Tag: EHR Incentives

55% of Doctors Have Received EHR Incentives

More than half of U.S. doctors have switched to electronic health records and are using them to manage patients’ basic medical information and prescriptions, according to federal data set to be released Wednesday.

The Department of Health and Human Services says it has reached a tipping point as it seeks to steer medical providers away from paper records. Advocates for electronic health records say they have the potential to make medical care safer and more efficient. In 2015, the federal government will start penalizing providers that haven’t begun using electronic health records in reimbursements they get for treating patients.

But some doctors have been cautious about changing long-standing practice, saying that typing into a computer while talking with patients requires more attention than taking notes by hand. Others are concerned that electronic systems don’t allow for enough family history or fail to highlight the important parts of a patient’s medical record. Some critics also cite privacy concerns.

Overall, some 291,325 doctors and other providers—or around 55% of the office-based providers eligible for federal incentives in exchange for adopting electronic records and using them at a set level—have received payments, the department said. Some 3,880 hospitals have also made the change. Doctors have been paid about $5.9 billion to date for participating in an incentive program established under the 2009 economic-stimulus law. An additional $8.7 billion has gone to hospitals, according to HHS data.

To get the funds, providers must have set up electronic systems that contain patients’ records, with details such as blood pressure, weight, height and medications. They also must write prescriptions electronically. The new systems are also designed to make some recommendations to providers when they enter orders into them, such as the potential for an allergic reaction to a drug.

Even medical practices that qualify for the federal payments may still use paper for some tasks, such as taking information from patients when they come for appointments. Some doctors have complained that their system gives them unnecessary warning alerts.

“Please, be patient with your physician as they transition to this,” said Farzad Mostashari, national coordinator for health information technology at HHS. “The ‘under construction, pardon our appearance’ sign—that’s the phase we’re in.”

Hospitals and doctors that have hit the current standard for using electronic records are being encouraged to move to a higher stage at which they can share information with other doctors and send patients electronic reminders or summaries of their visits.

David Blumenthal, who preceded Dr. Mostashari as national coordinator at HHS, said the agency had made a conscious decision not to push providers too far too quickly.

“It’s a matter of getting people on the escalator and moving them steadily up to higher and more demanding uses. You can’t get from the bottom of the escalator to the top in one step; you have to take them along for the ride,” he said. Dr. Blumenthal said he expected most of the remaining providers to come on board within five years.

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House Panel Passes Alternative Health Plan, Rejects Federal Funds

The House Appropriations Committee today passed HB 7169, a measure that creates a program called Florida Health Choices Plus, which will cover about 115,000 people.

The committee rejected a strike-all amendment from state Rep. Mia Jones, D-Jacksonville, that would have directed the state Agency for Healthcare Administration to accept federal funds and extend  the state Medicaid program under the federal Patient Protection and Affordable Care Act. The amendment would have meant health coverage for more than 1 million Floridians, including childless adults.

Jones said the state would have gained $1.2 billion over the next 10 years from the federal government with her amendment. But Republicans stayed firm in their opposition to accepting federal funds to help uninsured Floridians get coverage.

“In my opinion, Medicaid expansion is wrong for this state,” said House Majority Leader Stephen Precourt. “We have a great plan here today to vote on, and adopting this amendment would be irresponsible.”

The committee ultimately adopted three other amendments before approving the bill, sponsored by state Rep. Richard Corcoran, R-Lutz.

$5.6 Billion in Medicare Cuts for FY 2014 in President Obama’s Proposed Budget

President Barack Obama’s highly anticipated fiscal 2014 budget released Wednesday proposes $5.6 billion in Medicare payment cuts for that year and about $400 billion in total federal healthcare savings over the next decade.

In a news conference at the White House, the president called his budget—which aims to reduce the deficit by nearly $1.8 trillion over 10 years and would eliminate the sequester cuts—“a fiscally responsible blueprint for middle-class jobs and growth.” He also described the budget’s Medicare cuts as ways to reduce the cost of healthcare without shifting those costs to beneficiaries. The budget would derive much of the $5.6 billion in fiscal 2014 Medicare savings from $3.1 billion it expects to save by adopting a Medicaid drug-rebate program for the dual-eligible population. The drug rebate program requires refunds from pharmaceutical manufacturers to Medicaid programs.

