Meet Seema Verma, Trump's nominee to head CMS 

President-elect Donald Trump’s nomination of Seema Verma to head the Centers for Medicare and Medicaid has been largely overshadowed by his choice of Rep. Tom Price for director of the Department of Health and Human Services. But for those reading the tea leaves about the future of healthcare, especially the Affordable Care Act, Verma’s selection is well worth examining.

Verma, a healthcare consultant who runs a national health policy consulting company, has extensive experience with Medicaid. As president, CEO and founder of SVC, she was involved in expanding Medicaid in Indiana under then-Gov. Mike Pence, the Vice president-elect. SVC also assisted in formulating Medicaid expansion plans in Iowa, Kentucky, Michigan and Ohio. Here are a few more things to know about her:

  • She is an advocate of making patients more financially responsible for their healthcare, and supports freezing coverage for those who don’t pay their premiums, even those living below the poverty line.
  • She worked across party lines to push the Pence administration’s positions into the Indiana Medicaid expansion, known as the Healthy Indiana Plan, or HIP.
  • She supports requiring that Medicaid enrollees look for work, and that they reapply for coverage on time. Those who don’t, she maintains, could lose coverage for up to a year.
  • Patient advocacy groups predict she may call for a replacement of the Affordable Care Act before agreeing to its repeal. Her potential push-back might help mitigate the loss of coverage for those who received coverage through Medicaid expansions in the ACA—about 12 million people.
  • Indiana Rep. Charlie Brown, a Democrat, opposed many of Verma’s positions during debate over the Healthy Indiana Plan, but told National Public Radio that she is “a smooth operator, and very, very persuasive.”
  • The Indianapolis Star reported in 2014 that Verma was paid millions by Indiana for her work on the Indiana Medicaid expansion, and was also paid by Medicaid vendor Hewlett-Packard, which was paid more than $500 million by the state.
  • The American Medical Association, American Hospital Association and America's Essential Hospitals support Verma’s nomination, which—like Price’s—must be approved by Senate.

Parts of Obama's Healthcare Legacy Will Likely Continue Under Trump 

President-elect cites popular provisions he'd like to keep

As the dust settles after the presidential election, it appears that Donald Trump is already softening some of his positions, especially his position on Obamacare. Media outlets have speculated that President Obama pushed hard for the continuance of his signature healthcare program when he met with Trump at the White House following the election.

During the presidential campaign, Trump disparaged the Affordable Care Act and called for its repeal, although he didn't spell out what he would put in its place. A wholesale repeal of the ACA could leave as many as 22 million people without health insurance--a prospect that industry insiders consider unlikely.

Healthcare attorney Michael P. Strazzella told FierceHealthcare that Trump will focus on the ACA on the first day of his presidency, but that he doesn't expect anything dramatic to happen immediately. (Strazzella is co-head of Buchanan, Ingersoll & Rooney's District of Columbia office.)

"Repeal is good campaign language, but it's a 2,000-plus page bill and not everything can be repealed," Strazzella pointed out. To actually repeal all of Obamacare would require a 60-vote Senate supermajority, which Trump could not get unless some Democrats crossed party lines.
Other factors to consider:

  • The Republican Party is far from united under Trump, whom some GOP leaders have distanced themselves from, so the new president may not be able to count on the party's backing his every move.
  • Republicans may be wary of taking away well-liked provisions of Obamacare, especially if that doesn't play well with their constituencies.
  • The ACA's mandate that patients must not be denied coverage due to pre-existing conditions is very popular with voters, as is the act's provision for young people to be kept on their parents' insurance plans till age 26.*

What other aspects of healthcare might change under the Trump presidency? The future of pilot programs such as the Accountable Care Organizations under the Medicare Shared Savings Programs--like so many other Obama administration healthcare provisions--is murky. But many in the healthcare industry maintain that value-based care is here to stay. 

The credit ratings and research company Fitch Ratings issued this prediction: "The shift toward linking pricing to patient outcomes will continue as patients and health insurers grapple with the growing burden of healthcare costs over the longer term." 

*UPDATE: Trump recently told "60 Minutes" that he is in favor of keeping at least two provisions of Obamacare: the requirement that insurance companies accept patients with pre-existing conditions, and the provision that allows young adults to stay on their parents' health insurance plans until they reach the age of 26. He also signaled that he would not end Obamacare without having some other program in place.

Will the election of Trump impact your organization? Share your thoughts in our comment section below.

Leapfrog List Puts Focus on Patient Safety 

Patient safety is once again in the news with the recent release of the Leapfrog Group's Fall 2016 Hospital Safety Grade List. Almost all the hospitals on the list received a passing grade. Of the 2,633 hospitals evaluated, 844 earned an "A," 658 earned a "B," 954 earned a "C," 157 earned a "D" and 20 earned an "F."

