What exactly does quality mean in the healthcare context?

Quality healthcare is more than just a popular phrase. As the transition to value-based care moves forward, the focus in patient care is shifting to quality and away from quantity. Healthcare outcomes for the patient are more important for the independent physician than the number of patients seen during the day. Given that quality has become such a key factor in healthcare, what exactly does it mean to provide quality care? In The Essential Guide to Health Care Quality, the National Committee for Quality Assurance (NCQA) lists two definitions of quality that had been published by nationally recognized agencies. The first was established by the Institute of Medicine (IOM) of the National Academy of Sciences, which defined quality health care as “safe, effective, patient-centered, timely, efficient and equitable.” In addition, the Agency for Healthcare Research and Quality (AHRQ) defines quality health care “as doing the right thing for the right patient, at the right time, in the right way to achieve the best possible results.” The Centers for Medicare & Medicaid Services (CMS) published its Quality Strategy in 2016, listing six goals in the delivery of quality healthcare: Make care safer by reducing harm caused in the delivery of care. Strengthen person and family engagement as partners in their care. Promote effective communication and coordination of care. Promote effective prevention and treatment of chronic disease. Work with communities to promote best practices of healthy living. Make care affordable Quality in healthcare means providing the care the patient needs when the patient needs it, in an affordable, safe, effective manner. Quality healthcare also means engaging and involving the patient, so the patient takes ownership in preventive care and in the treatment of diagnosed conditions. Quality in the healthcare context is a collaborative effort that involves the patient, the independent physician, the patient’s family, and the community as a whole.

Roy Steiner
October 16, 2017

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Who is the new acting head of the department of Health and Human Services?

On September 29, 2017, Tom Price resigned his position as Secretary of Health and Human Services (HHS) amid controversies regarding his use of private, chartered flights for business use. His successor, for the immediate term at least, is Don Wright, who had been the Acting Assistant Secretary for Health at HHS since February 10, 2017. The resignation and transition to a new acting secretary may concern independent physicians who are unfamiliar with Mr. Wright. Wright is actually a family physician himself. He served as director of the Office of Occupational Medicine for the Occupational Safety and Health Administration (OSHA) from 2003 to 2007. He began his career at HHS in 2007 as the HHS Principal Deputy Assistant Secretary for Health. During this tenure, President George W. Bush appointed Wright to serve as the alternate U.S. delegate to the World Health Organization Executive Board. USA Today reports that Wright’s public service career “has focused broadly on public health, occupational health and health policy, as well as health care quality, disease prevention and health promotion.” Prior to his career in the federal government, however, Wright was a physician focused on family medicine and occupational health in Texas and is board certified in the areas of family medicine and preventive medicine. His education includes an undergraduate degree from Texas Tech University, a medical degree from the University of Texas, and a master’s degree in public health from the Medical College of Wisconsin. He completed his family medicine residency training at Baylor College of Medicine. He is a fellow of the American College of Occupational and Environmental Medicine and the American Academy of Family Physicians. As to his current position, Wright says that he looks “forward to ensuring that the important work of the Department in support of the President’s agenda continues to move forward during this interim period.”

Roy Steiner
October 10, 2017

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Graham-Cassidy bill dies: a timeline of Obamacare repeal efforts

By the numbers, there have been seven attempts to push through Affordable Care Act (ACA) repeal and replacement efforts in various forms and magnitudes since the inauguration of President Trump in January 2017. At some point, thirteen GOP senators voted against one or more of the repeal efforts. As of September 30, 2017, the 2017 budget reconciliation rules, allowing the GOP to pass a bill without being subject to a senate Democratic filibuster, expired. Although the effort is probably not over, there has been, to date, no successful repeal of the ACA (Obamacare). Although there have been many versions of the repeal efforts, the two main plans so far have been the American Health Care Act (AHCA), introduced in March, and the Better Care Reconciliation Act (BCRA), introduced in June. As Business Insider explained it, some of the highlights of the AHCA included: Doing away with Obamacare's individual mandate that compels all American to buy insurance or face a fine. Featured penalties such as increased premiums for failing to maintain continuous coverage. Allowed people with preexisting conditions to access coverage but penalizing lapses in coverage Introduced block tax credits for individuals to access health insurance Two versions of the BCRA failed, one in June and one in July. The first version of the BCRA “repealed and replaced Obamacare, but kept many of its regulations and structure, but with large Medicaid cuts.” The second version “kept Obamacare’s taxes to add more sweeteners” but “loosened regulations from Obamacare.” After the BCRA, smaller versions of the repeal efforts were introduced and defeated. The “partial repeal” and the “skinny repeal” met their demise within a day of each other in July. Most thought that was the end of the efforts, given that John McCain was instrumental in bringing down the “skinny repeal.” However, in September, one last bill was attempted, the Graham-Cassidy bill. Introduced as the last attempt to pass repeal before the expiration of the budget reconciliation rules, the Graham-Cassidy bill was soundly defeated just thirteen days after it was introduced. Elation Health will continue to monitor the status of the ACA and any future repeal efforts, in our continuing goal to help independent physicians understand the issues that impact them and their practices.

Nick Dealtry
October 9, 2017

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Tom Price resigns as HHS secretary - what does this mean for independent physicians?