Following a news conference at HHS headquarters, Jonathan Blum, deputy administrator and director for the Center for Medicare at CMS said the rationale behind that decision is to ensure that the Medicare program gets the same deals as state Medicaid programs.

“I think the question really is: why should one payer get a much better rebate for the same drug, for the same population?” Blum said, adding, that Medicare Part D should benefit from the same lower prices in the Medicaid program. “Same drugs, same people, but they just happen to be eligible for Medicare, not Medicaid, and so it’s a really data-driven approach to make sure that Part D is getting the best value for the program.”

Many of the healthcare savings proposed in the budget were derived through various drug cuts, including $740 million in separate drug savings in fiscal 2014 from barring pharmaceutical firm agreements to delay the availability of generic versions of brand name drugs. The drug cuts were hailed as “sensible changes to Medicare” by one advocacy group closely allied with the administration.

“It is high time that beneficiaries’ costs, rather than windfall profits of the pharmaceutical industry, are protected,” Ethan Rome, executive director of Health Care for America Now, said in a written statement.Other Medicare cuts in the budget included $780 million in graduate medical education, $830 million from post-acute care providers, $200 million less for hospital bad debt payments, $190 million in cuts to inpatient rehabilitation hospitals, and $90 million in cuts to critical-access hospitals.

The hospital cuts drew a sharp early rebuke from the industry.

“Instead of payment cuts that undermine hospitals’ ability to transform healthcare, we urge the Obama administration and Congress to seek a more transformational approach to reduce costs,” Blair Childs, senior vice president of public affairs at Premier healthcare alliance, said in a news release.

However, critics dismissed the proposals because they would do little to extend the solvency of the Medicare hospital insurance trust fund, which is scheduled to be exhausted in 2024.

“Trying to reduce costs by cutting what doctors and hospitals get paid or introducing price controls for prescription drugs doesn’t change the fundamental problems with Medicare and only threatens seniors’ healthcare,” Sen. Orrin Hatch (R-Utah), ranking member of the Finance Committee, said in a written statement.

Savings from “Medicare structural reforms” for fiscal 2014 were made up entirely of $350 million from encouraging low-income seniors to use more generic drugs. However, additional categories of reform savings would be added in future years. Over the long term, structural reforms totaling $67.8 billion would come primarily from increasing premiums for higher-income beneficiaries.

For Medicaid, spending would jump by $428 million in fiscal 2014, as the millions of new enrollees are added in states that opt to expand eligibility as encouraged by the Patient Protection and Affordable Care Act to 138% of the federal poverty level.

AHA airs concerns

Richard Umbdenstock, president and CEO of the American Hospital Association, said in a statement that the organization has “significant concerns” about certain payment policies in the budget, including the reductions for hospital bad debt payments, graduate medical education, and inpatient rehabilitation providers. But the AHA was satisfied with other areas of the budget, including a proposal to delay scheduled cuts to the Medicaid Disproportionate Share (DSH) program by one year until 2015.

“At the same time, we are pleased that the proposal backed off previous policies to cut Medicaid provider assessments and recognized the need to delay cuts to the Medicaid Disproportionate Share Hospital (DSH) program because there will be fewer insured people,” Umbdenstock said in the statement. “We also are pleased that the proposal does not include a single federal Medicaid matching rate that would have cut the program.”

The budget advocated a movement away from the Medicare’s sustainable growth-rate formula, instead of its outright repeal, which the White House favored in the deficit-reduction discussions late last year. The fiscal 2014 budget proposed “a period of payment stability lasting several years” to allow development of new payment models that encourage care coordination and tying provider payments to health outcomes. Providers who adopt the new payment models would receive increased payments while those that remained in the fee-for-service system would face cuts.

Meanwhile, the budget proposes $80.1 billion in discretionary funding for HHS in fiscal 2014, which is a $3.9 billion increase from the 2012 enacted level of funding. The proposal would provide $31 billion for the National Institutes of Health, a move that the medical research community was quick to praise.

“As the centerpieces of the medical innovation ecosystem, NIH not only supports the research that leads to treatments and cures for our most devastating diseases, but drives the life sciences economic engine, annually sustaining over 400,000 jobs and nearly $60 billion in economic activity nationwide,” according to a statement from United for Medical Research, an organization that represents research institutions and advocacy groups such as the American Association for Cancer Research, the American Heart Association, Johns Hopkins University, Northwestern University and PhRMA. “The president’s NIH budget proposal is an important step forward in restoring the crippling $1.6 billion cut the agency received as a result of the sequester.”