Leapfrog's biannual program assigns A, B, C, D and F letter grades to the hospitals surveyed. When compared to previous lists, several states showed significant improvement this time. North Carolina, for example, climbed to No. 5 in this fall's list, up from No. 19 in spring 2013.

Hawaii ranked No. 1 for the first time, while Alaska, Delaware, and North Dakota, along with Washington, D.C., brought up the rear. None of the bottom-ranked states had a hospital that earned an A grade.

Improving patient safety is, of course, a major priority for healthcare providers. Research published in The Journal of Health Care Finance found that medical errors cost the United States $19.5 billion in 2008 alone. A 2016 study estimated that these mistakes cause 251,000 deaths a year in the U.S., where they are the third-leading cause of death (after heart disease and cancer). 

For more information on the Leapfrog list, including a full description of the data and methodology used, click here.
 

 

Posted by Tuesday, November 01, 2016 10:03:00 AM Categories: health IT healthcare reform healthcare today HIT hospitals patient experience of care patient satisfaction

AUC and the CVIS 

Leveraging Appropriate Use Criteria for Better Outcomes—and Collateral Benefits

Appropriate Use Criteria (AUC) is intended to help physicians achieve the best outcomes using the most appropriate treatment plan for any situation. Ensuring that physicians comply with established AUC guidelines is crucial to the overall success of a facility. Demonstrated AUC excellence can impact: 

  • Patient outcomes and satisfaction
  • Hospital reputation
  • Reimbursement in the value-based care era

While the goal of all physicians is to provide best-quality, appropriate care for their patients, in the real world this can be challenging to accomplish—and to document—because of the lack of point-of-care access to complete, longitudinal patient information. Providing physicians with access to relevant patient data, and ensuring they have a clear understanding of AUC guidelines, can lead to improved outcomes—and cost savings as well. 


Rachanee Curry, LUMEDX Service Line & Analytics Consultant, explains how LUMEDX solutions help physicians access the patient data they need to comply with Appropriate Use Criteria.

Leveraging Appropriate Use for Cost Savings & More

With the shift to value-based care, service line leaders must seek out every cost-control opportunity. The good news is that there are collateral benefits to AUC compliance: In addition to improved clinical outcomes, collecting and serving up data so physicians can provide appropriate care helps heart and vascular centers improve their financial performance by:

  • Providing the right information, at the right time, to support appropriate clinical decision-making and best-quality care. When you deliver best-quality care, you are avoiding redundant or excessive treatment that can drive up costs; 
  • Delivering clinical workflows wherein quality data can be captured at or as close to the point of care as possible, optimizing efficiency and minimizing redundant manual work. This saves labor costs because clinicians spend more time on direct patient care rather than administrative tasks; 
  • Providing integrated clinical and operational data in near-real time so service line leaders can monitor their programs' performance and take action to improve.

In addition, when you demonstrate that your facility is consistently AUC-compliant, you are better positioned to work with payers on providing best-value care for that patient population. 

LUMEDX HealthView CVIS: Serving Up the Right Data at the Right Time 

HealthView CVIS helps heart hospitals navigate AUC and value-based care standards. The system collects point-of-care data and delivers actionable insights, facilitating better clinical decision-making and helping to improve business operations through increased efficiency and cost savings. 
HealthView CVIS can play a critical role in any hospital's move toward better patient care, greater efficiency, and improved fiscal performance. 


Early Reaction to MACRA Rule Mostly Positive 

Last weekend was a busy one for those trying to parse the new MACRA rule released on Friday. At 2,202 pages, the Medicare Access and CHIP Reauthorization Act rule wasn't exactly beach reading, and it gave the health IT community plenty to talk about on social media and in policy statements.

The dust is still settling, but it appears that early reaction to the rule was mostly positive. Healthcare organizations praised the CMS for being responsive to concerns they had raised during the comment period leading up to the rule's finalization. In fact, about 80 percent of the 2,000+ pages are comments CMS received and its responses.
The American Medical Association was pleased with the permanent elimination of the Sustainable Growth Rate (SGR) formula. "The new law," according to the AMA's press release, "gives many physicians the opportunity to be rewarded for the improvements they make to their practices and for delivering high-quality, high-value care to Medicare patients."
Other features that drew favorable reactions included:

  • The rule's overarching theme that improving the organization and payment models for medical care must stress quality over quantity.
  • Greater reporting flexibility for clinicians, as well as support for innovation in the delivery of care.
  • The formal adoption of a transition year during 2017, which makes major changes to the Quality Payment Program (QPP) reporting requirements, and provides a longer time frame for those transitioning to the QPP.
  • Emphasis on helping clinicians educate themselves about the rule.
  • Easing of the policy defining the Advanced Alternative Payment Model (APM), which will allow additional programs to quality.