Amid controversy surrounding his use of private, chartered flights on official business, which he used extensively rather than flying commercial, Secretary of Health and Human Services (HHS) Tom Price resigned on September 29, 2017. Just over seven months after being confirmed to the HHS post, Price offered his resignation and President Trump accepted. During those seven months, Price, a physician himself, was instrumental in helping independent physicians navigate through and manage requirements set forth by the Centers for Medicare & Medicaid Services (CMS). Trump named Don J. Wright, a deputy assistant secretary for health and the director of the Office of Disease Prevention and Health Promotion, to serve as acting secretary, effective with Price’s resignation. How long Wright will hold the position and whether he will continue to push through the changes that helped independent physicians overcome many of the regulatory challenges is yet to be seen. It appears that Price is hopeful that his efforts on behalf of independent physicians will continue. In his resignation letter, he stated that he has “spent 40 years both as a doctor and public servant putting people first.” He emphasized the need to continue with his initiatives, regretting that “the recent events have created a distraction from these important objectives. Success on these issues is more important than any one person.” Modern Healthcare guest columnist Jeff Goldsmith, national adviser at Navigant Healthcare and an associate professor of public health sciences at the University of Virginia, remarked at the end of August that Price had accomplished much for independent physicians in his short tenure. Notably, most independent physicians have been exempted from the Merit-based Incentive Payment System reporting requirements of MACRA for 2018. Goldsmith listed a number of additional upcoming policy options, noting that it is “possible that this is just the beginning of a campaign to re-advantage independent practitioners.” As to the future of HHS and independent physicians, those may lie in the hands of possible Secretary of Health and Human Services candidates such as Seema Verma, CMS administrator, and Scott Gottlieb, the commissioner of the Food and Drug Administration (FDA).

Nick Dealtry
October 4, 2017

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3 helpful tips for physician barriers to value-based care

Providing quality care is, of course, a priority for independent physicians. The recent shift to value-based care, away from fee-for-service reimbursement, would seem to be welcome news for physicians who want their practice to focus on quality health outcomes rather than on the quantity of patient visits. However, some of the regulations and requirements imposed by the value-based care measurements may pose obstacles to independent physicians. Thomas J. Van Gilder, MD, JD, MPH, writing in Medical Economics, recently pinpointed three of those obstacles and provided some guidance in overcoming each of them. Physicians do not have all of the data they need. There is a communication gap between the primary care physician and other providers that are seeing the patient. Information must be shared between all providers involved in a patient’s care in order for that care to be truly value-based. Relying on the patient to relay information between multiple providers can lead to dangerous errors. Optimizing the use of electronic health records to maintain patient data and to share information with multiple providers enables the independent physician to overcome this barrier. Physicians are not trained to respond to tedious reporting requirements. While the shift to value-based care is enticing to the independent physician who wants to focus on patient care, it also comes with many regulations and requirements that the physician is not necessarily equipped to deal with efficiently. Dr. VanGilder suggests that this barrier can be overcome with “improved electronic workflows, sustained by technology designed to support, not hinder, communication between physicians and patients.” Hiring staff more equipped to respond to reporting requirements will also help the independent physician overcome this barrier to value-based care. Physicians do not have the support tools they need to practice value-based care effectively. A Deloitte survey found that “roughly three in four physicians have tools with clinical protocols designed to meet quality goals, but few (36%) have access to comprehensive protocols spanning multiple conditions.” Independent physicians need to be engaged in the development process, to ensure their support tools are helping, not hindering, their clinical workflows. Physicians should also take advantage of these tools to provide quality care and succeed in the new value-based care model.

Sam Peirce
October 2, 2017

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HHS launches campaign to educate patients about HIPAA

Patients are asked to sign paperwork, when visiting a physician’s office, that states they understand their rights under HIPAA. Of course, most people do not read all of the fine print and probably do not truly grasp all that HIPAA covers. In fact, the Health Insurance Portability and Accountability Act, more commonly known as HIPAA, encompasses rules related to both security and privacy. Patients can be assured their medical information is safe and secure and can only be shared with authorized entities, under HIPAA. They can also be assured that they have access to their own medical information. The HIPAA Privacy Rule gives patients the right to examine their own health records, obtain a copy of their health records, and request corrections on their health records if necessary. The United States Department of Health and Human Services (HHS) has launched a campaign to help patients learn more about their health information rights: Get It. Check It. Use It. HHS encourages patients to ask for their health information, to review it for accuracy, and to communicate with their physicians regarding their healthcare. HHS emphasizes that all patients have rights to their own healthcare information. A patient who has access to healthcare records has a “powerful tool in staying healthy.” The campaign encourages all patients to request their health information so they can have a better understanding of what is in their records and so they can share it with others, if necessary. The campaign also points out that many physicians have web portals that enable patients to easily access their healthcare records electronically. When patients are able to review their physician’s visit notes, their lab results, and their medical history, they tend to “ask better questions and make healthier choices” because, as the campaign states, “Information is key to making good healthcare decisions.”

Parker Nieves
September 22, 2017

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Policy debates other than the ACA

The Affordable Care Act (ACA) and its potential replacements have been the center of attention in the national healthcare news over the past several months. However, there are a number of other important health-related issues that are either being addressed or that experts feel should be addressed in the coming months. Physicians Practice has gathered input from experts on ten other health policy items to consider: The opioid crisis: Physicians tend to prescribe opioids for patients who suffer from chronic pain; those physicians need more options for places to send patients who need alternative pain-management treatments. Medicare for all: A single payer system funded through taxes has been proven to be cost-effective in other countries. Studies have shown that “healthcare outcomes improve with simplified coverage.” MACRA/Quality Payment Program: Higher quality performers should be rewarded with bonus payments through the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, according to one healthcare expert. The regulatory burden: Independent physicians are feeling significant pain points in regard to the regulatory requirements around MACRA. The Medicare Red Tape Relief Project has been launched by the House Ways and Means Committee to address this issue. More timely feedback: Providers are not receiving timely or helpful feedback from the Centers for Medicare & Medicaid Services (CMS). Congress should re-emphasize the original suggestion of quarterly feedback, one healthcare expert suggests. Medicaid waivers: In an effort to make healthcare accessible and affordable, options are generally available in every state for waiving certain portions of the Medicaid law. Reducing provider consolidation: The trend toward hospitals consolidating is driving up healthcare costs, a healthcare expert suggests, and pricing should be regulated to stem the increases. Stark Law: In an environment that is transitioning toward value-based care, it may be time to review the purpose of the Stark Law, which is focused on physician self-referral. Cost of care: Access and affordability are key elements to effective healthcare and rising costs are creating unaffordable health insurance premiums and costs for physicians as well as patients. Funding rural health programs: Funding for rural teaching programs is slated to end with the 2017 fiscal year. Physicians training in these programs tend to serve in primary care and in underserved areas; funds should be approved at least another three years to support these programs.

Tyler Comstock
September 22, 2017

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Could independent physicians save healthcare?

In the move toward value-based care and a stronger patient-physician relationship, it may just be the independent physician who can save the state of healthcare in the US today. Several physicians provided input regarding their views on how physicians can save healthcare, in a recent edition of Medical Economics. Ed Bujold, MD, FAAFP, wrote that he believes the way to save the healthcare system is for every patient to “have a primary care physician in a highly functioning medical home.” Others pointed out that the physician should coordinate care provided by specialty physicians, to act on test results and to be sure that duplications do not occur. An industry shift to empowering independent physicians to be able to focus more on patient care can make a tremendous difference in patient outcomes, in expenditures, and in the cost to the patient as well as the healthcare professional. As Dr. Bujold suggests, “It is the physicians and their ancillary personnel who understand how the system should work. Build the system around a strong primary care workforce.” Many physicians see healthcare as being too hospital-centric or insurance-centric. New Medicare and Medicaid regulations feel restrictive, even as both entities are pushing the transition to value-based care. Independent physicians are truly on the “front lines” of patient care and are the ones who can effect change in the system. Elation Health’s philosophy has always been focused on giving the independent physician the tools necessary to provide value-based, patient-centric care. We are committed to bridging that enormous chasm between the world of policy and payers, and the world of the front-line physician. Elation’s electronic health record (EHR) system enables physicians to access patient data, input visit notes, and view information entered by multiple providers, so they can focus on their patients instead of on paperwork. Our mission is to strengthen the relationship between patients and physicians, and enable phenomenal care for everyone, both essential factors in the independent physician’s ability to save healthcare.

Nick Dealtry
September 19, 2017

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Update on the 21st Century Cures Act

One of President Obama’s last undertakings while still in office was to sign into law the 21st Century Cures Act, popularly known as the Cures Act. The bill provides funding for innovations in healthcare, including grant funds for the Department of Health and Human Services (DHHS) to address the growing opioid crisis. The Cures Act also amends a previous act, the Health Information Technology for Economic and Clinical Health Act, “to require HHS to establish a goal, develop a strategy, and make recommendations to reduce regulatory or administrative burdens relating to the use of electronic health records (EHR).” The Act establishes guidelines for health information technology and states that the Office of the National Coordinator for Health Information Technology (ONC) must establish a framework for interoperability between systems. Today, the status of the Cures Act is somewhat uncertain given the new administration’s focus on reducing regulations as well as a hiring freeze on executive branch positions. However, some progress is being made. The ONC is gathering feedback from healthcare stakeholders regarding the interoperability mandate. The office released their Proposed Interoperability Standards Measurement Framework in April 2017. A number of healthcare groups have provided responses to the proposed framework. The concept of interoperability is generally accepted as necessary and helpful in coordinating care effectively; however, many respondents pointed out there are a number of barriers to successful interoperability. The US Food & Drug Administration (FDA) is also moving forward with implementing some of the changes described in the Cures Act. The FDA has posted a list of 21st Century Cures Act Deliverables, last updated in July 2017, which includes the status of those deliverables and availability of documents on their website. Elation Health will continue to monitor the status of the 21st Century Cures Act, to keep independent physicians informed of further updates.

Sam Peirce
September 19, 2017

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Virtual groups and interoperability

The Centers for Medicare & Medicaid Services (CMS) has offered independent practices the option to participate in virtual groups, to fulfill the requirements of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Merit-based Incentive Payment System (MIPS). These virtual groups are comprised of ten or fewer independent physicians, with the primary purpose of easing the reporting burden on each individual provider. However, a recent article in Modern Healthcare notes that “CMS estimates that only 16 virtual groups made up of 765 clinicians will launch by Jan. 1, 2018 to comply with the merit-based incentive payment system (MIPS) under MACRA.” Although the virtual group option was intended to help independent physicians comply with the new requirements, there have been a number of challenges involved. Virtual groups take time to form, as long as three months in most cases, given the need for agreements and coordination. In addition, independent physicians considering the possibility of a virtual group face the challenge of interoperability between their electronic health record (EHR) systems. Each practice would have to be able to share data with the other practices in the virtual group, for CMS reporting purposes. That data would also have to be standardized across all of the systems in the virtual group. Such standardization and aggregation of data would require a significant financial investment, none of which CMS has offered to subsidize as yet. Interoperability between physicians coordinating care for a particular patient is an important aspect of EHR use. CMS requirements for a Certified EHR system are designed “to support interoperability and advanced quality objectives in a single, cohesive program that avoids redundancies.” The structure of virtual groups, though, would require interoperability between as many as ten independent practices, in order to meet MACRA reporting requirements. CMS continues to consider exactly how virtual groups would work, including the standards they would have to meet, for 2018 MIPS payments.