The administration also aims to bolster mental healthcare services in America by proposing a $130 million in initiative to help teachers and other adults recognize mental illness in young people. That includes $55 million for Project AWARE (Advancing Wellness and Resilience in Education) to provide mental health “first aid” training in schools and communities; $50 million to train 5,000 new mental health professionals to serve students and young adults; and $25 million for Healthy Transitions, a new competitive grant to help support transitioning young people between the ages of 16 and 25 and their families “access and navigate behavioral health treatment systems,” according to a summary of the budget for HHS.

In the HHS news conference, HHS Secretary Kathleen Sebelius detailed how much the administration has requested to implement the federally facilitated health insurance exchanges. The health insurance exchanges—both state-based and federally operated—will launch next year.

“This budget before you, the 2014 budget, asks for a total $1.5 billion in funding for the federally facilitated exchanges, both the operational side and education and outreach,” Sebelius said.

David Schlaifer, BizTech 2013 CEO of the Year

David Schlaifer is founder, president and CEO of Doctors Administrative Solutions, a health care technology firm in Tampa.

He has been recognized as one of the 100 leading CEOs in Tampa Bay and was named one of Tampa Bay’s “2011 Movers & Shakers” by Business Leader Magazine.

As more doctors are transitioning to electronic health records, DAS is helping increase the momentum and adoption in Tampa and across the state of Florida. Schlaifer is actively working to improve health care — both from a quality and a cost standpoint — by transitioning health care providers to fully functional EHR systems.

Schlaifer is expanding the company’s reach by acquiring and/or contracting with other channel vendors around the country to use the DAS method, according to award submission materials.

Because one of the largest barriers to entry for physicians transitioning to an EHR system is cost and lack of funding, Schlaifer saw an opportunity for DAS. He directed his team to create advanced training programs to ensure practices could quickly achieve “meaningful user” status, a requirement to qualify for incentive funds to implement electronic records.

He also focuses on making sure practices were getting the most of the EHR investment through participation in complementary incentive programs, like the Physician Quality Reporting System and ePrescribing, according to submission materials.

Combined, these efforts have helped local physicians receive more than $3 million in government incentive funds, which adds more than $20 million in economic stimulus to the local economy, according to submission materials.

He serves on the board of Eckerd Youth Alternatives, the Advisory Board of Education Africa USA and a White House advisory board. Recently he attended a meeting at the White House to provide input relating to the fiscal cliff, according to submission materials.

DAS has been ranked by the Tampa Bay Business Journal as one of the 20 fastest-growing companies for the last three years, received Florida’s Excellence in IT Leadership award and was recently named one of the top privately held companies in the country by Inc. Magazine.

Schlaifer was a finalist in the same BizTech category in 2012.

What the “Fiscal Cliff” Means for Health Care

Health care providers and patient advocates are anxious over pending cuts to federal health programs next year if Democrats and Republicans can’t strike a deal on budget cuts and taxes by Dec. 31.

Unless Congress can agree on at least $1.2 trillion in program cuts, wide-ranging reductions in domestic and defense spending, known as “sequestration,” will begin Jan. 2.

Some services are exempt, such as veterans’ health programs, Medicaid and the Children’s Health Insurance Program. Funding for the main provisions of the 2010 health care law doesn’t begin until 2014, so it also wouldn’t be affected by the 2013 sequester.

But money for crucial services such as community health centers, HIV and AIDS programming, bio-medical research, disease control and prevention, and the regulation of food, drugs and medical devices would face reductions of 8.2 percent beginning next year if Congress and the White House fail to reach a compromise.

Although similar sequester scares have been averted after serious negotiations, Tim Westmoreland, a law professor at the Georgetown University Law Center, wasn’t optimistic.

“This doomsday machine is going to go off this time,” said Westmoreland, who headed the Medicaid program in the final years of the Clinton administration.

If he’s right and President Barack Obama issues a sequester order on Jan. 2, Medicare would impose a 2 percent cut on payments to providers and insurers a month later.

