This whitepaper provides an assessment of the passing of the American Recovery and Reinvestment Act of 2009 (ARRA) which has given “legs” to accelerate physician electronic health record (EHR) adoption via Stark Safe Harbor compliant programs for hospitals.
The combined Stark Safe Harbor and ARRA makes a clear case to move quickly with an EHR initiative.
The document discusses India's policy journey towards establishing a national digital health ecosystem. Key events include the release of the National Health Policy in 2015, launch of the Ayushman Bharat program in 2018, and announcement of the National Digital Health Mission in 2020. Standards for electronic health records, metadata, and data dictionaries were drafted between 2008-2019 to enable interoperability. The National Digital Health Blueprint proposed an ecosystem approach with various building blocks like applications, standards, and an institutional framework. The financial lever of the government can support universal healthcare goals through a proposed health claims platform using e-governance and data analytics.
This document discusses how new clinical language understanding (CLU) technologies can help bridge the gap between physician dictation of patient narratives and the structured data entry required by Meaningful Use regulations for electronic health records (EHRs). CLU leverages natural language processing and artificial intelligence to extract structured clinical data like medications, allergies, and lab results from unstructured physician dictation. This extracted data can then automatically populate EHRs, helping providers meet Meaningful Use goals while maintaining preferred narrative documentation workflows. Nuance Healthcare is developing CLU solutions to address this need by extracting medical facts from dictation and formatting it for EHR consumption.
R&D Med Tech is an Oklahoma LLC that provides EHR software and services to physician practices using Greenway's PrimeSuite EHR. The document discusses the financial incentives available for physicians to adopt EHRs, including stimulus payments up to $44,000 per eligible professional from Medicare and up to $63,750 from Medicaid. It also outlines cost savings practices can see from improved coding, reduced billing costs, and lower malpractice insurance rates that provide doctors with incentives to adopt EHRs.
Accounting Update Overview with a Healthcare SlantPYA, P.C.
PYA Principal and Director of Audit Services Doug Arnold presented during East Tennessee State University’s 38th Annual Accounting, Auditing, and Tax Updating CPE conference. His presentation covered many recent Accounting Standards Updates, but leaned toward their applications in healthcare.
This document summarizes key points from a presentation on sustaining physician-led healthcare organizations. It discusses the current state of the US healthcare system including challenges around demographics, consumerism, technology, and economics. It then covers implications of the Affordable Care Act, such as Medicaid expansion decisions by states and the growth of high-deductible health plans. Finally, it discusses factors needed to build sustainable organizations, including value-based payments, delivery redesign, and blurred lines between providers and payers.
The patient-centered medical home (PCMH), an approach designed to rebuild primary care and improve care coordination, has become a major focus of healthcare reform. Thousands of physicians are already participating in medical home pilot projects across the country. Now is the time for practices to investigate the information technology tools that will help them medical home certification requirements.
PYA Presents Intro to Healthcare Valuation PYA, P.C.
PYA Principal Jim Lloyd, along with other presenters, provided a “Healthcare Valuation 101” during a pre-conference workshop at the 2013 AICPA Healthcare Industry Conference.
Employers are always looking for ways to reduce one of their biggest expenditures–the cost of providing health insurance to employees. Many employers have explored solutions such as adding wellness plans, reducing usage, and providing different provider access mechanisms, all with modest success.
Stemming the rising costs of health insurance requires management to understand and improve healthcare outcomes for their employee and dependent populations. Changing the future of employer health insurance will require a multi-faceted approach:
Driving additional value by reducing utilization of healthcare services within these employer populations.
Utilizing a wider lens through which to view performance of various providers, then making decisions based on those who are consistently providing low cost, high quality care.
Employer will need to combine their data with other companies across a geographic region to get a better picture of the provider landscape than has ever been possible before.
The document discusses India's policy journey towards establishing a national digital health ecosystem. Key events include the release of the National Health Policy in 2015, launch of the Ayushman Bharat program in 2018, and announcement of the National Digital Health Mission in 2020. Standards for electronic health records, metadata, and data dictionaries were drafted between 2008-2019 to enable interoperability. The National Digital Health Blueprint proposed an ecosystem approach with various building blocks like applications, standards, and an institutional framework. The financial lever of the government can support universal healthcare goals through a proposed health claims platform using e-governance and data analytics.
This document discusses how new clinical language understanding (CLU) technologies can help bridge the gap between physician dictation of patient narratives and the structured data entry required by Meaningful Use regulations for electronic health records (EHRs). CLU leverages natural language processing and artificial intelligence to extract structured clinical data like medications, allergies, and lab results from unstructured physician dictation. This extracted data can then automatically populate EHRs, helping providers meet Meaningful Use goals while maintaining preferred narrative documentation workflows. Nuance Healthcare is developing CLU solutions to address this need by extracting medical facts from dictation and formatting it for EHR consumption.
R&D Med Tech is an Oklahoma LLC that provides EHR software and services to physician practices using Greenway's PrimeSuite EHR. The document discusses the financial incentives available for physicians to adopt EHRs, including stimulus payments up to $44,000 per eligible professional from Medicare and up to $63,750 from Medicaid. It also outlines cost savings practices can see from improved coding, reduced billing costs, and lower malpractice insurance rates that provide doctors with incentives to adopt EHRs.
Accounting Update Overview with a Healthcare SlantPYA, P.C.
PYA Principal and Director of Audit Services Doug Arnold presented during East Tennessee State University’s 38th Annual Accounting, Auditing, and Tax Updating CPE conference. His presentation covered many recent Accounting Standards Updates, but leaned toward their applications in healthcare.
This document summarizes key points from a presentation on sustaining physician-led healthcare organizations. It discusses the current state of the US healthcare system including challenges around demographics, consumerism, technology, and economics. It then covers implications of the Affordable Care Act, such as Medicaid expansion decisions by states and the growth of high-deductible health plans. Finally, it discusses factors needed to build sustainable organizations, including value-based payments, delivery redesign, and blurred lines between providers and payers.
The patient-centered medical home (PCMH), an approach designed to rebuild primary care and improve care coordination, has become a major focus of healthcare reform. Thousands of physicians are already participating in medical home pilot projects across the country. Now is the time for practices to investigate the information technology tools that will help them medical home certification requirements.
PYA Presents Intro to Healthcare Valuation PYA, P.C.
PYA Principal Jim Lloyd, along with other presenters, provided a “Healthcare Valuation 101” during a pre-conference workshop at the 2013 AICPA Healthcare Industry Conference.
Employers are always looking for ways to reduce one of their biggest expenditures–the cost of providing health insurance to employees. Many employers have explored solutions such as adding wellness plans, reducing usage, and providing different provider access mechanisms, all with modest success.
Stemming the rising costs of health insurance requires management to understand and improve healthcare outcomes for their employee and dependent populations. Changing the future of employer health insurance will require a multi-faceted approach:
Driving additional value by reducing utilization of healthcare services within these employer populations.
Utilizing a wider lens through which to view performance of various providers, then making decisions based on those who are consistently providing low cost, high quality care.
Employer will need to combine their data with other companies across a geographic region to get a better picture of the provider landscape than has ever been possible before.