Roy Steiner
September 19, 2017

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Bipartisan healthcare efforts hit snag over state flexibility disagreements

As the debate over the Affordable Care Act (ACA) continues and the deadline for changes to 2018 market plans looms, there are still a number of issues to be resolved. The Senate health committee met recently with a goal of stabilizing ACA, given the reality that the healthcare plan would not be repealed and replaced soon. The deadline for insurers to decide if they would offer healthcare coverage in the form of individual plans in 2018 - and what the premiums would be for those plans - is September 27. One issue is the discussion around cost-sharing reductions, impacting lower-income individuals. As reported in Modern Healthcare, if there is no firm agreement on CSR payments, “insurers are expected to raise rates in some areas by more than 20%, or stop offering coverage on the exchanges entirely.” The senior Republican and the senior Democrat on the health committee disagreed as to how much flexibility to give individual states “to redesign the ACA's coverage requirements under state innovation waivers.” While there appeared to be a consensus that Congress should “swiftly fund payments” to subsidize healthcare for low-income individuals, the snag over state flexibility could “doom prospects for passage of a stabilization package” before the deadline. Concerns arose during the health committee meeting that giving states the flexibility to change their plan benefit categories could result in higher healthcare costs for individuals. A disagreement among the committee members focused on whether states should be allowed to strip down the ACA benefit requirements so they can sell cheaper healthcare plans. Some argued that that would allow individuals to customize their plan while others disagreed, saying it would simply result in less available coverage. Elation Health will monitor and report on the latest news in the ACA debate as it happens. At Elation, we are focused on helping independent physicians provide the highest quality care to their patients and to be successful in their practices. We continue to be dedicated to bridging the enormous chasm between the world of policy and payers, and the world of the front-line physician.

Sam Peirce
September 18, 2017

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How is the US doing in terms of health insurance coverage?

The Affordable Care Act (ACA) was passed in 2010. Since then, there have been several attempts to revise various parts of the act. Just recently, a number of new plans have been debated and defeated in Congress, leaving the ACA intact. Though the intent of the ACA was to offer healthcare coverage for everyone, the question among many physicians and their patients continues to be where the US is now in terms of health insurance coverage. The Commonwealth Fund recently published a brief, “Following the ACA Repeal-and-Replace Effort, Where Does the U.S. Stand on Insurance Coverage?" Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, March–June 2017,” that explores this question further. The survey found that 14% of American adults do not have health insurance currently, a figure that has not changed significantly from the previous year. Of those uninsured adults, approximately half probably qualify for subsidies for their health insurance costs. The rate of uninsured adults is less than the 20 percent that were uninsured before ACA’s open enrollment period began in 2013. In regard to the healthcare marketplace, the survey found that 40% of those uninsured adults were actually unaware of its existence. Those adults who are participating in the marketplace for their healthcare insurance with “incomes below 250 percent of poverty are much more likely to view their premiums as easy to afford compared with people with higher incomes.” Elation Health continues to monitor the state of the healthcare coverage in the US. We are focused on helping independent physicians navigate healthcare policy to ensure quality care for their patients and success for their business. Elation’s mission has always been to help bridge the chasm between the world of policy and payers, and the world of the front-line physician.

Nick Dealtry
September 18, 2017

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Health IT experts evaluate the HITECH act

The Health Information Technology for Economic and Clinical Health (HITECH) Act was signed into law in 2009, as part of the American Recovery and Reinvestment Act (ARRA), to “promote the adoption and meaningful use of health information technology.” Incentives integral to the HITECH Act were designed to encourage independent physicians to adopt the use of electronic health records (EHRs). A recent Perspective piece in the New England Journal of Medicine states that currently “nearly 80% of office-based practices use certified EHRs.” While most physicians and their patients agree that EHRs provide value in that they increase efficiency, improve communications, and enable physicians to focus more on their patient care, there are still some obstacles to their use, particularly involving interoperability uses. Interoperability essentially means that different EHR systems are able to talk to each other. Concerns regarding interoperability include ensuring the safety and security of transferred information. In addition, since so many different EHR systems exist, each with different interfaces, technical specifications, and capabilities it is more difficult to understand how to exchange information in a frictionless way. The role of the Office of the National Coordinator (ONC), originally a coordinating entity and not a regulating agency, may need to change to help overcome those obstacles going forward. The authors of the Perspective piece, who were formerly national coordinators for health IT “believe that the culture surrounding access to and sharing of information must change to promote the seamless, secure flow of electronic information.” According to the Perspective, the ONC role will also be integral in “coordinating federal agencies in developing guidelines for technology deployment — collaboration that must be complemented by private-sector–led innovation.” The US has seen rapid gains in the use of EHRs since the launch of the HITECH Act. According to health IT experts, much more can be done as Federal partners “model new innovations that promote the seamless flow of information for care delivery.”

Sam Peirce
September 18, 2017

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Easing MACRA's pain points for independent physicians

Voluntary reporting for the Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization Act (MACRA) begins in January of next year. The new value-based payment system, a shift from the fee-for-service reimbursement plan, comes with some pain points for independent physicians. Recently, Black Book Research conducted a survey of 8,845 physician practices and identified their top 10 concerns related to MACRA, as reported in Health Leaders Media: Merit-Based Incentive Payment System (MIPS) compliance technology. Physician practices are seeking technological solutions to help them achieve reporting compliance. Electronic Health Record (EHR) optimization. For the top eight EHR companies, 83% of their physician-practice users reported working to upgrade their system for MIPS compliance. Consultant opportunity. The EHR capabilities required for participation in MIPS or Alternative Payment Models (APMs) represent a business opportunity for EHR consultants. Data wrangling. Taming data to conform with the reporting requirements of MIPS and APMs is daunting for many physician practices. Paying for procrastination. Physician practices that have not developed an in-house strategy for participating in MIPS or an APM are looking for outsourcing options. MACRA-induced physician-practice consolidation. Three-quarters of independent physician practices surveyed are considering selling their practice to a health system, hospital, or large group practice because of the regulatory and capital-cost burdens of MACRA. Economic incentives. For the first five years of the Quality Payment Program, there are powerful economic incentives to beat the MIPS performance threshold. Reputation risk. MACRA will result in performance data being reported publicly through Medicare's Physician Compare website and other rating systems. ACO appeal. Joining an accountable care organization (ACO) can increase the odds of MIPS success. Cost and quality transparency. MACRA is anticipated to be one of the market factors driving healthcare cost and quality transparency. Easing these pain points starts with selecting an effective EHR system. MACRA focuses on value-based care that can be more easily managed through the practice management features found in a MIPS-compliant EHR system. Working with a quality technology tool can also help the independent physician become more efficient, managing the operations behind the practice and reducing the burden of administrative tasks. Elation’s philosophy is focused on bridging the enormous chasm between the world of policy and payers, and the world of the front-line physician. Our technology platform helps ease the pain points involved with MACRA, to enable the independent physician to provide the highest quality patient care while optimizing value-based reimbursements.

