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The Evolution of Communication in Healthcare

The following is a guest blog post by Erik Kangas, Founder of LuxSci.

Thanks to technological breakthroughs, communication in healthcare has evolved by leaps and bounds from the old days of paper filing systems, faxes, and phone calls. Although those methods are still widely used, there are faster ways to keep patients in touch with their medical practitioners, doctors, and nurses. Yet with a multitude of benefits come new risks: data breaches, unencrypted messages, and willful neglect that could bring about serious penalties from HIPAA. In order to fully take advantage of all that technology has to offer, the healthcare industry needs to know proper usage policies and to enforce adherence to HIPAA regulations. We might not be in the age of pagers anymore, but that just means that more precautions practitioners need to embrace the newly evolving world of healthcare communication.

Let’s take a look at how these methods of communication have changed over the years and what it all means for the security of ePHI.

Pagers
Anyone involved in the healthcare sector has surely encountered a pager at some point in time. Healthcare is one of the last industries to use this aging technology, but messaging systems that are easier and faster to respond are slowly replacing them. With so many smartphones and devices that can instantly let you know whether there’s an emergency, there’s less reason to carry around a separate bulky pager.

An article at HealthITSecurity has this to say about pagers: “Communicating internally via pagers could still have some benefits, but there are now secure messaging capabilities that can assist with routine health issues, address patient questions or concerns, help monitor patient conditions, while also ensuring that patients can properly manage their own conditions.” In other words, with technology that’s so much quicker and more efficient, it might be worth finally letting go of the beeper in your pocket and switching to something that can do everything a pager can and more.

Pagers may not be as efficient as current tech, but certain organizations still believe they serve a purpose, especially critical messaging.

Email
Email has become increasingly important in healthcare, increasing the scope of everyone’s efforts toward protecting patient privacy. Explained in this whitepaper about HIPAA and email, this security applies not only to personal information, but all Protected Health Information (PHI) –including a patient’s administrative, financial, and clinical information. Any health information related to an identifiable individual that is transmitted or maintained via email, or another medium, falls under HIPAA’s definition of PHI. That’s a huge amount of information that needs safeguarding if you want to continue using email to transmit healthcare data.

Ensuring that data remains encrypted on laptops, desktop computers, and all other devices is key to staying HIPAA compliant. While encryption can be costly to implement, it’s worth it to keep patients’ PHI (and other data) secure – and without it, an organization risks paying monumentally more in fines, in the case of a data security breach.

Given that data breaches frequently and increasingly occur in the healthcare sector, organizations need to ensure the continued safety of their patients’ data for both financial and personal reasons.

It’s also a wise idea to sign up with a security company that can handle the HIPAA compliancy of your inbound and outbound emails, as well as the security of your network as a whole. However, it’s still up to you to train your staff, review your HIPAA security policies, and keep a copy of the HIPAA Business Association Agreement that you signed with the security company.

Text Messages
Texting is pervasive as a method of healthcare communication, including using text messages to confirm appointments or deliver lab results to anxious patients. There are also plenty of texts exchanged between doctors and nurses in hospital environments, with many messages containing some form of patient information. All these transmissions fall under HIPAA regulations, and it’s very easy to unintentionally text patient data that could be intercepted, sent unencrypted, or stored in an external location like the cloud.

Sending health information via text is a clear HIPAA violation – even with seemingly harmless messages, like appointment reminders. The only case in which texting health information may not violate HIPAA is when the text is sent to a patient who has preemptively signed the proper consent form. Without patient consent and proper documentation, an organization can be fined up to $50,000 per text message, if the messages are found to be in violation of HIPAA’s rules. That’s a massive penalty for any organization.

As with email, it’s important to make sure that you encrypt and decrypt text messages properly, whether through common carriers, specialized apps for decryption, or customized programs that allow users to send and receive HIPAA-compliant messages without the worry of breaking regulation. You can send text messages securely, but it requires training and a financial cost to ensure the information stays safe and only the intended recipient reads it.