The document discusses electronic claim objects to support India's health insurance sector. It proposes using standardized electronic objects based on FHIR resources to enable interoperable and automated claim processing. This would allow faster claims processing, reduced costs, and improved data for monitoring. The electronic objects would include minimum required coded data elements in a JSON format to represent claims, payments, and clinical summaries like discharge records.
Electronic Health Records Protecting Assets With A Solid Security Plan Wp101207Erik Ginalick
EHR systems provide significant benefits but also require proper security plans to protect patient data. A solid security plan includes:
1) Conducting a risk analysis to identify vulnerabilities and ensure compliance with HIPAA security rules.
2) Implementing administrative safeguards like security policies, employee training, and systems to monitor threats.
3) Using technical security like firewalls, encryption, and authentication controls to restrict access and protect hardware and software.
This will allow organizations to maximize the benefits of EHR while safeguarding protected health information.
Splash 4 partners tele icu moving beyond the early innings Splash 4 Partners
This document discusses the tele-ICU industry. It defines a tele-ICU as using remote monitoring to provide intensive care support. The document outlines the history and growth of the tele-ICU market from its beginnings in 1998 to present day expanding adoption. It also compares tele-ICU to other acute telemedicine services and discusses limiting factors for telemedicine adoption like reimbursement rates and state licensing.
Splash 4 partners tele icu moving beyond the early inningsSplash 4 Partners
This document discusses the tele-ICU industry. It defines a tele-ICU as using remote monitoring to provide intensive care support. The document outlines the history and growth of the tele-ICU market from its beginnings in 1998 to becoming more widely adopted. It also compares tele-ICU to other telemedicine services and discusses limiting factors for telemedicine adoption like reimbursement rates and state licensing.
The Skilled Nursing Facility (SNF) “Program for Evaluating Payment Patterns Electronic Report” (PEPPER) was released in April 2014 by CMS. Join Keri Hart, MS, CCC-SLP, CHHRP-QT, RAC-CT, in this in-depth interpretation of the elements of the PEPPER. Keri will detail how to interpret your PEPPER and discuss the practical application of this critical information to your Skilled Nursing Facility’s practice. Follow along with your own PEPPER report to develop an action plan to ensure compliance with Medicare regulatory requirements and ensure accurate reimbursement for clinically appropriate care provided.
CMS introduced this new annual report for Skilled Nursing Facilities in August 2013. PEPPER data is shared with both Medicare Administrative Contractors (MACs) and the Medicare Recovery Audit Contractors (RACs). This important report details your facility-specific Medicare claims data in certain targeted areas and compares your facility to other SNFs Nationally, by State and by Jurisdiction (Medicare Administrative Contractors/Fiscal Intermediaries).
PYA Healthcare Consulting Senior Manager Robert Mundy co-presented during, “Valuing Hospitals,” Thursday, July 31, at 1 p.m. EST. This webinar explores the changing world of hospital economics, regulations, and valuations and how appraisers can best prepare themselves for both the opportunities and challenges that lie ahead.
Hot Valuation Issues for Physician AgreementsPYA, P.C.
The document summarizes key issues related to physician compensation agreements and the impact of healthcare reform. It discusses the increased complexity of compensation models with multiple layers and components. Ensuring fair market value and commercial reasonableness of the overall arrangement is important as the sum of individual components could exceed what is reasonable. The presentation also covers analyzing losses, benchmarks, and factors considered in commercial reasonableness determinations. Healthcare continues shifting toward value-based payments, quality incentives, and bundled payments through initiatives like Accountable Care Organizations.
Ehr number and characterists of providers awardedScott Zajkowski
- In 2012, 2,291 hospitals and an unknown number of professionals received $6.3 billion in Medicare EHR incentive payments, more than double the $2.3 billion awarded in 2011.
- For hospitals, 48% of eligible hospitals received payments in 2012, up from 16% in 2011. The median hospital payment was $1.4 million.
- Most hospitals (72%) and professionals receiving payments in 2012 were new to the program that year.
Workers' compensation faces challenges from rising medical and indemnity costs, expansion of opt-out legislation, impact of the Affordable Care Act, and questions around the constitutionality of exclusive remedy. Media reports have also highlighted deficiencies in how injured workers are treated. Internal challenges include debates over the financial sustainability of the system and whether all injured workers access benefits. Externally, advocacy groups lobby for further reforms while critics argue these may limit worker rights and benefits.
Healthcare is a business that, like all businesses, has key elements including leadership and governance, financing, human resources, health information systems, essential medical products and technologies, and service delivery. The future of healthcare business is evolving, with one prominent forecast being the use of Interacted Practice Units which enable faster treatment, better outcomes, lower costs and improved market share. However, only time will tell which approaches will be most effective.
The document summarizes insights from a panel discussion on post-Affordable Care Act healthcare M&A trends. Key points include:
- Panelists expect growth in healthcare IT due to increasing demand for electronic records, data analytics, and population health management. However, hospitals may consolidate to cut costs in response to lower reimbursement rates.
- Successful companies will integrate services across the care continuum and leverage technology to improve outcomes and lower costs. The future involves value-based reimbursement models that reward quality over volume.
- Opportunities lie in care coordination, analytics, and population health management. Technology will continue driving consolidation and improvements to the healthcare system.
The Migration to Clinician Network Management - Chilmark ResearchBrian McCalley
- The healthcare industry is undergoing major changes driven by the shift from fee-for-service to value-based reimbursement models.
- To succeed under value-based models, healthcare organizations will need to better coordinate care across their networks of providers using health information exchange infrastructure.
- This report defines a new concept called Clinician Network Management, which uses health information exchange platforms to support provider networks through activities like longitudinal patient data viewing, risk scoring, care guidance, and cost of care tracking.
Maggio Article re Off-Campus Ambulatory DevelopmentCharles S. Maggio
The document discusses new legislation that reduces Medicare reimbursement for hospital-owned physician practices located more than 250 yards from the main hospital campus. This will significantly impact the willingness of hospitals to acquire off-campus facilities. While some facilities established before the legislation will maintain higher reimbursement rates, new off-campus facilities will face lower rates similar to private practices. Healthcare providers and real estate developers must adjust their strategies and underwriting models to account for this change.
Top Challenges & Opportunities for Spine in 2011Nicola Hawkinson
The document discusses the top challenges and opportunities for spine care in 2011, as presented by Nicola Hawkinson. The biggest challenges are healthcare reform, declining reimbursement, decreasing overhead costs, staff retention, and increasing efficiencies. The biggest opportunities are new trends, minimally invasive procedures, education advancement, electronic technology, and growth in outpatient care. ASCs will need to adapt to healthcare reform by focusing on coordinated care, outcomes, and becoming centers for multidisciplinary outpatient services.
Electronic Health Record offers a number of opportunities for Hospitals, Clinics,
Doctors and eligible Health care providers to earn meaningful incentives in the field of
Medicare and Medicaid services.
Accountable Care Organizations and The Medicare Shared Savings ProgramPhytel
Population Health Management, Enabled by Information Technology, Will Be Critical To Success. In 2012, the Centers for Medicare and Medicaid Services (CMS) will launch a shared-savings program with accountable care organizations (ACOs). ACOs that meet specified quality goals will be able to split with CMS any savings that surpass a minimum level. The challenge facing ACOs is choosing the right information technologies so they can track the health status of and the care provided to every one of their patients to produce significant savings or meet the quality benchmarks of CMS
The document summarizes the American Recovery and Reinvestment Act (ARRA) and its impact on electronic health records. It provides incentives for hospitals and physicians to implement qualified electronic health records systems and demonstrate meaningful use by 2015. Those that do not implement EHRs will face penalties after 2015. The ARRA sets standards for qualified EHRs and meaningful use, and provides Medicare and Medicaid incentive payments to support implementation from 2009 to 2015.
