Industry Watch

Information Exchange

Glenn Keet

With financial, clinical and regulatory pressures increasing steadily, and the new and confounding acronyms appearing daily, many hospitals and health systems today are wondering where they should first put their focus – building a robust health information exchange (HIE) or preparing for an accountable care organization (ACO) or other payment reform model?

Each variety of HIE (statewide, regional or private/IDN) has different goals. Privately held HIEs are rooted in the desire to achieve clinical and operational excellence among physicians within a health system, while regional or statewide systems are focused on sharing patient information across providers in a geographic area. We all know that trying to connect these disparate systems can be challenging, and that linking into a larger network requires additional infrastructure investment. But rather than implementing a less robust system that will need to be replaced in two years, the inevitability of some kind of payment reform and shared risk model coming to a town near you means that healthcare organizations need to invest in an HIE that both enables meaningful use now and has the power to support collaborative care models later.

Regardless of whether the shared-risk model adopted in the area is an episode of care, bundled payment, full capitation or per-member per-month model, the functionality that is inherent in a robust, full-featured HIE will be a requirement for any successful ACO. Primary caregivers, specialty physicians, the hospitals, the health plans, employers – any group assuming risk for the healthcare of a set of patients – are going to need to be able to communicate efficiently and electronically about patients and their health data. Moreover, they need to be able to access key analytics on that data so that they can segment their riskiest patients and treat them in ways that make them healthier while controlling costs. They also need to enable real-time decision support and alerts to the caregivers with actionable intelligence to reduce gaps in care.

The reality is that HIEs can be up and running for years before any payment reform model is adopted or implemented, and those healthcare organizations that have HIE experience will be best positioned for the change. With the inevitable shift toward collaborative and accountable care on its way, there is no reason to wait. But providers need to make sure that the HIE system they select is flexible, scalable and “ACO ready,” avoiding the trap of implementing a less robust system to tide them over until the time comes. When ACOs take hold, the last thing organizations will want is to have to make a square HIE peg fit into a round ACO hole.

Both HIEs and ACOs are on the mind of every hospital C-level executive, and faced with these big changes, it can be extremely difficult to know where to start and how to prepare. But regardless of the ACO or collaborative care models that are adopted tomorrow, these systems need a fully functioning HIE today – one that will help them exchange information securely and operate more efficiently now, providing the data and analytics to support continued care and workflow improvements that will be core to models we adopt in the future.

Glenn Keet is president of Axolotl, part of OptumInsight (formally known as Ingenix).
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Revenue Cycle Management

In the current Medicare scenario, hospitals, physicians and other clinicians bill and are paid separately for their services. But that may change soon.

The U.S. Department of Health and Human Services (HHS) announced at the end of August that doctors, hospitals and other healthcare providers can now apply to participate in a program called the Bundled Payments for Care Improvement initiative (Bundled Payments initiative).

The Centers for Medicare & Medicaid Services (CMS) program seeks to align payments for services delivered across an episode of care, such as heart bypass or hip replacement, rather than paying for services separately. Bundled payments aim to give doctors and hospitals new incentives to coordinate care, improve the quality of care and save money for Medicare.

The Bundled Payments initiative is being launched by the new Center for Medicare and Medicaid Innovation, which was created by the Affordable Care Act. The program is based on research and previous demonstration projects that suggest the approach has lucrative potential. For example, a Medicare heart bypass surgery bundled payment demonstration saved the program $42.3 million, or roughly 10 percent of expected costs, and saved patients $7.9 million in coinsurance while improving care and lowering mortality.

“This Bundled Payment initiative responds to calls from the hospital and physician communities for a flexible approach to patient care improvement,” says Donald Berwick, M.D., CMS administrator. “All around the country, many of the leading healthcare institutions have already implemented these kinds of projects and seen positive results.”

The Center for Medicare and Medicaid Innovation’s request for applications (RFA) outlines four broad approaches to bundled payments. Providers will have the choice to determine which episodes of care and which services will be bundled together.

“From a patient perspective, bundled payments make sense,” says Dr. Berwick. “You want your doctors to collaborate more closely with your physical therapist, your pharmacist and your family caregivers. But that sort of common-sense practice is hard to achieve without a payment system that supports coordination over fragmentation and fosters the kinds of relationships we expect our healthcare providers to have.”

Find out more about the Bundled Payments initiative at www.innovations.cms.gov.

Tracking Systems

A tracking system that significantly aids in the successful conservation of stored blood has been developed and put into use at Wake Forest Baptist Medical Center.

Launched at the hospital in August 2010, the technology employs proprietary real-time location system (RTLS) tags affixed to the exteriors of portable coolers to track their location and elapsed time in use. The system was created at Wake Forest Baptist by Ron Noel, a resource-management manager, and Mary Rose Jones, blood bank manager.

By tracking the location and elapsed time of coolers and electronically conveying that information to the appropriate personnel, RTLS allows staff members to retrieve coolers containing unused blood before a specified time expires, which greatly reduces the possibility that unused blood may have to be destroyed. Blood must be kept chilled, typically between 1 and 6 degrees Celsius (33.8 to 42.8 degrees Fahrenheit), to be suitable for use in transfusions and other medical procedures. Any blood stored in a cooler beyond the specific effective time span (generally between five and 10 hours) is considered expired and must be destroyed, even if not used.

“We use RTLS technology to track the location of wheelchairs, beds and other mobile items,” says Noel. “We employed the RTLS system to track the coolers and added a timing function to alert the blood bank staff when the validated time is approaching.”