Sam Peirce
September 11, 2017

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Evaluating value-based care

The Centers for Medicare & Medicaid Services (CMS) initiated the idea of value-based care and reimbursement as part of its Quality Strategy. The CMS value-based programs, designed to “reward health care providers with incentive payments for the quality of care they give to people with Medicare,” support the agency’s three-part aim of: Better care for individuals Better health for populations Lower cost. Any major program such as the value-based program, however, needs to be assessed on a regular basis to ensure that it continues to meet the needs of its stakeholders. In this case, the evaluation must focus on the benefit to providers as well as patients. Participants in a Health Affairs forum held in April 2017 asked many questions around value-based care, with the goal of determining whether it needs to be revisited or revised. As reported in the Health Affairs Blog, the forum “built on the growing evidence that our current efforts aren’t working as designed, a topic of much debate across the quality/performance measurement communities.” There was concern among the forum participants that “performance measurement could become an exercise in mandated compliance instead of actual performance improvement.” A key theme among the forum participants and many other independent physicians is that measurement and reporting can become an additional administrative burden. Independent physicians are tasked with providing quality care to their patients along with the regular daily tasks of practice management. Even when taking advantage of technology tools that give them ready access to their patient records and that enable them to input and review patient data seamlessly, independent physicians continue to feel the added burden of reporting requirements under the value-based care program. Health Affairs forum participants and others believe that it may be time to evaluate whether the value-based program, as it exists in its current form, is truly working to achieve its goals without further straining the resources of independent physicians.

Nick Dealtry
September 11, 2017

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Improving quality and lowering costs

In an environment that is experiencing increasing costs, physicians and patients alike long for a time when the financial impacts of healthcare will start to decrease while the quality of delivery significantly improves. The transition to value-based care may be part of the solution, as physicians begin to be reimbursed based on the quality of patient outcomes rather than on the number of office visits or procedures. A 2014 report published by The National Center for Biotechnology Information states that “expenditures in the US health care system total almost $3 trillion per year and account for 18% of the gross domestic product (GDP) or about $8,000 per person annually.” In terms of the quality of care received for these expenditures, the US ranks lower than most other developed countries. In fact, the World Health Organization (WHO) ranked the US 37th in overall health status. Independent physicians are understandably concerned about maintaining their financial stability while also continuing to provide the highest level of care available to their patients. A large portion of the healthcare costs involved in care delivery can be attributed to physician decisions regarding a patient’s care plan as well as to overhead expenses. When the physician has access to the patient’s complete medical profile, including notes from specialty providers, labs, and healthcare facilities regarding the patient’s diagnosis and treatment, that physician can more efficiently manage the patient’s healthcare plan. Streamlined electronic communication between the physician and patient and between multiple providers can help ensure that redundancies are reduced and quality of care is increased. In addition, an effective practice management tool can help efficiently manage the operations behind the independent physician’s practice and reduce the burden of day-to-day administrative tasks. Elation Health is focused on bridging that gap between the world of policy and payers, and the world of the front-line physician. Our solutions are designed to transfer the face of healthcare delivery, so independent physicians and their patients can realize their goals of lowered costs and improved care quality.

Nick Dealtry
August 31, 2017

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Understanding HIPAA

Today, most patients and physicians take for granted the need to protect medical information. When patients visit the provider they are asked to sign an acknowledgement that they understand how their information will be used. They may also be asked to indicate which family members will be authorized to have access to their medical data or their account information. All of these requirements have come about within the last twenty years and are connected to a much more extensive set of rules regarding protected information. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established uniform, national standards for the protection of patient’s health information. Prior to HIPAA, there was no consistent set of regulations applied with regularity across the healthcare industry. The HIPAA Privacy Rule “establishes national standards to protect individuals’ medical records and other personal health information.” The HIPAA Security Rule applies to electronically transmitted medical information, such as that contained in electronic health records (EHRs). Additionally, the Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted in 2009, to “promote the adoption and meaningful use of health information technology” while further protecting electronic health information. Protected health information (PHI) includes any identifiable information that is included in a patient’s medical record. HIPAA protects the patient from the unauthorized release or use of this information. Electronic protected health information (ePHI) protects electronically transmitted data. The Security Rule that protects ePHI applies to any system or any individual who has access to confidential patient data. Access is defined as having the means to read, write, modify, or communicate ePHI or personal identifiers that may reveal the identity of the patient. EHRs must be particularly adept at protecting patient health records, to ensure the independent physician and all collaborating physicians remain HIPAA compliant. The cloud-based EHR provides the added advantage of safety and security, in addition to seamless delivery of patient information when and where it is needed and appropriate. Cloud-based servers utilize careful and tactical efforts (such as conducting risk analysis, encrypting data, etc.) in order to assure that a patient’s ePHI is kept safe and private.

Sam Peirce
August 31, 2017

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How do doctors feel about interoperability?