The Future of Compliant Messaging
“It’s not enough to decide it’s time to ‘jump on the bandwagon’ or secure messaging,” says HealthITSecurity. “Healthcare organizations need to realize that this communication is part of an evolutionary process, and it’s necessary to implement a system that can easily integrate with the facilities’ current capabilities.” Organizations need to recognize they can’t do compliance in various messaging systems piecemeal or from one staff member to another, they need to make it a blanket effort that ensures everyone is onboard. And while it may create a more convenient system, the legal ramifications of any slipups can more than outweigh the cost of encryption programs or specialized apps.

As long as there are security protocols in place, we’ll continue to see a growing role for secure messaging technology in healthcare.

Communication in healthcare was and is always about making services easier and more convenient for both medical staff and patients alike. With the constantly evolving nature of technology, more organizations can expand their services and share information faster than ever before. As long as HIPAA regulations and cybersecurity are in place, the healthcare sector ought to continually evaluate what new high-tech solutions work for them—and what old traditions could still have a place.

May 12, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Providers Must Attest to 2015 EHR Incentive Program Requirements by March 11, 2016 at 11:59 PM EST

The attestation deadline for the Medicare Electronic Health Record (EHR) Incentive Program is only 3 days away!

Eligible professionals, eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare EHR Incentive Program must attest using the Medicare & Medicaid EHR Incentive Program Registration and Attestation System no later than Friday, March 11, 2016 at 11:59 p.m. ET.

Medicaid EHR Incentive Program participants should refer to their respective states for attestation information and deadlines. Certain Medicaid eligible professionals may use the Registration and Attestation System as an alternate attestation method to avoid the Medicare payment adjustment (80 FR 62900 through 62901).

To attest to the EHR Incentive Programs in 2015:

  • Eligible Professionals may select an EHR reporting period of any continuous 90 days from January 1, 2015 (the start of the 2015 calendar year) through December 31, 2015.
  • Eligible Hospitals/CAHs may select an EHR reporting period of any continuous 90 days from October 1, 2014 (the start of the federal fiscal year) through December 31, 2015.
March 8, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

CMS ICD-10 Stats and Metrics

On October 1, 2015 health systems across the country transitioned to the International Classification of Diseases, 10th Revision – ICD-10. This change will enable providers to capture more details about the health status of their patients to improve patient care and public health surveillance.

CMS has been carefully monitoring the transition and is pleased to report that claims are processing normally. Generally speaking, Medicare claims take several days to be processed and, once processed, Medicare must– by law – wait two weeks before issuing a payment Medicaid claims can take up to 30 days to be submitted and processed by states. For this reason, we will have more information on ICD-10 transition in November.  .

With this in mind, CMS is continuing its vigilant monitoring process of the ICD-10 transition and can share the following metrics detailing Medicare Fee-for-Service claims from 10/1-10/27.

Metrics

October 1-27

Historical Baseline*

Total Claims Submitted

4.6 million per day

4.6 Million per day

Total Claims Rejected due to  incomplete or invalid information

2.0% of total claims submitted

2.0% of total claims submitted

Total Claims Rejected due to invalid ICD-10 codes

0.09% of total claims submitted

0.17% of total claims submitted
(estimated based on end-to-end testing)

Total  Claims Rejected due to invalid ICD-9 codes

0.11% of total claims submitted

0.17% of total claims submitted
(estimated based on end-to-end testing)

Total Claims Denied

10.1% of total claims processed

10% of total claims processed

NOTE: Metrics for total ICD-9 and ICD-10 claims rejections were estimated based on end-to-end testing conducted in 2015 since CMS has not historically collected this data. Other metrics are based on historical claims submissions.

It’s important to know help remains available if you experience issues with ICD-10:

October 29, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Transcription vs IBM Watson Figuring Out Song Lyrics Infographic

I was recently sent this fascinating infographic that pitted IBM’s Watson against transcriptionists trying to transcribe song lyrics. It’s pretty fun to see the results and how they compare. However, I’m not sure it’s really fair to call it IBM Watson. It looks like they used the voice recognition software in Watson to do the voice to text. If they were really using Watson, then they would have done the voice to text and then compared it against all the song lyrics ever written and then produced the exact song lyrics. However, they said that the transcriptionists weren’t allowed to Google the lyrics. I assume the same was true for Watson.