The tracking system’s software displays each cooler’s status on a computer monitor. When a cooler’s status changes, the system changes the color of that cooler’s screen icon and automatically sends an e-mail notice to designated addresses.

“Since adopting the RTLS system last August, the results have been outstanding. We have not lost one cooler in the medical center,” Jones says. “We also have reduced labor time – blood bank staff members no longer have to make multiple phone calls trying to locate coolers – and realized considerable dollar savings.”

A provisional application for a patent on the tracking system has been filed with the U.S. Patent and Trademark Office. Noel and Jones are listed as the inventors; Wake Forest Baptist would be the holder of the patent.

The Office of Technology Asset Management (OTAM) at Wake Forest Baptist is working with Noel to form a company, Time Temp Trac, that will market the system to hospitals and other healthcare facilities. Wake Forest Baptist will have an equity share in the company.

Health Plans Interfacing

Centers for Medicare & Medicaid Services (CMS) is encouraging the creation of consumer operated and oriented plans (CO-OPs). A CO-OP is a private, non-profit organization that sells health insurance coverage, similar to a health maintenance organization (HMO) or a preferred provider organization (PPO), and will be subject to the same rules as other health insurers. All profits are used to benefit members by lowering premiums, for example, or improving health benefits.

CMS is proposing standards for CO-OPs and for qualifying for $3.8 billion in repayable loans to help start up and capitalize the new health plans. All CO-OP loans must be repaid with interest, and loans will only be made to private, non-profit entities that demonstrate a high probability of becoming financially viable.

CO-OPs will sell coverage through a state’s affordable insurance exchange as well as have the opportunity to sell coverage to small businesses through a state’s small business health option programs (SHOP exchanges). According to CMS, several successful health insurance cooperatives currently exist around the country, covering nearly 2 million individuals. A number of diverse groups are organizing to take advantage of this new opportunity. In one state, primary care providers are working to create a CO-OP to focus on care for rural areas. In another, a CO-OP steering committee has been formed by interested physicians, technology and business experts, and community groups.

The CO-OP program provides for loans to private entities with the goal to create a new CO-OP in every state to expand the number of exchange health plans with a focus on consumer accountability. The CO-OP program contains extensive provisions to protect against fraud, waste and abuse. Loan recipients are subject to strict monitoring, audits and reporting requirements for the length of the loan repayment period plus 10 years.

CMS will accept comments on the proposed rule until September 16, 2011.

EHRs

On July 6, 2011, the Missouri Health Information Technology (MO HIT) Assistance Center became the fifth regional extension center in the United States to reach its goal, enrolling nearly 1,200 priority primary healthcare providers to assist them in achieving meaningful use of an EHR.

The MO HIT Assistance Center provides special support and services to healthcare providers to make the transition to EHRs faster, easier and more successful. These healthcare providers are physicians, nurse practitioners and physician assistants who individually, or in a small practice, focus on primary care in Missouri.

“In the past, the transition to EHRs has often been difficult, with numerous risks and challenges,” says Lanis Hicks, principal investigator, MO HIT Assistance Center. “So, the decision to change a practice in this way is not easy to make, and we appreciate the conviction and commitment of these healthcare providers.”

Hicks says she is very proud of the center’s collaborative partners, the Kansas City Quality Improvement Consortium, Missouri Primary Care Association, Missouri Telehealth Network, Primaris and the Missouri Hospital Association. She credits their enthusiasm and exceptional work for MO HIT Assistance Center’s outstanding performance as a regional extension center.

For information on the Medicare and Medicaid EHR incentive programs, EHR adoption or how the MO HIT Assistance Center helps healthcare providers adopt and achieve meaningful use of certified EHRs, go to http://www.EHRhelp.missouri.edu.

Imaging

Baptist Health System, one of the largest healthcare systems in Alabama, and Henry Ford Health System, an integrated health system based in Michigan, have signed on to pilot AT&T’s cloud-based Medical Imaging and Information Management Service, a vendor-neutral offering that combines AT&T Synaptic Storage as a Service with Acuo Technologies’ Universal Clinical Platform. The solution helps providers store, access, view and share patient medical images and information over a highly secure infrastructure. It works on a pay-as-you-go pricing model where providers pay per gigabyte, per month, for storage and get fast access to x-rays, MRIs and other digital images regardless of original capture device or equipment. As for backup, the service provides copies of data at two geographically diverse sites. Data is stored compressed and includes encryption at rest.

For Baptist Health System, the new system will provide a single source for its physician community to access and share the more than 2 million images that it has accumulated and the 30,000 new images per month that it creates.

At Henry Ford Health System, the plan is to store new cardiology medical imaging studies and to move other cardiology studies from its existing solution to the AT&T cloud. Significant efficiencies are expected to be gained from consolidated and expandable storage, providing anywhere access to cardiologists in various heart centers.

Learn more about this service at
http://www.synaptic.att.com

Publication

“Over Our Heads: An Analogy on Healthcare, Good Intentions and Unforeseen Consequences” by Rulon F. Stacey, Ph.D., FACHE, (Fire Starter Publishing, 2011; $18.95), uses a neighborhood grocery store as a metaphor to trace the long and complicated history of healthcare policy in America and how it has caused the current healthcare crisis. “While the people who work in this industry are deeply caring and compassionate individuals, they are forced to work within a system that has become so convoluted and complex that it’s nearly impossible to comprehend the roots of the problem or to even keep up with current policy,” says Dr. Stacey, who was selected to be the 77th chairman of the board of governors of the American College of Healthcare Executives in 2011.