But the rule is not without its detractors. "It's disappointing that the flexibility provided for quality reporting in 2017 largely disappears in 2018 and beyond," the Medical Group Management Association said in a policy statement.
Other organizations complained that the nominal risk standard defining the Advanced APM remains too high.

Want to know more? Healthcare Dive has a great breakdown of the rule changes you need to know. And for even more information on the new rule, click here. 
What's your take on the final MACRA rule? Share your thoughts in our comment section below.

Clinician mobile device use increasing as healthcare organizations struggle to protect data 

The number of clinicians who use smartphones and other mobile devices on the job is rising rapidly, and so is the number of facilities that have created mobile device management strategies to cope. "Organizations with a documented mobility strategy have nearly doubled, and in-house use of pagers has increased slightly during the past two years," according to Health Data Management.

Almost 90 percent of physicians surveyed reported using smartphones, while about half of nurses and other staff members use them. In response, more than 60 percent of hospitals surveyed have a documented mobile device strategy. (The survey, by mobile messaging service vendor Spok, included responses from about 550 hospitals.)
The leading mobile devices used in hospitals are:

  • Smartphones (78 percent)
  • In-house pagers (71 percent)
  • Wi-Fi phones (69 percent)
  • Wide-area pagers (57 percent)
  • Tablets (52 percent)

Security and privacy, of course, are huge concerns for those setting mobile device policy, leading some organizations to forbid clinicians to use personal devices for work-related communication. About 80 percent of surveyed hospitals with such policies cited fear of data breaches as the reason behind their rules. 

Click here to download the survey.
What's the mobile device policy at your organization? Share your thoughts with the LUMEDX community by commenting below. 

Healthcare Cybersecurity Failings Draw the Ire of Accountability Office 

GAO Recommends Corrective Action by Department of Health and Human Services

More than 113 million electronic health records were breached in 2015, a year that saw a total of 56 cybersecurity attacks in healthcare alone. That's a 13-fold increase from 2006 to 2015.
The Government Accountability Office isn't going to let those cybersecurity failures go unremarked upon. The GAO last week came down hard on the Department of Health and Human Services, pointing out a number of weaknesses in efforts by HHS to help health plans and other providers protect data.
"HHS has established an oversight program for compliance with privacy and security regulations, but its actions did not always fully verify that the regulations were implemented," wrote the GAO in a report released Sept. 26. The report also called out HHS for giving technical assistance "that was not pertinent to identified problems" in cybersecurity, and for failing to follow up on cases it investigated. 
In short, the GAO found, loss or misuse of health information is not being adequately addressed by HHS. To help healthcare organizations comply with HIPAA and prevent further data breaches, the Office said, HHS should take the following corrective actions:

  • Update its guidance for protecting electronic health information to address key security elements.
  • Improve technical assistance it provides to covered entities.
  • Follow up on corrective actions.
  • Establish metrics for gauging the effectiveness of its audit program. 

HHS generally concurred with the recommendations and stated it would take actions to implement them.

UPDATE: On Oct. 4, HHS announced that it had awarded funding to help protect the health sector against cyber threats. Learn who received the funding, and how it is intended to help healthcare organizations.

Medical Errors Are Made at an Alarming Rate 

How Integrated Systems Can Help 

Medical errors are dangerous, deadly, and all too common. Research published in The Journal of Health Care Finance found that these mistakes cost the United States $19.5 billion in 2008 alone. A 2016 study estimated that medical errors cause 251,000 deaths a year in the U.S., where they are the third-leading cause of death (after heart disease and cancer). 

To Err is Human, the groundbreaking report by the Institute of Medicine, found that nearly half of all deaths attributed to medical errors were preventable. What's even more disturbing is the limited improvement that has occurred since the publication of that 1999 report. "The overall numbers haven't changed, and that's discouraging and alarming," Kenneth Sands of Beth Israel Deaconess Medical Center told the Washington Post.


Mickey Norris, National Vice President of Sales for LUMEDX, discusses how a CVIS can help reduce medical errors.

Medical errors can obviously result from many factors. Some relate to process or people issues, such as the inability to read another physician's handwritten notes, verbal communication breakdowns between medical professionals, or delays in adding notes to a case after treatment occurs.

But many errors stem from the lack of having accurate, up-to-date, or complete information about a patient readily available to clinicians at the point of care. In most cases this is a technology problem, yet technology can also be the solution.