Understandably, independent physicians want to be able to do what they do best, take care of their patients. To be able to do that effectively, they need to have all of their patients’ data readily available to them. That data includes records of a patient’s visits to other providers, lab results, medications, diagnoses, and treatment plans. Many physicians currently take advantage of the features of electronic health records (EHR) so they can input their own information regarding their patients. What they want is for those EHRs to talk to each other so they can coordinate care more efficiently and more effectively. Interoperability enables all physicians involved in treating a patient to access that patient’s complete medical information on screen rather than wasting time faxing, calling, and otherwise requesting the information from each other. A recent article in Medical Economics cites surveys showing that “the majority of doctors believe that exchanging health information with other providers could help them deliver better care. But they don’t want to spend time searching for the information; they want it delivered to them.” Physicians do not want to spend more time making interoperability happen. They want their systems to talk to each other so they have the information they need when they need it, for their patients’ healthcare quality. Elation understands the importance of coordinated care and the role that interoperability plays in that care. Our innovative Collaborative Health Record (CHR) was built with physicians’ and patients’ needs in mind. With CHR, all physicians are able to provide truly collaborative care. CHR automatically shares updates directly from the physician’s Clinical HER and other providers get immediately notified so they can take action based on the most up-to-date clinical information. Physicians want to see a complete medical profile without the need to ask for - and wait for - that information. True EHR interoperability enables them to do just that, further improving their ability to provide quality healthcare for their patients.

Tyler Comstock
August 31, 2017

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Why collaborative health records enable care coordination

Electronic health records (EHRs) have evolved! Collaborative health records (CHRs) digitally link a patient’s entire care network, improving care coordination and the quality of care everyone on the team is able to provide. Working across systems, CHRS are designed to enable each provider caring for a patient the access to information needed to care for that patient properly. No more need for shuffling or requesting paperwork. If your patient has seen a specialty provider, that provider can share the patient information digitally using the Collaborative View tool, giving you automatic access to a comprehensive patient view. Care coordination between providers is seamless, efficient, and in real-time. Why the need for CHRs? In a study published by the AMIA Annual Symposium, the authors stated that “experts have agreed that more collaborative, team-based care will be required to meet the increasing burden of chronic disease.” In another study published in the Annals of Family Medicine, the researchers found that patients with chronic conditions were the most likely to experience poor primary care coordination. Patients with chronic conditions, in particular, generally see more than one provider. Those multiple providers need to be able to collaborate, to share diagnoses, medication recommendations, lab results, and care plans, to better and more effectively treat their patients. Through the use of CHRs, these providers can coordinate information that can be easily shared and used at the point of care. Updates are communicated automatically, so providers and their staff do not have to fax or call and then wait for paper updates. Collaboration through the use of advantaged technology significantly improves the quality of care coordination by helping to ensure the accuracy of the information being shared as well as speeding up the process by which it is shared. Taking advantage of collaborative health record technology can help you with your main focus - providing the highest quality care to your patients. Check out the features of CHRs and learn how to coordinate care with the Collaborative Health Record!

Roy Steiner
August 31, 2017

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The significance of connected care technology

Advances in technology have significantly improved communication tools in general. For the healthcare industry, in particular, advanced connectivity enables physicians and patients to communicate and to collaborate on the patient’s healthcare plan. The Future Health Index report explores the areas in which connected care technology impacts patient healthcare the most, where it benefits patients and how it needs to improve for future care quality. The report indicates that: Seventy-eight percent of Americans and 78 percent of healthcare professionals see connected care technology as most useful for treating medical issues. Seventy-six percent of Americans and 75 percent of healthcare professionals think it’s most useful for diagnosing medical conditions. The Index reports on results of “surveys and interviews with more than 33,000 healthcare professionals, insurers and members of the public across 19 countries and five continents.” One of the main findings of these surveys and interviews is that most participants agreed “that digital technology can and must provide people with more control to manage their own health and health providers with tools to improve care delivery.” Connected care technology includes the ability for patients and physicians to communicate seamlessly and with minimal effort. Patients who are able to collaborate with their physicians are more engaged in their own healthcare plan, resulting in improved patient outcomes. Collaboration between physicians is also crucial to the quality of a patient’s healthcare plan. When technology enables an independent primary care physician, for example, to electronically share records and view notes from other healthcare providers, that physician is better able to manage the total healthcare for the patient. Lab results and visit notes available electronically reduce the time waiting for information and reduce the risk of errors and duplications. Elation Health’s philosophy is focused on the much-needed connected care technology platform that strengthens the relationship between patients and physicians and enables phenomenal care for everyone.

Roy Steiner
August 29, 2017

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Care coordination trends

Care coordination is a hot topic in healthcare right now. The move toward more coordinated care will help reduce costs and will result in higher quality care for the patient. What are some of the ways physicians are improving care coordination in primary care practices? The first thing a primary care physician needs to do is to communicate with other providers who are also treating the patient. Particularly for patients with chronic or complex illnesses, a number of specialty providers may be involved in the care plan. Care coordination in primary care involves an understanding of the procedures, medications, lab tests, and care plans ordered by the other providers. Care coordination should also involve the patient, to be sure the patient knows which medications to take when and which doctor to contact for each medical concern. Primary care physicians should encourage their patients to connect with them directly for questions or clarifications. Another tool used to improve care coordination in primary care practices is the EHR system. As an article published by HealthIT.gov states, “EHRs have the potential to integrate and organize patient health information and facilitate its instant distribution among all authorized providers involved in a patient's care.” Elation works diligently to provide solutions that help the independent primary care physician enhance care coordination efforts. Our innovative Collaborative Health Record enables you to access patient information from every provider in your network. Coordination used to require endless hours of paperwork, sending and receiving faxes, and waiting on answers from other providers, but now you have that information at your fingertips. Shawn Myers, RN, a Patient Engagement Solution Strategist, writes in Healthwise that “organizations are accountable to provide high-quality health care at lower costs, which requires efficiency and coordination of resources.” Elation’s EHR solutions will help you provide the care coordination your primary care practice needs, to reduce your costs and to improve patient outcomes.