It’s also worth mentioning that song lyrics can be much harder for a computer to hear than just a straight transcription. I also bet my friends at Nuance would argue that their voice recognition would have performed much better. Plus, I wonder how long the transcriptionists took on these songs. A double or triple checked transcription would be very accurate.

All of this said, this infographic and the results of their experiment (specifically stated as non-scientific) illustrates what most of us that have used the technology already know. Transcriptionists are more accurate than voice recognition. The question most people in healthcare make is whether the costs of a transcriptionist is worth that increase in accuracy. That’s the challenge.

Ok, without further ado, here’s the infographic:
Transcription Services versus IBM Watson and Song Mondegreens

September 29, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Accountable Care Organization (ACO) Investment Model

Overview

Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to provide coordinated, high-quality care to their Medicare patients to help them deliver better care at lower cost.

The goal of coordinated care is to ensure that patients, especially people with chronic conditions, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

ACOs represent one part of a comprehensive series of initiatives in the Affordable Care Act that are designed to lower costs and improve care. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.

Medicare currently offers or is planning to offer several ACO initiatives:

  • Medicare Shared Savings Program
  • Pioneer ACO Model
  • Next Generation ACO Model
  • Advance Payment ACO Model
  • Comprehensive End Stage Renal Disease (ESRD) Care Initiative

This fact sheet provides a general description of the ACO Investment Model, a new ACO model being offered to support the Medicare Shared Savings Program ACOs.

Summary of the ACO Investment Model

The ACO Investment Model is an initiative developed by the Center for Medicare & Medicaid Innovation (Innovation Center) for organizations participating as ACOs in the Medicare Shared Savings Program (Shared Savings Program). The ACO Investment Model is a new model of pre-paid shared savings that builds on experience with the Advance Payment Model to encourage new ACOs to form in rural and underserved areas and current Medicare Shared Savings Program ACOs to transition to arrangements with greater financial risk.

The ACO Investment Model will be available to:

1) New Shared Savings Program ACOs that joined in 2015 or are joining in 2016. The ACO Investment Model seeks to encourage uptake of coordinated, accountable care in rural geographies and areas where there has been little ACO activity, by offering pre-payment of shared savings in both upfront and ongoing per beneficiary per month payments. CMS believes that encouraging participation in areas of low ACO penetration may spur new markets to focus on improving care outcomes for Medicare beneficiaries.

2) ACOs that joined the Shared Savings Program starting in 2012, 2013 or 2014. Here, the ACO Investment Model will help ACOs succeed in the Shared Savings Program and encourage progression to higher levels of financial risk, ultimately improving care for beneficiaries and generating Medicare savings.

Background

CMS is encouraging providers to participate in ACOs through the Medicare Shared Savings Program, which creates financial incentives for ACOs that lower growth in health care costs while meeting performance standards on quality of care and putting Medicare beneficiaries first.

The Innovation Center

The Innovation Center was created by the Affordable Care Act to test innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care. It is committed to transforming the Medicare, Medicaid and Children’s Health Insurance Programs and is expected to help deliver better care for individuals, better health for populations, and lower growth in expenditures for Medicare, Medicaid and CHIP beneficiaries.

Working in concert with the Shared Savings Program, the Innovation Center is testing the ACO Investment Model and the Pioneer ACO Model, and has sponsored learning activities that help providers form ACOs and improve their results.  More information on all of these initiatives is available on the Innovation Center website at http://innovation.cms.gov.

The ACO Investment Model was developed in response to concerns and available research suggesting that some providers lack adequate access to the capital needed to invest in infrastructure necessary to successfully implement population care management.

Structure of Payments

New ACOs

Under the ACO Investment Model, ACOs that will begin participating in the Medicare Shared Savings Program on January 1, 2015 or January 1, 2016 will receive three types of payments:

  • An upfront, fixed payment:  Each ACO receives a fixed payment.
  • An upfront, variable payment:  Each ACO receives a payment based on the number of its preliminarily prospectively-assigned beneficiaries.
  • A monthly payment of varying amount depending on the size of the ACO:  Each ACO receives a monthly payment based on the number of its preliminarily prospectively-assigned beneficiaries.