Robotic Process Automation in Healthcare-An Urgency! By.Dr.Mahboob KhanHealthcare consultant
Robotic process automation (RPA) can help the healthcare industry address current challenges by automating repetitive manual tasks. This allows staff to focus on higher value work while improving efficiency. RPA has the potential to save $350-410 billion annually in the healthcare sector by 2025 by streamlining processes like patient scheduling, claims management, and treatment workflows. As healthcare workers are overburdened during the pandemic, RPA can reduce their workload and risk of exposure by handling administrative tasks digitally. Widespread adoption of RPA in the Indian healthcare system is urgently needed to address staffing shortages and enhance response efforts amid the ongoing crisis.
Whether the designation is electronic
medical records (EMR) or electronic
health records (EHR), there is widespread
consensus that the costs and difficulties
associated with system adoption are surpassed
by the benefits to be gained by all stakeholders. In
addition to providing more efficient and cost-effective
care delivery workflows, EHRs offer opportunities
to standardize care delivery processes, reduce
medical errors, and speed reimbursements.
Understand Benefits Of Electronic Health Records Wp091005Erik Ginalick
The document discusses the benefits of implementing electronic health records (EHR) systems. It outlines how EHRs can help improve patient care by providing instant access to patient information. It also describes how EHRs can help practices be more efficient by streamlining administrative tasks and improving communication. The document recommends developing a thorough implementation plan that addresses technology, workflow changes, training and other key factors to successfully adopt EHR systems.
The document discusses recent healthcare reforms in the United States and their potential impacts. It notes that the Patient Protection and Affordable Care Act aims to increase insurance coverage while lowering costs. Additionally, the HITECH Act promotes the meaningful use of IT in healthcare to improve quality and reduce spending. Major effects may include 45-55 million Americans gaining insurance, increased use of electronic health records and pay-for-performance programs between providers and payers. Overall the reforms seek to align financial incentives around improved patient outcomes and care coordination.
The document discusses electronic claim objects to support India's health insurance sector. It proposes using standardized electronic objects based on FHIR resources to enable interoperable and automated claim processing. This would allow faster claims processing, reduced costs, and improved data for monitoring. The electronic objects would include minimum required coded data elements in a JSON format to represent claims, payments, and clinical summaries like discharge records.
Electronic Health Records Protecting Assets With A Solid Security Plan Wp101207Erik Ginalick
EHR systems provide significant benefits but also require proper security plans to protect patient data. A solid security plan includes:
1) Conducting a risk analysis to identify vulnerabilities and ensure compliance with HIPAA security rules.
2) Implementing administrative safeguards like security policies, employee training, and systems to monitor threats.
3) Using technical security like firewalls, encryption, and authentication controls to restrict access and protect hardware and software.
This will allow organizations to maximize the benefits of EHR while safeguarding protected health information.
Splash 4 partners tele icu moving beyond the early innings Splash 4 Partners
This document discusses the tele-ICU industry. It defines a tele-ICU as using remote monitoring to provide intensive care support. The document outlines the history and growth of the tele-ICU market from its beginnings in 1998 to present day expanding adoption. It also compares tele-ICU to other acute telemedicine services and discusses limiting factors for telemedicine adoption like reimbursement rates and state licensing.
Splash 4 partners tele icu moving beyond the early inningsSplash 4 Partners
This document discusses the tele-ICU industry. It defines a tele-ICU as using remote monitoring to provide intensive care support. The document outlines the history and growth of the tele-ICU market from its beginnings in 1998 to becoming more widely adopted. It also compares tele-ICU to other telemedicine services and discusses limiting factors for telemedicine adoption like reimbursement rates and state licensing.
The Skilled Nursing Facility (SNF) “Program for Evaluating Payment Patterns Electronic Report” (PEPPER) was released in April 2014 by CMS. Join Keri Hart, MS, CCC-SLP, CHHRP-QT, RAC-CT, in this in-depth interpretation of the elements of the PEPPER. Keri will detail how to interpret your PEPPER and discuss the practical application of this critical information to your Skilled Nursing Facility’s practice. Follow along with your own PEPPER report to develop an action plan to ensure compliance with Medicare regulatory requirements and ensure accurate reimbursement for clinically appropriate care provided.
CMS introduced this new annual report for Skilled Nursing Facilities in August 2013. PEPPER data is shared with both Medicare Administrative Contractors (MACs) and the Medicare Recovery Audit Contractors (RACs). This important report details your facility-specific Medicare claims data in certain targeted areas and compares your facility to other SNFs Nationally, by State and by Jurisdiction (Medicare Administrative Contractors/Fiscal Intermediaries).
PYA Healthcare Consulting Senior Manager Robert Mundy co-presented during, “Valuing Hospitals,” Thursday, July 31, at 1 p.m. EST. This webinar explores the changing world of hospital economics, regulations, and valuations and how appraisers can best prepare themselves for both the opportunities and challenges that lie ahead.
Hot Valuation Issues for Physician AgreementsPYA, P.C.
The document summarizes key issues related to physician compensation agreements and the impact of healthcare reform. It discusses the increased complexity of compensation models with multiple layers and components. Ensuring fair market value and commercial reasonableness of the overall arrangement is important as the sum of individual components could exceed what is reasonable. The presentation also covers analyzing losses, benchmarks, and factors considered in commercial reasonableness determinations. Healthcare continues shifting toward value-based payments, quality incentives, and bundled payments through initiatives like Accountable Care Organizations.
Ehr number and characterists of providers awardedScott Zajkowski
- In 2012, 2,291 hospitals and an unknown number of professionals received $6.3 billion in Medicare EHR incentive payments, more than double the $2.3 billion awarded in 2011.
- For hospitals, 48% of eligible hospitals received payments in 2012, up from 16% in 2011. The median hospital payment was $1.4 million.
- Most hospitals (72%) and professionals receiving payments in 2012 were new to the program that year.
Workers' compensation faces challenges from rising medical and indemnity costs, expansion of opt-out legislation, impact of the Affordable Care Act, and questions around the constitutionality of exclusive remedy. Media reports have also highlighted deficiencies in how injured workers are treated. Internal challenges include debates over the financial sustainability of the system and whether all injured workers access benefits. Externally, advocacy groups lobby for further reforms while critics argue these may limit worker rights and benefits.
Healthcare is a business that, like all businesses, has key elements including leadership and governance, financing, human resources, health information systems, essential medical products and technologies, and service delivery. The future of healthcare business is evolving, with one prominent forecast being the use of Interacted Practice Units which enable faster treatment, better outcomes, lower costs and improved market share. However, only time will tell which approaches will be most effective.
The document summarizes insights from a panel discussion on post-Affordable Care Act healthcare M&A trends. Key points include:
- Panelists expect growth in healthcare IT due to increasing demand for electronic records, data analytics, and population health management. However, hospitals may consolidate to cut costs in response to lower reimbursement rates.