David Burke
August 29, 2017

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Frequently asked questions about interoperability

Interoperability has become a topic of some significance in the healthcare field. The Centers for Medicare & Medicaid Services (CMS) has emphasized the need for interoperability as it relates to the meaningful use of certified electronic health record (EHR) technology. In addition, the Office of the National Coordinator (ONC) for Health Information Technology (IT) has published a Proposed Interoperability Standards Measurement Framework “to determine the nation’s progress in implementing interoperability standards in health information technology (health IT) and the use of the standards as a way to measure progress towards nationwide interoperability.” As much as the topic has been discussed, however, there are still many questions in the minds of independent physicians and other healthcare providers regarding interoperability. What is interoperability? Essentially, interoperability enables different electronic health record (EHR) systems to talk to each other. Interoperable EHRs allow the electronic sharing of patient information between different EHR systems and healthcare providers, improving the ease with which doctors can provide care to their patients. Such coordinated care is particularly important for patients with chronic or complex conditions who may see multiple providers for their care. What are some of the challenges to interoperability? There are often large fees associated with setting up connections between EHR systems A lot of different EHR systems exist, each with different interfaces, technical specifications, and capabilities–this makes it harder to understand how to exchange information in a frictionless way Patient data has traditionally been kept very private, causing confusion as to how to share information safely Additionally, certain stakeholders such as IT companies are incentivized to block the sharing of patient health information What are some of the benefits of interoperability? The eHealth Initiative outlines many of the benefits in their Fact Sheet: Health IT Interoperability: Lower healthcare costs Better, coordinated care Improved patient safety Population health When physicians are able to communicate with each other through interoperable systems, there are fewer duplications, omissions, and errors, resulting in improved healthcare delivery and improved patient outcomes.

Parker Nieves
August 29, 2017

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Groups comment on MACRA's proposed rule

In June, the Centers for Medicare & Medicaid Services (CMS) issued a Proposed Rule for Quality Payment Program Year 2, with a goal to “keep what’s working and use stakeholder and clinician feedback to improve the policies finalized in the transition year.” CMS requested comments from the healthcare community regarding the proposed rule for the Quality Payment Program, established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), as well as on the CMS message and education delivery. The deadline for those comments was August 21, 2017. A number of groups submitted a variety of feedback to CMS regarding the proposed rule. As reported in Medscape, the American Medical Association (AMA) and the American Medical Group Association (AMGA) both “sought more flexibility for eligible clinicians and group practices to take part in the Merit-Based Incentive Payment System (MIPS). However, these two groups differed in their comments regarding the CMS proposal regarding Low-Volume Threshold, which reads: Increase the threshold to exclude individual MIPS eligible clinicians or groups with ≤$90,000 in Part B allowed charges or ≤200 Part B beneficiaries during a low volume threshold determination period that occurs during the performance period or a prior period. The AMA was supportive of the proposed threshold, while the AMGA was critical of the higher numbers and recommended keeping the current threshold of $30,000 or less. According to the Medscape article, the Medical Group Management Association (MGMA) commented that “it was unrealistic to expect practices to be ready for full-year reporting by January 1, just a couple of months after the final QPP rule is expected to be released” and asked CMS to “permanently shorten the reporting period for quality measures from the calendar year to 90 consecutive days.” Elation Health will continue to monitor and report on updates to the Proposed Rule for Payment Program Year 2, as well as on any other changes to the Medicare Access and CHIP Reauthorization Act (MACRA) with a focus on helping independent physicians provide quality healthcare to their patients while managing their practices more efficiently.

Sam Peirce
August 28, 2017

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How Elation Health helps independent physicians navigate health policy

Elation Health’s Clinical First EHR gives you the freedom to focus on your patients by assuming the burden of your practice’s technology needs, helping you stay up-to-date with the latest policy requirements, and supporting your overall business viability. One of our goals is to help independent physicians thrive and in doing that, we continually support health policy programs like CPC+ and MACRA. In December of last year we submitted our public comment to the Centers for Medicare & Medicaid Services (CMS) regarding the virtual groups concept included in the final rule of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Elation’s CEO and Co-Founder Kyna Fong submitted our take on how CMS should implement the concept of virtual groups “to clinically benefit patients and to encourage collaboration.” In our comment, we discussed how this provision benefits the independent physicians attempting to navigate the complexities of reimbursement reform by allowing providers to collaborate and combine resources without sacrificing their independence. In February of this year Elation Health developed a series of new resources that help physicians stay up-to-date with the latest policy requirements and healthcare trends, while supporting the way an independent practice cares for its patients. The resources that rolled out earlier this year are the Elation Resource Center, Webinar Calendar, and the MACRA e-Book. In April of this year Elation announced our support for independent primary care physicians that are participating in the Centers for Medicare and Medicaid Services (CMS) Comprehensive Primary Care Plus (CPC+) program. We will be supporting CPC+ practices for the full five-year duration of the program using Elation’s technology and support resources. We’re devoted to making our platform CPC+ ready and we have done that by developing workflow improvements, reporting capabilities, and collaboration tools within our Collaborative Health Record, all of which enable participating physicians to get the most out of this program. In March of this year, Elation’s Clinical First EHR was recognized as a top-three, Best in KLAS EHR in the Small Practices category. Specifically, the Best in KLAS summary states: “Elation delivers a stunningly easy-to-use EMR backed by the guidance and assistance providers need to navigate changing regulations that can sometimes be overwhelming for the smallest practices.” This recognition is a huge honor for Elation because every year, the health IT industry looks to KLAS, a leading health IT research firm, to recognize the EHR systems that are performing best in serving the needs of their customers. Elation is dedicated to aiding small practices to succeed, strengthening the patient-physician relationship and enabling phenomenal care.

