In February 2009, the American Recovery and Reinvestment Act (“Stimulus Act”) provided significant financial incentives for healthcare providers to adopt and implement electronic health records. Because healthcare providers were encouraged to electronically store and transmit patient protected health information, patient advocates became concerned about the privacy and security protections for patient information. In order to improve the privacy and security requirements, the Stimulus Act included an entire section that enhanced the security requirements and increased the penalties if the providers failed to comply. This section of the Stimulus Act is the Health Information Technology for Education and Clinical Health Act (“HITECH”) and it modified the Health Insurance Portability and Accountability Act (“HIPAA”). HIPAA created the minimum privacy and security requirements. HITECH takes security and privacy to a new level. Over the last three years, hundreds of
Believe it or not, the HIPAA Omnibus has not had a major overhaul since the late 1990’s. The original Health Insurance Portability and Accountability Act was released in 1996. An updated expansion of the Act is set for official release later this week (the contents of the expansion were unveiled last week). The Act, which covers the transferability and security of private health information, for all intents and purposes, was written for the “paper” era, prior to the transformation of today’s digital and mobile age. As such, there were many outdated rules by which the privacy of patient information was not accounted for – such as the dissemination of data via the information “super highway” and mobile communication devices. However, the recent omnibus rule does not adequately address the complexity of today’s digital ecosystem, but it attempts to piece together parts that make the whole run more proficiently.
Healthcare payment reform is a work in process. The Centers for Medicare and Medicaid Services (CMS) Innovation Center is rolling out various test projects to identify how to bend the curve of healthcare costs while improving quality outcomes. These projects are gravitating towards a common underlying reimbursement theme, a fixed payment for services covering the episode of care (ambulatory, acute, and post-acute services) with a linkage to quality outcomes. Present healthcare IT solutions do not meet the anticipated needs of the market for this new form of reimbursement. There are two key requirements a healthcare provider’s IT solution needs to provide:
Last month we tiptoed away from the fiscal cliff. This month we are bumping up against the debt ceiling, and if we avoid that concussion, later this spring we’ll clash on the budget threatening to shut the Federal government down. Congress members from Harry Reid to John Boehner are declaring that we can’t continue to kick this can of long-term budget deficits down the road.
With respect to health care I would suggest that “kicking the can down the road” is exactly what we should be doing. Our current deficits are largely the result of a large tax cut, two wars, and the Great Recession. Hopefully the wars are winding down, we are slowly growing our way out of the recession and for better or worse some of the tax cuts have been repealed. In any case, in the short term deficits are having no effect on the economy: interest rates near zero, price inflation in minimal, and the cost to the government of borrowing is as low as it has ever been.
In the long term however,
As the Georgia legislative session gets into full swing this month, many events are being held around the Capitol to help legislators get acquainted (or reacquainted) with each other, their constituents, and the issues and organizations impacting the state as a whole. The recent Healthcare Unscrambled event put on by Georgians for a Healthy Future highlighted three big areas of legislative interest: Medicaid expansion, telemedicine, and child-only insurance policies.
This week Health and Human Services announced the first HIPAA breach settlement involving less than 500 patients. Hospice of North Idaho will pay a fine of $50,000.00 for breaches of electronic PHI. The breach resulted when an unencrypted laptop was stolen containing PHI of 441 patients.
In its press release regarding the breach and settlement, HHS emphasized that Hospice of North Idaho had not conducted a risk analysis to safeguard their electronic PHI and further did not have policies and procedures in place regarding electronic devices.
This is the first indication from HHS of how serious they are taking HIPAA breaches, especially involving electronic devices. In response to this case, HHS has even started a mobile device initiative, which can be found at www.HealthIT.gov/mobiledevices
In an era where every Healthcare Executives is carrying multiple mobile devices at any given time, it will behoove every organization to take a strong look at their policies and
The GBI reported that prescription drug deaths jumped 10% in 2010 and the Centers for Disease Control is calling prescription drug overdose deaths an epidemic (recently report in GA Public Broadcasting News). If this substance abuse has not affected you, your family or people you associate with, just wait. It could be that you are not aware of the problem which lurks so close to your home.
The prescription drug problem is additive to the illegal drug market which has been both condemned and glamorized. Drugs (and alcohol) are a daily crutch for many of us whether we meet the criteria for abuse and dependence or not. Too many of us turn our heads to these problems which are so prevalent at home and on the job. Crime and abuse are frequently connected to people who are abusing some type of illegal or legal substance. Also many of those who are diagnosed with mental illness tend to abuse substances for self medication or, in many instances; the substance is the root cause
As we ring in the New Year, many features of the Accountable Care Act (ObamaCare) will begin to take shape. State Benefit (Insurance) Exchanges will begin to unfold. The Medicare and Medicaid Innovation Center within HHS will continue to examine and support promising models of care delivery. Cost containment programs like Accountable Care Organizations (ACOs) will begin to reshape the way Medicare pays for healthcare services.
So what are Accountable Care Organizations (ACOs)?
ACOs are organizations created by either groups of doctors or hospitals that improve quality measures in five key areas that impact affect patient care:
• Patient (caregiver) experience and satisfaction;
• Care coordination;
• Patient safety;
• Preventive health; and
• At-risk population health management.
HHS wants to improve the quality of care Medicare patients receive. ACOs are seen as a way to drive improved care through better coordination of healthcare
Today, Secretary Geithner informed Congress that the United States would hit the debt ceiling limit on Monday, December 31st. The following day, absent successful Congressional intervention, Physicians will incur a twenty-six and half percent (26.5%) reduction in Medicare Reimbursement. And yet one day later on January 2nd, if Congress fails to address the “fiscal cliff”, healthcare providers will incur a two percent (2%) reduction in Medicare payments. The two percent (2%) decrease is projected to save over $11 Billion from the Medicare program in 2013 alone. So while many Americans are focused upon the potential increase in taxes, healthcare providers must evaluate how to address these dramatic pay cuts.
Each year, physicians demand for Congress to correct the Medicare Sustainable Growth Rate (“SGR”) to prevent this significant decrease in Medicare reimbursement. Each year, the physicians have successfully obtained a delay in the implementation of the payment
With the implementation of the Patient Protection and Affordable Care Act (PPACA), the delivery of healthcare will transform in the near time horizon. These changes are driven by necessity. There are three key dynamics changing what healthcare will look like in the near future:
How the market responds to these dynamics is evolving though it will require a convergence of technology with a broader range of healthcare services.
Technology provides the infrastructure to support scaling of solutions. It will also be an enabler of delivering quality healthcare in a cost effective manner. Here are some examples of how technology is used today and we can anticipate expansion: