register and be transferred more easily between MTFs during PCS season."

Read the full Air Force article here ► 

Return to the table of contents ► 

Doctors say Obamacare rule will stick them with unpaid bills

Doctors groups fear their members won’t get paid because of an unusual 90-day grace period for government-subsidized health plans and are urging physicians to check patients' insurance status before every visit.

“This puts the physician and their patients in a very difficult situation,” said Dr. Ardis Dee Hoven, president of the American Medical Association (AMA), which advised physicians Wednesday about how to minimize their risk.

“If a patient is being treated for a serious illness, that requires ongoing care,” she said. “The physician is having to assume the financial risk for this. That’s the bottom line.”

If an enrollee in a subsidized plan falls behind on their premium payments, the Affordable Care Act requires insurers to cover their medical bills for 30 days.

But for the next 60 days, insurers may “pend,” or hold off paying the claims -- and ultimately, deny them if the patient doesn't catch up on his premiums. That means doctors don’t get paid for their services. If the insurer ends up canceling the policy after 90 days, doctors can bill patients directly but may face difficulty collecting.

Read the full Kaiser Health News article here ► 

Return to the table of contents ► 

Hospital mergers raise price concerns

Hospital administrators in Connecticut who have been involved in the unprecedented streak of mergers and consolidations often tout the financial benefits and efficiencies of such moves. But as the number of independent hospitals in the state dwindles -- with more than half of the 29 acute-care hospitals now operating in networks with other hospitals or out-of-state partners -- experts and advocates worry that the consolidations will reduce competition in the market and give hospitals more leverage to raise prices.

For hospitals, however, the mergers give them a change to gain buying power through increased volume, and to share staff and expertise and to spread the cost of new technology across different facilities. All this, they say, helps them control costs, not increase them.

"Creative partnerships and hospital affiliations lead to benefits from economies of scale, grow intellectual capital and bring innovative therapies forward locally for our patients and community,'' said Andrea Rynn, spokeswoman for the Western Connecticut Health Network, which now includes Danbury, New Milford and Norwalk hospitals. "Every day, we share talent, services and resources across a three-hospital network with the promise to be better at providing care, and more efficient than the day before.''

Read the full News Times article here ► 

Return to the table of contents ► 

On the ramifications of high-tech, big-data medical care

As mentioned this morning, in our new issue I have an interview with Dr. David Blumenthal about the paradox of modernization in the American health care system. We all know that everything about medicine is becoming technologized, in ways good and bad. On the good, see previous interview with Eric Landerabout the genomic-knowledge revolution. On the bad, see Jonathan Rauch on the industrialized process of dying. But we also know that nearly every visit to a medical facility begins with the tedium of filling out forms by hand.

David Blumenthal was in charge of the Obama administration's effort to speed the adoption of electronic medical records, and in the interview he explains why that has been hard but will be worthwhile.

Now, responses from readers in the tech and medical worlds. First, from David Handelsman, of a health-related data company in North Carolina:

Read the full The Atlantic article here ► 

Return to the table of contents ► 


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