The structure of these payments addresses both the fixed and variable costs associated with forming an ACO.

Existing ACOs

Under the ACO Investment Model, ACOs that began participating in the Medicare Shared Savings Program on April 1, 2012, July 1, 2012, January 1, 2013, or January 1, 2014 will receive two types of payments:

  • An upfront, variable payment:  Each ACO receives a payment based on the number of its preliminarily prospectively-assigned beneficiaries.
  • A monthly payment of varying amount depending on the size of the ACO:  Each ACO receives a monthly payment based on the number of its preliminarily prospectively-assigned beneficiaries.

The structure of these payments addresses both the fixed and variable costs associated with making ongoing investments to improve care coordination for existing ACOs.

Recovery of ACO Investment Model Payments

For ACOs already participating in the Shared Savings Program, CMS will recover the ACO Investment Model payments through an offset of an ACO’s earned shared savings. ACOs selected to receive ACO Investment Model payments will enter into an agreement with CMS that details the obligation to repay ACO Investment Model payments.

If the ACO does not generate sufficient savings to repay the ACO Investment Model payments as of the first settlement for the Shared Savings Program, CMS will continue to offset shared savings in subsequent performance years and any future agreement periods, or pursue recovery where appropriate.

For ACOs new to the Shared Savings Program in 2015 and 2016, CMS will recover payments from earned shared savings for as long as the participant remains in the Shared Savings Program ACO. CMS will pursue full recovery of pre-paid shared savings from any ACO that does not complete its initial Shared Savings Program agreement period or the full term of the ACO Investment Model agreement.

Eligibility/Selection

The ACO Investment Model is expected to help provide support to organizations whose ability to invest in infrastructure and redesigned care processes would be improved with additional access to capital.

In order to be eligible for the ACO Investment Model, an ACO already participating in the Shared Savings Program must meet the following criteria:

1) The ACO must be accepted into and participate in the Shared Savings Program. The ACO’s first performance period in the Medicare Shared Savings Program must have started in 2012, 2013, 2014, or 2015 or will start in 2016.

2) If the ACO started in the Medicare Shared Savings Program in 2012, 2013 or 2014, it has completely and accurately reported quality measures to the Medicare Shared Savings Program in the most recent performance year, excluding ACOs that started in 2015 or that will start in 2016.

3) The ACO has a preliminary prospective beneficiary assignment of 10,000 or fewer beneficiaries for the most recent quarter, as determined in accordance with the Shared Savings Program regulations.  However, ACOs that started the Medicare Shared Savings Program in 2015 or will start in 2016, and are determined to be from a rural area using the application selection criteria, are permitted to exceed the 10,000 beneficiary assignment limit.

4) The ACO does not include a hospital as an ACO participant or an ACO provider/supplier (as defined by the Shared Savings Program regulations), unless the hospital is a critical access hospital (CAH) or inpatient prospective payment system (IPPS) hospital with 100 or fewer beds.

5) The ACO is not owned or operated in whole or in part by a health plan.

6) The ACO did not participate in the Advance Payment Model.

During the selection process, the ACO Investment Model will target new ACOs serving rural areas, areas of low ACO penetration, and existing ACOs committed to moving to higher risk tracks. CMS will also give preference to ACOs that provide high quality of care, achieved their financial benchmark, and demonstrate exceptional financial need.

Application Process

The application period for ACOs that started in 2014 and 2015 — or will start in 2016 — will open July 1st, 2015 and close July 31, 2015.

CMS staff will review applications for the applicant organization’s ability to meet criteria identified in the solicitation. All applicants are also required to be accepted into the Shared Savings Program, in accordance with program rules.

Participants

In the first round of applications for ACOs that started in the Medicare Shared Savings Program in 2012 and 2013, the ACO Investment Model has accepted six ACOs into the model.

Additional Resources

More information about the ACO Investment Model, including the Request for Application, is available on the Innovation Center website at http://innovation.cms.gov/initiatives/ACO-Investment-Model/.  Any questions about the program can be directed to AIM@cms.hhs.gov

For information about the Shared Savings Program, please see: www.cms.hhs.gov/sharedsavingsprogram/.