- Successful companies will integrate services across the care continuum and leverage technology to improve outcomes and lower costs. The future involves value-based reimbursement models that reward quality over volume.
- Opportunities lie in care coordination, analytics, and population health management. Technology will continue driving consolidation and improvements to the healthcare system.
The Migration to Clinician Network Management - Chilmark ResearchBrian McCalley
- The healthcare industry is undergoing major changes driven by the shift from fee-for-service to value-based reimbursement models.
- To succeed under value-based models, healthcare organizations will need to better coordinate care across their networks of providers using health information exchange infrastructure.
- This report defines a new concept called Clinician Network Management, which uses health information exchange platforms to support provider networks through activities like longitudinal patient data viewing, risk scoring, care guidance, and cost of care tracking.
Maggio Article re Off-Campus Ambulatory DevelopmentCharles S. Maggio
The document discusses new legislation that reduces Medicare reimbursement for hospital-owned physician practices located more than 250 yards from the main hospital campus. This will significantly impact the willingness of hospitals to acquire off-campus facilities. While some facilities established before the legislation will maintain higher reimbursement rates, new off-campus facilities will face lower rates similar to private practices. Healthcare providers and real estate developers must adjust their strategies and underwriting models to account for this change.
Top Challenges & Opportunities for Spine in 2011Nicola Hawkinson
The document discusses the top challenges and opportunities for spine care in 2011, as presented by Nicola Hawkinson. The biggest challenges are healthcare reform, declining reimbursement, decreasing overhead costs, staff retention, and increasing efficiencies. The biggest opportunities are new trends, minimally invasive procedures, education advancement, electronic technology, and growth in outpatient care. ASCs will need to adapt to healthcare reform by focusing on coordinated care, outcomes, and becoming centers for multidisciplinary outpatient services.
Electronic Health Record offers a number of opportunities for Hospitals, Clinics,
Doctors and eligible Health care providers to earn meaningful incentives in the field of
Medicare and Medicaid services.
Accountable Care Organizations and The Medicare Shared Savings ProgramPhytel
Population Health Management, Enabled by Information Technology, Will Be Critical To Success. In 2012, the Centers for Medicare and Medicaid Services (CMS) will launch a shared-savings program with accountable care organizations (ACOs). ACOs that meet specified quality goals will be able to split with CMS any savings that surpass a minimum level. The challenge facing ACOs is choosing the right information technologies so they can track the health status of and the care provided to every one of their patients to produce significant savings or meet the quality benchmarks of CMS
The document summarizes the American Recovery and Reinvestment Act (ARRA) and its impact on electronic health records. It provides incentives for hospitals and physicians to implement qualified electronic health records systems and demonstrate meaningful use by 2015. Those that do not implement EHRs will face penalties after 2015. The ARRA sets standards for qualified EHRs and meaningful use, and provides Medicare and Medicaid incentive payments to support implementation from 2009 to 2015.
Robotic Process Automation in Healthcare-An Urgency! By.Dr.Mahboob KhanHealthcare consultant
Robotic process automation (RPA) can help the healthcare industry address current challenges by automating repetitive manual tasks. This allows staff to focus on higher value work while improving efficiency. RPA has the potential to save $350-410 billion annually in the healthcare sector by 2025 by streamlining processes like patient scheduling, claims management, and treatment workflows. As healthcare workers are overburdened during the pandemic, RPA can reduce their workload and risk of exposure by handling administrative tasks digitally. Widespread adoption of RPA in the Indian healthcare system is urgently needed to address staffing shortages and enhance response efforts amid the ongoing crisis.
Whether the designation is electronic
medical records (EMR) or electronic
health records (EHR), there is widespread
consensus that the costs and difficulties
associated with system adoption are surpassed
by the benefits to be gained by all stakeholders. In
addition to providing more efficient and cost-effective
care delivery workflows, EHRs offer opportunities
to standardize care delivery processes, reduce
medical errors, and speed reimbursements.
Understand Benefits Of Electronic Health Records Wp091005Erik Ginalick
The document discusses the benefits of implementing electronic health records (EHR) systems. It outlines how EHRs can help improve patient care by providing instant access to patient information. It also describes how EHRs can help practices be more efficient by streamlining administrative tasks and improving communication. The document recommends developing a thorough implementation plan that addresses technology, workflow changes, training and other key factors to successfully adopt EHR systems.
The document discusses recent healthcare reforms in the United States and their potential impacts. It notes that the Patient Protection and Affordable Care Act aims to increase insurance coverage while lowering costs. Additionally, the HITECH Act promotes the meaningful use of IT in healthcare to improve quality and reduce spending. Major effects may include 45-55 million Americans gaining insurance, increased use of electronic health records and pay-for-performance programs between providers and payers. Overall the reforms seek to align financial incentives around improved patient outcomes and care coordination.
The document summarizes insights from a panel discussion on post-Affordable Care Act healthcare M&A trends. Key points include:
- Panelists expect growth in healthcare IT due to increasing demand for electronic records, data analytics, and population health management. However, hospitals may consolidate to cut costs in response to lower reimbursement rates.
- Successful companies will integrate services across the care continuum, using analytics to improve outcomes while containing costs. The future involves tracking individual patients' adherence to care plans.
- Opportunities lie in care coordination, case management, and supporting providers and payers through regulatory changes like ICD-10. Healthcare IT companies facilitating these trends will see strong demand.
Chapter 17 Implementing and Upgrading an Information System Soluti.docxcravennichole326
Chapter 17 Implementing and Upgrading an Information System
Solution
Christine D. Meyer
No matter whether the electronic health record (EHR) is new or an upgrade, the ultimate goal in implementations is to provide the highest level of care at the lowest cost with the least risk.
Objectives
At the completion of this chapter the reader will be prepared to:
1.Discuss the regulatory and nonregulatory reasons for implementing or upgrading an electronic information system
2.Compare the advantages and disadvantages of the “best of breed” and integrated system approaches in selecting healthcare information system architecture
3.Explain each step in developing an implementation plan for a healthcare information system
4.Develop strategies for the successful management of each step in the implementation of a healthcare information system
5.Analyze the benefits of an electronic information system with an integrated clinical decision support system
6.Explain the implications of unintended consequences or e-iatrogenesis as it relates to implementing an electronic health record (EHR)
Key Terms
Best of breed, 277
Big bang, 284
Phased go-live, 284
Scope creep, 276
Tall Man lettering, 276
Workarounds, 279
Abstract
The decision to implement a new electronic health record (EHR) or to upgrade a current system is based on several factors, including providing safe and up-to-date patient care, meeting federal mandates and Meaningful Use requirements, and leveraging advanced levels of clinical decision support. Implementing EHRs entails multilayered decisions at each stage of the implementation. Major decisions include evaluating vendor and system selection, determining go-live options, redesigning workflow, and developing procedures and policies. The timeline and scope of the project is primarily dictated by expenses, staff, resources, and the drop-dead date for go-live. Success depends on variables such as a well-thought-out and detailed project plan with regular review and updating of the critical milestones, unwavering support from the organization's leadership, input from users during the design and build phases, mitigation of identified risk factors, and control of scope creep. The implementation of an EHR is never finished. Medication orders, nonmedication orders, and documentation screens or fields will continuously need to be added, modified, or inactivated; patches will be installed and tweaks to workflows and functionality will be ongoing.