Monthly payments to Medicare prescription-drug plans and Medicare Advantage plans – the private plans that provide Medicare benefits – also would face a 2 percent reduction, said Lisa Potetz, a principal with Health Policy Alternatives, a private consulting firm.

Medicare administrative spending would be subject to the same 8.2 percent cuts faced by most other non-defense agencies, as well, Potetz added.

In September, the Office of Management and Budget estimated that the reductions would take $11.6 billion from Medicare’s budget in 2013. The cuts would total $99 billion if the sequester were in effect for the full nine years as current law provides, according to the Congressional Budget Office.

That’s far less than the 10-year $400 billion reduction in the program that Obama envisions as part of his new proposal to avert sequestration. But an $11.6 billion funding cut would have serious consequences nonetheless.

While benefits wouldn’t be cut directly, the impact of reductions in revenue to health care providers and their effects on beneficiaries are unclear. Some worry that the 2 percent cut might lead doctors to shun Medicare patients.

That possibility that would only increase if Congress fails to prevent a separate 27 percent cut in Medicare physician-payment rates that’s scheduled to take effect Jan. 1.

Congressional action has prevented this rate reduction, triggered by Medicare’s inability to meet its targeted expenditures, for the last 11 years, and it’s almost certain to be skirted again for 2013.

Nevertheless, Potetz said it only added to the pressure lawmakers faced to strike a “fiscal cliff” deal early in order to avoid any disruptions in payments to Medicare providers.

“It’s in everybody’s interest, if it’s going to be fixed, to fix it as soon as possible,” she said.

A study commissioned by the American Medical Association, the American Hospital Association and the American Nurses Association estimates that nearly 500,000 jobs would be lost or not created in 2013 if the 2 percent sequester cuts for Medicare go through.

More than 40,000 of these positions would disappear from the offices of doctors, dentists and other providers, the report found.

California would be hit the hardest, with an estimated 51,000 jobs lost because of the Medicare reductions. Florida would lose about 36,000, while New York and Texas each would lose about 32,000 jobs.

Medicare’s payments to skilled-nursing facilities would face a $782 million cut next year under the sequester, according to an analysis by Avalere Health and the Alliance for Quality Nursing Home Care.

Again, California, Florida and Texas would face the biggest cuts, at $76 million, $66 million and $51 million, respectively. Payments to facilities in Illinois would be trimmed by roughly $46 million, while those in Pennsylvania face a $37 million cut and North Carolina eyes a $22.5 million reduction.

Here’s how other federal health programs might be affected:

COMMUNITY HEALTH CENTERS

The 8,500 centers would see about 1.3 million fewer low-income patients next year if $167 million in funds is cut, according to the National Association of Community Health Centers.

“We know we’d have layoffs and we know we’d have decreased access and we know that patients, especially uninsured patients, would start to use (hospital) emergency rooms. There’s no ambiguity on our part,” said Brian Toomey, the chief executive officer of Piedmont Health Services of Carrboro, N.C., which operates seven community health centers in the state and might lose about $500,000 in federal aid next year. “The average Piedmont patient typically comes three times a year at half the cost of a single emergency-room visit. “

NATIONAL INSTITUTES OF HEALTH

It would lose $2.5 billion in fiscal year 2013, resulting in about 2,400 fewer bio-medical research grants, according to a report by the Democrats on the House of Representatives Appropriations Committee. The NIH invests about $31 billion a year in research.

FOOD AND DRUG ADMINISTRATION

The FDA might see a loss of $318 million next year, even as its number of inspectors has grown by more than 8 percent over the last two years. The testing of food, drugs and medical products from other countries probably would suffer. So would the evaluation of new drugs.

“So the one-year review period that FDA is trying to get at for most products, the average drug-approval time is going to slow for those products,” said Westmoreland, the law professor. “And somebody out there is waiting for an approved oncology drug to come onto the market.”

HIV/AIDS

These programs, along with services to fight viral hepatitis, would lose $659 million, resulting in more than 400 people with HIV not being diagnosed, while 5,000 low-income households with AIDS patients would lose federal housing support, according to the National Minority AIDS Council, the Foundation for AIDS Research and the National Alliance of State and Territorial AIDS Directors.

The federal AIDS Drug Assistance Program provides anti-retroviral medications for low-income people. An 8.2 percent funding cut would mean 15,700 fewer people served under the program, according to AIDS prevention groups.