CMS Blog:   http://blog.cms.gov/2015/06/25/affordable-care-act-initiative-supports-care-coordination-in-rural-areas/

June 25, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Access All of CMS’ Sessions at HIMSS15

Visit the CMS eHealth Events page to access all of CMS’ HIMSS15 program sessions. An overview of each individual session can be found below.

Sunday, April 12

  • Opening Keynote: CMS on Federal Quality Reporting (Session QU1): Dr. Kate Goodrich, Director of the Quality Measurement and Health Assessment Group, outlines 2015 clinical quality measurement and reporting requirements and how they align with quality performance and public reporting through CMS quality programs.

Monday, April 13

  • CMS EHR Incentive Programs Overview (Session 10): CMS provides an update on EHR Incentive Programs participation and gives an overview of the Modifications to Meaningful Use in 2015-2017 proposed rule.
  • CMS Meaningful Use Stage 3 Requirements (Session 40): CMS presents an outline of the proposed Stage 3 requirements.

Tuesday, April 14

  • Keynote: The Intersection of Quality and Innovation at CMS (Session 67): Dr. Patrick Conway, Chief Medical Officer, outlines how CMS envisions health IT as a key component of health care transformation.
  • CMS Quality Strategy (Session 86): Dr. Kate Goodrich presents the overall quality strategy for CMS, and explains how it will be used to achieve the agency’s vision.
  • CMS Quality Reporting Update (Session 116): CMS discusses 2015 CQM reporting requirements and provides an overview of the PQRS, IQR, HVBP, and VBM quality reporting programs.

Wednesday, April 15

  • CMS Future Directions in Quality Measurement (Session 131):Panelists discuss current challenges and the future of quality measurement and quality measure development.
  • CMS Meaningful Use Stage 3 and ONC 2015 Edition Certification Criteria Changes (Session 160): CMS and ONC provide an overview of the Stage 3 and 2015 Edition Health IT Certification Criteria proposed rules.
  • Improving Health Care Delivery through Collaboration with Lean Tools (Session 176): Industry experts outline how Lean tools have led to cost savings, increased collaboration, and provide high quality products.
May 18, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

HIMSS Formally Submits Comments on ONC on Nationwide Interoperability Roadmap

In an April 3rd letter to the Office of the National Coordinator (ONC), HIMSS submitted its final comments in response to ONC’s Connecting Health Care for the Nation: A Shared Nationwide Interoperability Roadmap.

In an April 3 letter to the Office of the National Coordinator (ONC), HIMSS submitted its final comments in response to ONC’s Connecting Health Care for the Nation: A Shared Nationwide Interoperability Roadmap.

HIMSS overall supports ONC’s tenets of the Interoperability Roadmap for an interoperable health IT infrastructure.  The Interoperability Roadmap lays out a plan that builds on what HIMSS has already invested in: standards that enable the foundation for interoperability today, and processes to test and certify that health IT systems implement those standards consistently and according to constrained implementation guidance.  In its comments, HIMSS is recommending ONC focus on six key ideas:

  • The plan put forth by ONC to advance interoperability requires well-coordinated governance processes that include involvement from federal partners, the private sector, payers, and the patient community, with robust incentives for each domain to buy-in to the process
  • Many of the timelines put forth in the Interoperability Roadmap for the three, six, and ten-year timeframes for critical actions are too aggressive and need to be reevaluated, with the exception of the privacy and security provisions
  • HIMSS applauds ONC for its person-centric vision in the Interoperability Roadmap that enables interoperability and empowers patients to demand that their providers and relevant health IT systems be interoperable
  • HIMSS does not support the idea that individual consent should be required for use and disclosure of information if individual consent is not required under applicable law
  •   Regarding security, HIMSS observes that healthcare, as a critical US infrastructure, needs support at many levels to keep data secure and to be positioned to address cyber threats
  •   HIMSS is committed to being a thought leader on interoperability and spurring the community and stakeholder groups forward

HIMSS is committed to continuing our role as a thought leader on advancing the principles described in our public comments and stands ready to work with ONC, federal partners, and all stakeholders to realize an achievable vision for interoperability and health information exchange.

HIMSS’ final comments are available here.