Introduction
This chapter focuses on the implementation of healthcare information systems. Of course, many different types of applications are used within a healthcare information system. The general principles for implementing these many different applications are the same; however, for the purposes of discussion this chapter will focus mainly on the implementation of an electronic health record (EHR) to demonstrate these general principles. In 2004 President George W. Bush promoted the i ...
This document discusses electronic health records (EHRs) and related topics. It provides background on medical records and their value. EHRs offer benefits like being digitized and accessible across networks. The US is promoting EHR adoption through initiatives like the HITECH Act which provides incentives. Physicians generally see benefits of EHRs but costs are a concern. Challenges include ensuring data reliability and developing standards. Innovation in health IT offers opportunities through technologies like cloud-based EHRs.
Regional extension centers (RECs) were created to help physicians implement electronic health record (EHR) systems and achieve meaningful use. However, RECs face limitations including short-term funding, endorsement of select EHR vendors, and lack of experience with all systems. The Veterans Health Administration (VHA) offers a successful example of large-scale EHR implementation through a collaborative development process tailored to clinician needs. While RECs aim to support physicians, their assistance may be constrained without long-term, sustainable support.
Chapter 4 Information Systems to Support Population Health Managem.docxketurahhazelhurst
Chapter 4 Information Systems to Support Population Health Management Learning Objectives To be able to understand the data and information needs of health systems in managing population health effectively under value-based payment models. To be able to discuss key health IT tools and strategies for population health management including EHRs, registries, risk stratification, patient engagement, and outreach, care coordination and management, analytics, health information exchange, and telemedicine and telehealth. To be able to discuss the application and use of data analytics to monitor, predict, and improve performance. The enactment of the Affordable Care Act (ACA) brought about sweeping legislation intended to reduce the numbers of uninsured and make health care accessible to all Americans. It also ushered in an era in which changing reimbursement and care delivery models are driving providers from the current fragmented system focused on volume-based services to an outcomes orientation. As a result, the health care system now taking shape is one in which value-based payment models financially reward patient-centered, coordinated, accountable care. Against this backdrop, providers' increasing use of evidence-based medicine and growing capabilities in managing volumes of clinical evidence through sophisticated health IT systems will mean that treatments can be tailored for the individual and interventions can be made earlier to keep patients well. Furthermore, patient engagement is fast becoming a critical component in the care process, particularly in the area of population health management (PHM). Health care providers' interest in improving population health appears to be increasing because of the sudden ubiquity of the phrase, because many are participating in accountable care organizations (ACOs), and because even hospitals not participating in an ACO increasingly have incentives to reduce their number of potentially unavoidable admissions, readmissions, and emergency department visits (Casalino, Erb, Joshi, & Shortell, 2015). In this chapter we'll not only seek a common understanding of PHM but also explore how the advent of shared accountability financial arrangements between providers and purchasers of care has created significant focus on PHM. We'll also review the core processes associated with accountable care and examine the strategic IT investments and data management capabilities required to support population health management and enable a successful transition from volume-based to value-based care. PHM: Key to Success Although the ACO model is still new and evolving, approximately 750 ACOs are in operation today, covering some 23.5 million lives under Medicare, Medicaid, and private insurers. Although not all ACOs have demonstrated success in delivering better health outcomes at a lower cost, many have achieved promising results (Houston & McGinnis, 2016). As such, significant ACO growth is expected. In fact, it is predicte ...
White Paper - Building Your ACO and Healthcare IT’s RoleNextGen Healthcare
The tools needed to capture, organize, and share healthcare data are truly evolving at the speed of light. Patient Centered Medical Homes play a vital role in the path toward accountable care and technology, staff, and workflow transformation are necessary to achieve PCMH recognition. This transformation allows healthcare providers to deliver higher quality coordinated care by streamlining and rationalizing the patient experience.
What explains why certain services were covered and others were not .docxajoy21
This document contains questions about various healthcare topics and a passage about the HIPAA Privacy Rule, which established the first national standards for protecting private health information. It discusses what protected health information is and the deadline for covered entities to comply with the Privacy Rule. It also contains passages about public health practices using protected health information and ERISA rules that medical providers can use to challenge health insurance claim denials.
The document discusses Accountable Care Organizations (ACOs) which were created by the Affordable Care Act to improve quality and lower costs. It provides frequently asked questions about ACOs, including whether they are viable, how providers can save money through ACOs, examples of successful ACO programs like Marshfield Clinic, and the healthcare IT components needed to support ACOs. Providers are encouraged to invest in quality, innovation, and data/analytics to prepare for value-based payment models like ACOs.
This document discusses the future of physician payments and accountable care models. It provides an overview of recent observations in healthcare such as the growth of accountable care organizations and transition away from fee-for-service payments. It also summarizes emerging opportunities like meaningful use incentives and accountable care organization initiatives from Medicare and private payers. Key trends in payment reform like the transition to risk-based payments and the role of consumers are also predicted.
Chris Carnahan, President of Carnahan Group, presented at the National Association of Certified Valuators and Analysts' (NACVA) Advanced Valuation: Applications and Models Workshop on December 6, 2016. The presentation covers valuing physician practices; specifically,fair market valuations (FMVs) in healthcare, the government regulations surrounding FMVs, the current trends and marketplace, as well as valuing physician compensation.
The system of delivery within health care has always been on the change and rise due
to technology along with self-care, health care, development, education, and creating a healthy society. As the old saying goes, “where there is good health there is also good financial wealth” and this is where the formation of the ACA took place and a new integrated delivery system created.
The document discusses questions regarding a healthcare system's vendor selection process for an IT project. It recommends the types of information an organization should provide to vendors in a Request for Information (RFI) and gather from vendors in the early planning stages. This includes vendor background, technical requirements, functionality, implementation processes, and training. An RFP with more specific details is issued to a select few vendors.
Part I Comparing Accreditation Standards Across Health Care Settin.docxdanhaley45372
Part I Comparing Accreditation Standards Across Health Care Settings
Standards that address appropriate documentation of patient care and effective management of health information can be found among accrediting bodies at each level of health care. While the standards cover the same area, their scope and requirements for compliance can vary widely.
Review the standards for authentication (signing) and timeliness of medical record entries for acute care hospitals, ambulatory facilities, long-term care facilities and mental health hospitals. Create a table to compare and contrast the standards, select which accrediting body’s standard you would recommend if only one standard could be applied to all health care delivery systems and support the reason for your selection. where you describe the corresponding standard for each type of facility. Address these at a minimum the “criteria” below in your table:
1. Are there requirements that are the same for each standard?
2. Which clinical staffs are allowed to make entries in the medical record in each type of facility? (e.g. physician, nurse, physician assistant)
3. Which accreditation standards address the use of electronic signatures?
4. Explain how the standards differ in terms of type of the entries that should be authenticated (i.e. consultations, procedure notes, progress notes).