Technology Can Help Reduce Medical Errors

The best technology solutions take an analog process and make it more efficient and accurate through a digital solution. The same is true in healthcare. The effectiveness of patient treatment hinges on getting the right information in front of the right caregivers at the right time. And historically that has been a challenge because the data physicians need is often located in multiple systems. These systems don't always communicate with each other.

For example, a physician may check a pharmacy log to determine which medications have been administered to a patient. But the patient may have been given additional medications in the cath lab, which weren't documented in the same log. This lack of complete information could result in drug interactions or overdoses, or in simply repeating tests. Similarly, the results of tests conducted outside a hospital may not be immediately available to a physician in a hospital. 

Integrating critical patient data from multiple systems automatically, and making it accessible to physicians and clinicians where and when they need it, helps reduce medical errors and improve care overall. Indeed, by minimizing the "number of hands" and number of times information is entered into a system, data quality improves, as there are fewer chances of error. 

Integrating data also reduces costs, because integration minimizes duplicative manual work. Clinicians can spend less time entering redundant data into silo'd systems and more time working with patients. Complete, accessible, high-quality data and improved operational efficiency in CV care are critical to the financial success of a facility.

LUMEDX HealthView CVIS: Increase Efficiencies, Reduce Errors

LUMEDX HealthView CVIS has the ability to interface digitally with almost every point-of-care device in use, and is completely vendor-neutral. Our suite of clinical interfaces allows device and clinical system data-ECG, hemodynamic systems, PACS, cardiac ultrasounds and more-to be captured automatically so that physicians and clinicians always have the most up-to-date information at their fingertips. And our structured reporting applications and registry modules support improved workflow efficiency and clinical quality, while minimizing redundant data entry and the potential for human error. 

HealthView CVIS also complements established workflows. It collects more than 30,000 discrete data points-from point-of-care devices to physician reporting. The robust analysis and reporting engine provides meaningful insights in the areas of treatment options, clinical evaluation and training, and service-line optimization. It's an important addition to any heart hospital's electronic records system, turning it into a robust and dynamic dataset where new information is added in near real-time. Fresh, relevant data that enables better medical care is a critical step in reducing medical errors. 


Heart Attack Patients Get Faster Care When Medical Teams Use Smartphone Social Network System 

18-month study tracked 114 STEMI patients

New research shows that patients in need of a hospital transfer were treated 27 minutes faster when their medical teams used a smartphone app-based social network system (SNS) to set up the transfer, compared to medical teams who didn’t use the smartphone technology.

The research, published in the Journal of the American College of Cardiology, monitored the time that patients with ST-elevated myocardial infarction (STEMI) suffered from ischemia (reduction in blood supply) while they waited to have a procedure opening their blocked arteries. On nights and weekends, the treatment time reduction was even greater than during the regular work week.

One of the study’s senior researchers, Jin Joo Park, M.D., pointed out that there is a higher risk of death for patients who get to a hospital during off hours—a worldwide trend.

“Transferred STEMI patients rarely achieve timely reperfusion due to delays in the transfer process, especially when transferred during off-hours,” Park told Dicardiology.com. “The use of a smartphone SNS (Social Network System) can help to achieve timely reperfusion for transferred STEMI patients with rapid, seamless communication among healthcare providers.”

Over a period of 18 months, the study enrolled 114 STEMI patients who were transferred to Seoul National University Bundang Hospital. The transfers for 50 of the patients were completed using the SNS app, while the remaining patient transfers used a non-smartphone-based STEMI hotline. The transit times for both groups of patients were similar.

Click here to read the research letter.

 

Spotlight on Analytics, Part 6 

Q & A with Gus Gilbertson, LUMEDX Products Manager

 

The Role of Mobile & The Cloud

Q: What is the role of mobile and the cloud in the healthcare analytics industry?

A: Cloud-based technologies hold the promise of delivering better technology solutions at reduced cost. Mobile will increasingly be the platform of choice for quick updates of the most relevant information for a specific situation. Mobile platforms provide an efficient and effective way to consume healthcare analytics.

Q: What challenges and benefits do you predict will arise as mobile and cloud-based access becomes more prevalent?

A: Security protocols will have to meet standards and may limit access to specific patient data. Analytics not at the patient level will become easy to access. Increasingly, caregivers will know how their organizations are doing at meeting care quality goals efficiently. Eventually, patients may get there too.

Q: What use will healthcare organizations have for patient-generated data?

A: Over time, biometric data collection devices will become connected, cheap enough, and prevalent enough that we will all know our health metrics much better than we do today. As standards arise, healthcare organizations will have to engage with patients to better understand what stories biometrics have to tell, and patients will want to share with their providers to gain better insights into their own health. If providers are not able to deliver insights from biometric data, someone else will.

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