April 3, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

St. Patrick’s Day ICD-10 Codes

Wendy Aiken, Product Manager at ADP AdvancedMD, sent me a few ICD-10 codes that might come in handy during your St. Patrick’s Day shenanigans.

I25.810 Coronary Artery Bypass
Graft Corned beef and cabbage are staples at any St. Patrick’s Day celebration. But if eating too much red meat requires a different kind of CABG, use this code.

L25.2 Unspecified Contact Dermatitis
Due to Dyes Green beer, green clothes, green…well, everything. If someone’s skin is sensitive to the color of the holiday, this code could end up in his or her electronic health records.

H53.50 Unspecified Color Vision Deficiencies
Legend has it that leprechauns hide their gold at the end of the colorful rainbow. Color blindness may make finding the treasure difficult.

D50.8 Hypochromic Anemia
No doubt you may get sick of seeing all the green this St. Patrick’s Day. However, if a patient exhibits a greenish discoloration of skin, he or she may have the real “green sickness”—Hypochromic Anemia.

R44.1 Visual Hallucinations
Leprechauns are a fanciful legend for children. But if you see little green men running around, your doc may use this ICD-10 code.

F40.11 Social Phobia, Generalized
The Irish celebrate St. Paddy’s Day by gathering for large parties and parades. Not everyone loves the chaos of large groups, however. This ICD-10 code is perfect for anyone missing out on festivities due to their fear of crowds.

B27 Infectious mononucleosis
With so many shirts and pins reading “Kiss Me, I’m Irish”, there is bound to be some smooching going on. Irish or not, not all St. Patrick Day partiers will be lucky enough to avoid the “kissing disease.”

I42.6 Alcoholic cardiomyopathy
Drinking green beers year after year may put a hamper on the St. Paddy’s Days in the future. This code is used for what’s been called “beer-drinker’s heart.”

Y92.22 Religious Institution as Place of Occurrence
Some celebrants may observe the religious day of Saint Patrick in a more traditional way. This code may get some use if a trip to the cathedral results in injury.

March 17, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Next Generation Accountable Care Organization (ACO) Model Fact Sheet

Overview

Medicare Accountable Care Organizations (ACOs) provide coordinated, high-quality care and better value to Medicare beneficiaries.  Building on experience from the Pioneer ACO Model and the Medicare Shared Savings Program (MSSP), the Next Generation ACO Model offers a new opportunity in accountable care—one that sets predictable financial targets, enables greater levels of financial risk so that providers have more opportunities to coordinate beneficiaries’ care, and maintains the highest of quality standards consistent with other Medicare programs and models.  This is in accordance with the Department of Health and Human Services’ “Better, Smarter, Healthier” approach to improving our nation’s health care and setting clear, measurable goals and a timeline to move the Medicare program — and the health care system at large — toward paying providers based on the quality rather than the quantity of care they provide to patients.  CMS is adding the Next Generation ACO Model to its existing portfolio of ACO models:

  • Medicare Shared Savings Program (Shared Savings Program)
  • Pioneer ACO Model
  • Advance Payment ACO Model
  • ACO Investment Model
  • Comprehensive End Stage Renal Disease (ESRD) Care Initiative

This document includes background information on ACOs, a summary of the Next Generation ACO Model, information on eligibility and the application process for the model, and general information on the CMS Innovation Center.

Medicare ACO Background

Medicare ACOs are comprised of groups of doctors, hospitals, and other health care providers and suppliers who come together voluntarily to provide coordinated, high-quality care at lower costs to their Original Medicare patients. ACOs are patient-centered organizations where the patient and providers are true partners in care decisions.  Participating patients will see no change in their Original Medicare benefits and will keep their freedom to see any Medicare provider.  Provider participation in ACOs is also voluntary.  When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.

The goal of care coordination is to ensure that patients, especially those with chronic conditions, get the right care at the right time while avoiding medical errors and unnecessary duplication of services.  Any patient who has multiple doctors has experienced the frustration of fragmented and disconnected care: lost or unavailable medical charts; duplicated medical procedures and tests; difficulty scheduling appointments; or having to share the same information repeatedly with different doctors.  ACOs are designed to lift this burden from patients, while improving the partnership between patients and doctors in making health care decisions.  Medicare beneficiaries will have better control over their health care, and providers will have better information about their patients’ medical history and better relationships with patients’ other providers.  For providers, ACOs hold the promise of realigning the practice of medicine with the ideals of the profession—keeping the focus on patient health and the most appropriate care.