5. How is compliance with each standard to be evaluated (e.g. medical record audit, summary reports)?
Part II Transitioning from Conditions of Participation to Joint Commission Standards
A healthcare facility is interested in pursuing Joint Commission accreditation. Senior management has asked departments to submit reports about implementation of applicable Joint Commission standards in their areas of responsibility. You are the HIM director who will draft a report for implementation of procedures to comply with standards related to Information Management (IM) and Record of Care, Treatment and Services (RC). Using the terms below do an internet search to locate the standards and Condition of Participation needed. Create a document, spreadsheet or table that compares the COP and Joint Commission standards, and address differences in preparation (e.g. accreditation cycles, resources needed) and training and preparing of staff. The report should also include how compliance is reported to and monitored by the Joint Commission.
Joint Commission Standard IM
Joint Commission Standard RC
Conditions of Participation 42 CFR 482.24 Medical Record Services
Submit an Annotated Bibliography with a minimum of 4 proposed sources for your project. Remember to use sources acceptable for academic papers. (Wikipedia is not an academically acceptable source.)
For guidelines on what goes into an annotated bibliography, click the linked document below. Note that your annotated bibliography should include your citation in APA format followed by:
· 2-4 sentences that summarize the main idea(s) of the source.
· 1-2 sentences that evaluate th.
4 hours ago
Amy Miller
RE: Discussion - Week 7
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NURS 6050C: Policy and Advocacy for Improving Population Health
Main Question Post. The Patient Protection and Affordable Care Act of 2010 created several positive healthcare policies such as affordable health care, lifting the preexisting health condition clause from health insurance, requiring facilities to make healthcare charges public knowledge, and enforcing healthcare providers to become active in improving quality and health outcomes for patients (Library of Congress, n.d.). The act addressed a combination of the health care drivers of cost, quality, and access. According to a report released by the White House Press Secretary on April 17, 2014, “The Affordable Care Act is working. It is giving millions of middle class Americans the health care security they deserve, it is slowing the growth of health care costs and it has brought transparency and competition to the Health Insurance Marketplace.” (The White House, 2014). However, the price some healthcare providers had to pay a heavy financial - forcing some providers out of business. The negative side of the act is seldom portrayed in the news and media.
Section 3131(a) of the act required payment for home health services to be rebased over a period of four years (Centers for Medicare & Medicaid Services, 2013); resultant in a 2.8% reduction beginning in 2014 for four consecutive years totaling a reduction in payment of 11.6%. The reductions were placed along with mandates for quality reporting, new forms, and new processes resulting in increased administrative overhead costs while shouldering the burden of financial reductions.
Initiating a Change in Policy Process
Living in a rural community, I witness firsthand the lack of access to care as there are limited numbers of primary care providers. Couple the limited access to providers with the amount of paperwork and forms that must be signed by a physician and patients are not referred to home health services as often as one should be – the result is the patient presenting to the emergency room or a hospitalization to have one’s health care needs met. Currently, Medicare and Medicaid do not allow physician assistants or advanced practice registered nurses (APRNs) to sign the necessary orders and plan of care for home health services – only a “doctor of medicine, osteopathy, or podiatric medicine” may sign for services (Government Publishing Office, 2014, p. 693). I would like to use the knowledge gained as an APRN to legislate for this mandate to be changed and allow both physician assistants and APRNs to sign for coverage of home health services.
The Kingdon Model would be utilized for the legislation process by finding the three streams of problem, policy, and politics to coordinate with the above-mentioned issue (Milstead, 2019, p. 24). The problem would consist of the burdensome amount of paperwork imposed upon.
The Healthcare Payments Hub: A New Paradigm for Funds and Data Transfers in H...Ed Dodds
The document proposes establishing an interoperable "Healthcare Payments Hub" that would enable straight-through processing of healthcare financial transactions. It describes the opportunity for cost savings and efficiencies through such a hub. The document recommends forming a pilot program to test operational cost savings and improved efficiencies for stakeholders like healthcare providers, banks, and health plans. The pilot would create a prototype hub platform to streamline the transfer of electronic funds and associated remittance data between stakeholders.
Implementing A Certified Electronic Health Record SystemCrystal Torres
The document discusses implementing a certified electronic health record system in a healthcare organization to improve patient safety, ensure privacy and security of patient data, and improve patient outcomes. It addresses the progress many health systems have made in meeting meaningful use regulations through using electronic health records and systems like Epic. Barriers to successful implementation are also discussed.
The document discusses how the American Recovery and Reinvestment Act (ARRA) provided major funding to promote health information technology adoption and health information exchange through programs like regional health IT extension centers. It specifically discusses West Virginia's application for over $9 million over 4 years to create a regional extension center consortium to help over 1,800 healthcare providers adopt and meaningfully use health IT. The extension centers will provide various services to help providers implement systems, achieve meaningful use criteria to qualify for incentive payments, and improve healthcare through use of health IT.
1. simplifying IT
Stark Safe Harbor
meets the
Stimulus Bill
An assessment of the impact the American
Recovery and Reinvestment Act should have on
the adoption of Electronic Health Records –
and how to deal with it
3. STARK SAFE HARBOR MEETS THE STIMULUS BILL
“The Stark Safe Harbor Meets the Stimulus Bill”
The Synopsis
The passing of the American Recovery and Reinvestment Act of 2009 (ARRA) has given “legs”
to accelerate physician electronic health record (EHR) adoption via Stark Safe Harbor compliant
programs for hospitals. The nature of these combined incentives creates a window between
now and 2014 where completing an ambulatory EHR implementation and getting providers up
to a measurable level of use on the system provides a one-time opportunity for both hospitals
and physicians such that:
• Hospitals are able to significantly strengthen their Medical Staff Model by “gluing”
community physicians more tightly to the hospital through a common EHR which will
improve market position and the ability to coordinate care.
• Physicians, both hospital owned and community, will have a one-time bonus of up to
$44,000, paid over five years, which should more than offset the acquisition and
implementation cost of an EHR.
Transitioning to an EHR, however, is not a trivial process. It is a significant initiative that will
transform the way ambulatory care delivery is managed. In this regard, the adoption of an
ambulatory EHR should be viewed by hospitals and hospital systems at the CEO level and as a
fundamental change in how the Medical Staff Model will support the hospital/hospital system
going forward through profound changes in coordination-of-care and the availability of data.
In assessing the changed environment, timing is critical. Those who act earlier will have market,
medical staff model, and bonus advantages. Those who do not, will be facing increased
implementation/adoption risk, clinical disaggregation pressure, and/or Medicare payment
penalties.
However, while there is a need to act with deliberate urgency if the window of opportunity is to
be seized, the approach should be pragmatic, phased, and undertaken as a disciplined, fully
resourced project. In this context, there needs to be recognition that the EHR is not an
information technology project, but rather a transformation of clinical practice and work flow that
is enabled by an EHR system.
Lastly, we all need to recognize that having an EHR on every physician’s desktop is only the
starting point for physicians, hospitals, and communities to effectively manage clinical quality,
medical costs, and the needs of consumers and their communities.
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4. STARK SAFE HARBOR MEETS THE STIMULUS BILL
Introduction
As long as there have been hospitals, the goals of demonstrating superior clinical quality,
improving the cost effectiveness of care delivery, competing on patient service, and improving
hospital-physician relationships have been achieved unevenly at best. Now the Federal
Government has thrown the tools and “Incentive Challenge” on the table that could make a
significant difference if hospitals act with a sense of deliberate urgency.