“I would point out that most of those people have no place else to go for the drugs that they need,” Westmoreland said. “For them, AIDS will no longer, during the sequester, be a manageable medical condition.”

HEALTH CARE LAW

While the sequester wouldn’t affect the main portions of the Affordable Care Act, such as premium subsidies for individuals and cost-sharing subsidies for the poor, funding for the Prevention and Public Health Fund and the National Health Service Corps would face a 7.6 percent funding cut in 2013, according to the Association of American Medical Colleges.

The fund, which was created by the 2010 law, has provided more than $1.2 billion in grants for local programs to help fight chronic disease, obesity, tobacco use and other health problems. The service corps repays student loans and provides scholarships for health care providers who agree to work for two years in areas that are short of caregivers. Additional money through the health care law boosted the service corps’ funding to $229 million in 2012 and has nearly tripled program enrollment since 2008.

Allscripts and Aprima Settle Legal Matters Over Allscripts MyWay™

DALLAS, Nov. 8, 2012 – Aprima Medical Software announced today that it has reached a mutually agreeable settlement in the lawsuit brought on October 19, 2012 by Allscripts Healthcare Solutions, LLC. In that lawsuit, Allscripts alleged that some of Aprima’s advertising copy violated various state and federal laws. The parties reached an amicable resolution and will continue pursuing their respective business goals. Under the settlement terms, Aprima has modified some of the advertising copy associated with its Aprima Rescue Plan™ for those who currently use the Allscripts MyWay™ product, and who may be looking to replace that product in light of Allscripts’ October 3 announcement about its future.

Allscripts MyWay™ is the EHR product offered by Allscripts that it has opted not to develop or update to be in compliance with government incentives and requirements such as Meaningful Use and ICD-10.

The Aprima Rescue Plan™ remains in place for customers of Allscripts MyWay™. Many believe this program – and Aprima’s EHR and PM products – to be the most practical and viable option for providers, since the original Allscripts MyWay™ application was based on the source code that Allscripts licensed from Aprima in 2008.

Allscripts MyWay™ resellers and customers can maintain and even strengthen their current business relationships. Aprima is offering an easy upgrade for practices that may feel frustrated by Allscripts’ announcement about MyWay™ and anxious – or even outraged – about the prospect of a potentially expensive conversion if they want to demonstrate 5010 and ICD-10 compliance, or qualify for government incentives including Meaningful Use Stage 2, PQRS, e-Prescribing, and others.

Providers who bought Allscripts MyWay™ for a specific reason, such as the unique non-template approach to charting, the speed and ease-of-use, and the adaptive learning feature, are typically averse to having to change to something that is very different.

Aprima Rescue Plan™ for customers of Allscripts MyWay™ includes:

  • Free Aprima licenses for each Allscripts MyWay™ license – no need to repurchase software; up to an $8,500 savings per provider
  • Similar look and feel; Aprima has made nearly 1,000 enhancements since it licensed the original source code to Allscripts in 2008, including hundreds of substantive improvements to the Practice Management system
  • Minimal learning curve, since it is only needed for the new features
  • Minimal downtime compared to what is typical when changing systems and having to re-learn many new workflows
  • Existing data remains intact; this is a proven product upgrade, not a conversion
  • U.S.-based support

Aprima is pleased to be able to offer a lifeline to these users for minimal cost and with virtually no downtime. This will circumvent the need for Allscripts MyWay™ users to switch to another Allscripts EMR product, which would require a change in systems, plus a potentially arduous data conversion and retraining period, thus creating additional mental, physical and financial disruption to the practice.

“Ironically, Allscripts MyWay™ users can avoid such a potentially expensive and disruptive situation by switching to Aprima instead of another Allscripts product. We welcome these customers to the Aprima family and we are thrilled to be able to easily upgrade our ‘cousins’ to the Aprima way,” said Aprima president and CEO Michael Nissenbaum. “The difference between a conversion and a simple and proven upgrade can also make the difference on whether practices will achieve compliance on important healthcare initiatives. We are very pleased with the outcome of this legal situation.”

Contact our sales team to receive more information, request a demo, or receive a custom quote by emailing Sales@Dr-Solutions.com or call (813)774-9800; Ext 2.

 

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