Medicare beneficiaries whose doctors participate in an ACO will still have freedom of choice among providers and can still choose to see providers outside of the ACO.  Patients choosing to receive care from providers participating in ACOs also will, as in Original Medicare, have access to information about how well their doctors, hospitals, or other caregivers are meeting quality standards.

Summary of the Next Generation ACO Model

The Next Generation ACO Model is an initiative developed by the Center for Medicare & Medicaid Innovation Center (CMS Innovation Center) for ACOs that are experienced in coordinating care for populations of patients.  It will allow these provider groups to assume higher levels of financial risk and reward than are available under the current Pioneer Model and Shared Savings Program (MSSP).  The goal of the Model is to test whether strong financial incentives for ACOs can improve health outcomes and lower expenditures for Original Medicare fee-for-service (FFS) beneficiaries. Core principles of the Model are:

  • Protecting Medicare FFS beneficiaries’ freedom to seek the services and providers of their choice;
  • Engaging beneficiaries in their care through benefit enhancements that directly improve the patient experience and reward seeking care from ACOs;
  • Creating a financial model with long-term sustainability;
  • Utilizing a prospectively-set benchmark that: (1) rewards quality; (2) rewards both improvement and attainment of efficiency; and (3) ultimately transitions away from an ACO’s recent expenditures when setting  and updating the benchmark;
  • Mitigating fluctuations in aligned beneficiary populations and respecting beneficiary preferences by supplementing a prospective claims-based alignment process with a voluntary process;
  • Smoothing ACO cash flow and supporting investment in care improvement capabilities through alternative payment mechanisms.

The Next Generation ACO Model includes strong patient protections to ensure that patients have access to and receive high-quality care.  Like other Medicare ACO initiatives, this Model will be evaluated on its ability to deliver better care for individuals, better health for populations, and lower growth in expenditures.  In addition, CMS will publicly report the performance of the Next Generation ACOs on quality metrics, including patient experience ratings, on its website.

The CMS Innovation Center

The CMS Innovation Center was created by the Affordable Care Act to test innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care for CMS beneficiaries.

Working in concert with the Shared Savings Program, the CMS Innovation Center is testing a number of ACO models and has sponsored learning activities that help providers form ACOs and improve their results.  More information on all of these initiatives is available on the CMS Innovation Center website at http://innovation.cms.gov.

Eligibility/Selection

CMS expects approximately 15 to 20 ACOs to participate in the Next Generation ACO Model with representation from a variety of provider organization types and geographic regions.  The Model will consist of three initial performance years and two optional one-year extensions.  Specific eligibility criteria are outlined in the Request for Applications found at the Next Generation ACO Model web page.

Application Process

For round one consideration, interested organizations must submit a Letter of Intent (LOI) no later than 11:59 p.m. EDT May 1, 2015.  Round one applications will be made available in March, 2015 and must be submitted electronically no later than 11:59 p.m. EDT June 1, 2015.  Round two Letters of Intent and applications will be made available in March, 2016.  The round two Letter of Intent must be submitted electronically no later than 11:59 p.m. EDT May 1, 2016, and the application no later than 11:59 EDT p.m. June 1, 2016.

To file an LOI and complete the online application, interested organizations may access the instructions at the Next Generation ACO Model web page.

CMS staff will review applications for the applicant organization’s ability to meet criteria identified in the solicitation.

Additional Resources

More information about the Next Generation ACO Model, including the Request for Applications, is available on the CMS Innovation Center website at the Next Generation ACO Model web page.  Any questions about the Model can be directed toNextGenerationACOModel@cms.hhs.gov.

March 10, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Self Encrypting Drive Infographic

If you’re not encrypting your hard drives in healthcare, you’re just asking for a HIPAA penalty. If you want to learn more about the importance of encryption in general, check out this infographic:

Self Encrypting Drive Infographic

December 15, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.