In October 2006, the federal government enacted a “Safe Harbor” policy related to the Stark
Regulations, allowing hospitals to donate Electronic Health Record (EHR) related hardware,
software, Internet connectivity, implementation and training, and support services to physicians.
In February 2009, the same government enacted the American Recovery and Reinvestment Act
(ARRA) which provides incentives for moving forward with a physician EHR, including potential
bonuses in the range of $44,000 per physician.
The nature of these combined incentives creates a window between now and 2014 where
acting on an EHR implementation provides a one-time opportunity for both hospitals and
physicians.
Given these events, this Whitepaper addresses four key questions:
1. Does it make sense to expedite an ambulatory EHR?
2. Are there alternative approaches?
3. What are the “key considerations” in developing a Stark Safe Harbor Program?
4. What are the immediate next steps?
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5. STARK SAFE HARBOR MEETS THE STIMULUS BILL
The New Framework of Rules
The Stark Safe Harbor and ARRA are creating a framework of rules and incentives that are
intended to urge hospitals to equip their clinical staff model with EHRs, and to do it soon.
The American Recovery and Reinvestment Act
The ARRA has allotted $17.2 billion to reward Medicare and Medicaid providers who can prove
they are using certified healthcare IT "in a meaningful way." With the ARRA, independent
physicians and hospitals with owned physicians, can earn $44,000 per physician, and in some
case additional payments, over a five-year period. If the first year of “meaningful use” is 2011 or
2012 the initial payment is $18,000 per physician, with the subsequent payments ramping down
to $12,000 for the second year, $8,000 for the third year, $4,000 for the fourth year, and $2,000
for the fifth year. If the first payment year is after 2013, the initial payment is $15,000.
To qualify for these incentives, providers must be using certified electronic health record
technology. At the moment, the Certification Commission for Healthcare Information Technology
(CCHIT) (www.cchit.org) is the only government sponsored certifier. The provider must be able
to certify that they are “meaningful EHR users” which at this time is defined as:
• Providing for the electronic exchange of health information with other sources to
improve the quality and coordination of health care
• Providing for electronic prescribing (ePrescribing)
• Having the ability to report on clinical quality measures
For those failing to use certified healthcare IT by 2014, there will be no incentive payment. If a
physician is not using an EHR by 2015, Medicare payments will be reduced to 99 percent in
2015, 98 percent in 2016, and 97 percent thereafter.
The ARRA has yet to be defined through the regulatory process, and there are a number of
definitions and interpretations that will be forthcoming over time.
The Stark Safe Harbor
The Stark Safe Harbor legislation provides hospitals an exception to the restrictions of the Stark
and Anti-Kickback laws. This exception allows hospitals to donate “Items & services necessary
and used predominantly to create, maintain, transmit, or receive EMRs” to community or
affiliated physicians. Hospitals can provide the EHR items and services to physicians, as long
as the selection criteria do not take into account the volume or value of referrals, or other
business between the parties. The Stark Safe Harbor requires that ePrescribing be included
and prohibits a hospital from donating physician office equipment or replacing an existing EHR.
The receiving providers must contribute 15% of the donor’s cost for the items and services
provided, but at the hospitals discretion may be required to contribute a larger amount. The safe
harbor exception ends December 31, 2013.
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6. STARK SAFE HARBOR MEETS THE STIMULUS BILL
What the Combination Means
The combined Stark Safe Harbor and ARRA makes a clear case to move quickly with an EHR
initiative. Hospitals, hospital systems, and community physicians will lose the combined benefits
of the acts in the 2013 – 2014 window. This “window of benefits” includes:
- The ability to reinvent the Medical Staff Model to more effectively include
community and affiliated physicians through the “glue” provided by a common
EHR
- The ability to differentiate the hospital/hospital system and its physicians in the
market based on greater patient service
- Realizing the bonus incentives provided through the ARRA
The combination of government incentives also means that there is likely to be a substantial
increase in demand for qualified resources able to plan, implement, and support the number of
potential adoptions in such a short time.
Recognizing that deploying an EHR “at scale” is challenging and requires thoughtful and diligent
preparation, achieving the “window of benefits” will require most organizations to start acting
now.
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7. STARK SAFE HARBOR MEETS THE STIMULUS BILL
The Case To Act
Given that acting on an ambulatory EHR is a “When” and not “If” situation, there are a number
of clinical, operational, and financial benefits linked to adopting an EHR. These benefits will
apply to several constituencies including:
• The Patient
- Improving the patient experience through increased continuity-of-care
- Improving patient satisfaction with timely test results, access to physician,
appointment scheduling, and involving patients in self management of their
diseases
- Increasing the sophistication of patient services to include personal health
records and the information needed to support emerging “consumerism”
• The Physician
- Increasing the availability and timeliness of patient clinical information to improve
the quality for diagnosis and care planning
- Reducing cost through more efficient test order and results tracking, patient flow
and communication, and chart access; less cost for transcription and the
elimination of manual billing interventions
- Restructuring clinical roles so that each clinical professional can work at the
“Top-of-Licensure” thereby more effectively leveraging the physician
- Realizing potential incremental revenues from risk-adjusted coding, pay-for-
performance, government incentives, and the like
• The Hospital/Hospital System
- Increasing the bond between the community physicians and the hospital through
coordination-of-care, seamless communication in the patient’s interest across
multiple provider entities (both physician and hospital), improved clinical quality
and patient safety, and the effectiveness of clinical offerings
- Achieving a more cohesive and integrated medical staff model composed of
“owned” and credentialed community physicians with benefits such as improving
referral management and tracking leakage outside the system
- Positioning to move up the “Clinical Care Management Evolution Curve” (See
diagram) moving from simple display of clinical data to integrated care and
disease management with evidence based tools and the aggregation of clinical
information at the patient level rather than the encounter level, enabling cost
effective disease management, enhanced proactive health maintenance and
error avoidance, and supports measures of quality outcomes and reporting.
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8. STARK SAFE HARBOR MEETS THE STIMULUS BILL
- Realizing a Return on Investment up to 25% - 60% annually once the systems
are fully implemented (approximately 18 - 24 months from start date) through
lower costs and new or incremental revenues.
In addition to the above benefits, the ARRA provides for direct incentives which are paid based
on the number of “meaningful EHR users”. For larger organizations, these bonuses can be
substantial as indicated in the hypothetical 200 physician group example below which will earn
over $8 million in bonuses if all the physicians are operational by 2013.
While these benefits should be sufficient to act on an ambulatory EHR, the actual decision
needs to be considered in the context of the specific hospital/market situation. In this regard,
there are five key considerations and one or more may apply to any market situation.
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9. STARK SAFE HARBOR MEETS THE STIMULUS BILL
1) Highly competitive markets: In highly competitive markets, the “first mover” to provide
EHRs to the community physicians is most likely to secure the loyalty of those
physicians. Accordingly, late movers are at risk of losing referrals from physicians
who join a competing hospital’s Stark program.
2) Hospital – Physician Integration: A Stark EHR program needs to integrate within the
larger fabric intended to “Glue” community physicians to the hospital. This larger
program can include facility joint ventures, MSO services, payor contracting, and the
like, which the EHR will only serve to strengthen.
3) Commitment to Quality: The hospital is committed to tangibly improving the quality of
care in its community, and recognizes that supporting a hospital – community
physician EHR initiative will directly improve continuity-of-care, patient safety, and the
patient experience.
4) Position for the Future: The hospital recognizes that the ability to collect and report on
clinical data across the community will effectively support negotiating “Value Based
Reimbursement” (i.e. P4P, acuity coding, etc.) contracts, providing “Report Cards” on
performance, and responding to “Episodes of Care” payments if and when they are
initiated.
5) Avoiding a “Mess”: With the new ARRA now in place, community physicians will be
incented to move forward with an EHR in order to realize the available bonuses.
Without hospital leadership, there is the risk of too many EHR products being poorly
implemented which will compromise the hospitals’ ability to realize a number of
advantages.
The last consideration regarding the “Case To Act” is that time is running out. Unless the law
changes, the Stark Act sunsets at the end of 2013 and there will no longer be an opportunity
for the hospital to directly impact its community physicians using this tool. Additionally, to
earn the maximum ARRA bonus, a physician must be meaningfully using the EHR by the
end of 2011, and all bonus payments stop after 2016.
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10. STARK SAFE HARBOR MEETS THE STIMULUS BILL
Alternative Approaches
While there are compelling reasons to move forward with an ambulatory EHR program, it is
a complex challenge requiring a measured and pragmatic approach. Jumping in without a
strategy, a plan, sufficient capital, and EHR trained resources can result in organizations
failing to achieve their targets, and an unsuccessful effort will be very costly.
The approach should be phased, and undertaken as a disciplined, fully resourced project
with a deliberate sense of urgency and managed to a date-specific timeline. In this context,
there needs to be recognition that the EHR is not simply an information technology project,
but rather a clinical practice and work flow transformation that is enabled by an EHR system
The most essential step is to first develop a plan. Each hospital/system needs to assess
how the ambulatory EHR fits into its market strategy and its ability to successfully execute.
Key considerations to be addressed during a planning process, among many, include:
• Target Physician Participation: It rarely makes sense to provide a “Blanket” Stark
Safe Harbor Program, and the hospital will need to determine how many physicians
should be invited to participate and the basis (not referral volume).
• Stark Subsidy Strategy: The subsidy can be close to zero or as high as 85% for
allowable items. Each hospital needs to determine what subsidy strategy makes
sense in its particular situation and build a program around criteria such as:
- Differentiating the subsidy level based on specialty, location, “first in”, etc.
- Linking the nature of the subsidy to the hospital’s core strategy
- Decreasing the subsidy over time
- Front loading the costs to the physicians or using an ASP model
• The ROI Plan: Have a clear plan
for realizing a tangible ROI (see Sample Return On Investment Schedule
sample table). There is
increasing evidence that when
EHRs are effectively utilized they
will deliver positive ROI.
• Process Integration: Linking the
introduction of the EHR with
other processes such as “patient
intake”, hospitalist liaison, system
interoperability, etc.
• “Loose or Tight”: Does the
hospital want to have a “loose”
arrangement with the physicians
where there are no cross
platform standards or policies, or a “tight” framework of standards and policies which
will enable greater use of data and more effective Health Information Exchange.
• On-going Support: Does the hospital want to assist in providing on-going support
related to Help Desk, Network Management, Template Development, etc.
• Vendor Partnerships: Does the hospital wish to support a single vendor or a multiple
vendor solution.
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11. STARK SAFE HARBOR MEETS THE STIMULUS BILL
• Capital Sources: Funding the implementation of an ambulatory EHR is costly,
particularly if it is to be done right, and front-end loaded.
• Timeframe: What is pragmatic in terms of a deployment schedule?
In many cases, it makes sense to survey the owned and community physicians to ensure a
complete understanding of the current status of existing installed systems, their “appetite”
for an EHR (which with the ARRA will be increasing), their readiness to adopt an EHR, and
the price point they are willing to pay.
Once a basic plan has been developed (which should take less than 120 days), the
alternative approaches to execution can be assessed. There are several including:
• Hospital Sponsored and Managed: With this approach, the hospital directly performs
the market feasibility assessment, manages the deployment, and provides the post
implementation support.
• Hospital Sponsored – 3rd Party Managed: There are cases where either the hospital
does not want to commit its Information Technology resources to a ambulatory
and/or Stark program, or there is concern that the community physicians will be
reluctant to let the hospital have access to their data. In these situations, an
independent entity can be used that the hospital and physicians fund (the hospital
through Stark grants and the physicians through monthly payments). The major
advantages of this approach include:
- Community Physician Adoption Rate: Community physicians will often more
quickly sign-on to a Stark Safe Harbor program when they know their
financial data will not be readily accessible by the hospital, with the data
protected by an independent entity.
- Availability of Resources: Information technology people resources are
limited, particularly those with physician Practice Management/EHR
experience.
- Controlling the Cost: All of the cost of the program will be highly visible and
not “hidden” in embedded salaries.
- Delegating the “Hassle”: The necessary activities of physician Stark
Contracting, fee collection, daily technical support, and community physician
communication can be delegated to the outsourced service firm thereby
insulating the provider organization.
• Community Sponsored: In situations where the physicians do not have, and/or are
not likely to develop single hospital loyalty, it may make sense for more than one
hospital to collaborate in a Stark initiative, probably through a new independent
entity.
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12. STARK SAFE HARBOR MEETS THE STIMULUS BILL
A Note of Caution
Implementing physician EHRs under the best of conditions is challenging. It is a labor intensive,
“high touch” transformational undertaking. The clinical needs and computer experience of each
individual physician should be considered and accommodated. A successful result requires a
structured roll-out that integrates clear change management with extensive work flow redesign,
specific checks and verifications, and training, training, and training. It cannot be emphasized
enough that deploying an EHR is in no way a mere software implementation.
An EHR project also requires EHR specialized, trained resources that are not “learning-on-the-
job”. These resources are scarce and will be more so as the market moves to complete the
EHR transition within the Stark/ARRA window. As recently noted by Dave Garets, president
and CEO of HIMSS Analytics:
“94 percent of hospitals currently don't have enough healthcare IT in place to meet the
stipulations required to receive (ARRA) bonuses. It's not as simple as hiring a software
technician to make the transition. There is a need for qualified people who know how to
help with workflow adaptation and how to implement software packages so they work for
the organization.”
Absent a rigorous methodology and sufficient resource commitment, it is a costly “redo”.
The End Game - Not
The Stark – ARRA combination places great incentives on the table to achieve widespread EHR
adoption in the next five years. The winners will approach this challenge with a sense of
pragmatic urgency, improving their market position, their ability to manage the clinical process,
and their ability to take advantage of reimbursement trends. The losers will either be at
increasing risk for clinical “disaggregation” and/or have a very costly experience because they
waited too long and/or were not sufficiently deliberate.
Given all the benefits of an EHR on every physician’s desktop, it is not the end game. It is the
starting point for physicians, hospitals, and communities to effectively manage clinical quality,
medical costs, and the needs of consumers and their communities.
* * * * * * * * * * * * * *
For more information
To read the actual stimulus bill online, go to the government printing office version at
http://fdsys.gpo.gov/fdsys/pkg/BILLS-111hr1ENR/pdf/BILLS-111hr1ENR.pdf.
To read the Stark regulations and the Center for Medicare and Medicaid Services analysis online go to
www.cms.hhs.gov/PhysicianSelfReferral/ .
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