Tyler Comstock
August 28, 2017

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Public opinion on the ACA repeal and replace efforts

Multiple debates and Congressional votes have taken place in 2017, regarding the possible repeal and replacement of the Affordable Care Act (ACA). Several new plans have been proposed and rejected. Congress has spent a considerable amount of time on its efforts to repeal and replace the existing healthcare plan. What does the public think about all of this activity? The August Kaiser Health Tracking Poll asked that question. Most Americans, 60 percent, stated that it is a “good thing” that the ACA was not successfully repealed and replaced. 62 percent disagree with the President’s strategy that Congress should “not take on other issues, like tax reform, until it passes a replacement plan for the ACA.” In addition, 57 percent want Republicans and Democrats to work together to make improvements to the current version of the ACA. The poll, conducted in August 2017, continues to show that the majority of the public “holds a favorable view of the ACA than an unfavorable one (52 percent vs. 39 percent).” These numbers are “an overall increase in favorability of nine percentage points since the 2016 presidential election as well as an increase of favorability among Democrats, independents, and Republicans.” In fact, the poll shows that most Americans are “relieved” or “happy” that the repeal and replace efforts were not successful. The Kaiser Health poll found that most people want to see the ACA healthcare law succeed. “Eight in ten (78 percent) Americans think President Trump and his administration should do what they can to make the current health care law work.” Elation Health will continue to monitor the progress of the debate around the healthcare policy and its effects on independent physicians. We are committed to providing the latest information as we work to help providers succeed in their practices, in our mission of strengthening the relationship between patients and physicians, and enabling phenomenal care for everyone.

Nick Dealtry
August 28, 2017

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What is ICD-10?

The International Classification of Diseases (ICD) actually began as the International List of Causes of Death, adopted by the International Statistical Institute in 1893. The World Health Organization (WHO) was entrusted with the ICD system in 1948, publishing the sixth edition as ICD-6. ICD is, according to WHO, the “diagnostic classification standard for all clinical and research purposes.” ICD is designed for: Easy storage, retrieval and analysis of health information for evidenced-based decision-making Sharing and comparing health information between hospitals, regions, settings and countries Data comparisons in the same location across different time periods. Now in its tenth revision and known as ICD-10, the coding system is seen by many independent physicians as a source of stress and frustration. Though helpful for categorizing and tracking patient data, ICD-10 is a major shift from its predecessor, and as of October 2015, is mandated by the Centers for Medicare & Medicaid Services (CMS) as a replacement for ICD-9. ICD-10 is more complicated and more specific. While the old ICD-9 codes used 3-5 characters consisting only of numbers, the new ICD-10 system uses codes with 3-7 characters in an alphanumeric combination, thus allowing for greater specificity in making diagnoses. ICD-9 did not have the specificity needed in many cases to enable the physician to identify, for example, whether a broken bone is in the right or left hand. In addition, most other countries had already transitioned to the ICD-10 system so the US mandate was effective in making coding systems compatible for collaboration internationally. While helpful in identifying conditions and injuries, ICD-10 has been a challenge for many independent physicians. ICD-10 has approximately 69,000 codes compared to the 14,000 ICD-9 codes. Providers who use electronic health records (EHRs), however, have found that the transition from ICD-9 to ICD-10 seamless. The ICD-10 mandate, according to CMS, is required for all medical providers subject to HIPAA regulations, not just to those who bill Medicare or Medicaid.

Sam Peirce
August 22, 2017

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This advisor's take on solving interoperability for small independent practices

Part of the beauty of an electronic health record (EHR) system is that it gives the independent physician ready and immediate access to information on a patient, including lab results, medications, and visit notes from other providers the patient may have seen. The interoperability of EHR systems plays an incredibly important role in this process. Interoperable electronic health records (EHR) allow the electronic sharing of patient information between different EHR systems and healthcare providers, improving the ease with which doctors can provide care to their patients and patients can move in and out of different care facilities. What happens when there is no interoperability between systems? David Wasserman, an advisor with the practice solutions and medical economics group at the Massachusetts Medical Society, was recently interviewed by Physicians Practice on the subject of solving interoperability for small practices. When asked what solving the interoperability problem could mean for patient care, Wasserman stated that it would impact: … maintaining continuity of care for patients, minimizing or eliminating the duplicity of services, and helping physicians share patient information so they can gain insight from specialists that would complement their diagnoses. He elaborated on the interoperability challenge, providing an innovative approach to the problem that is caused when EHR systems are not able to talk to each other. Wasserman suggested that an independent physician who has a good relationship with a patient might be able to use that high level of patient engagement to have the patient persuade other healthcare facilities: … if your patient has a good relationship with you as a physician, your patient can then ask for the hospital to provide you with access to their systems. Providing you with access to your patient via the hospital's EHR means you can track their progress. Wasserman agreed that all parties involved, including independent physicians and healthcare facilities, must work together to drive interoperability “and they have to put the patient first, and their cash second.”

Roy Steiner
August 21, 2017

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Report compares the US healthcare system to other countries

During the past decade there have been many studies done on the United States healthcare system, more specifically on primary care, due to the efforts to try and change the healthcare system for the better. The legislation that started it all was the Affordable Care Act (ACA), whose main goal was to expand the access of health coverage for Americans; with others aims being to protect patients against irrational actions by insurance companies and to lower costs. Because ACA started the change to a better healthcare system, we are now finally making a transition from a fee-for-service reimbursement structure to a value-based care reimbursement structure and are now more than ever, focused on the benefits of an efficient and effective primary care system. What better way to improve our own health care system than to look at the structures of other countries healthcare and primary care? Here are some of the main statistics and facts from a slew of research studies including the 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians: Nearly 25% (1 in 4) of primary care physicians in the US report that they are not prepared to care for the sickest and weakest patients, and 84% say that they are not prepared to manage patients with serious mental health illness. The US has a younger patient population but still a higher share of patients with chronic illness, mental health issues and other significant health problems. In the US only 31% of primary care physicians report that they get notified when a patient is sent to the ED or is discharged from the hospital, compared to the 69% of PCPs in the Netherlands who report to always getting notified when these events happen. Slightly less than 40% of US PCPs had made arrangements for patients to get after hours care without going to the ED which was the lowest rate in one of the surveys, this was compared to 94% in the Netherlands and 92% in New Zealand and 89% in the UK. Only 6% of US PCPs can make home visits compared to more than 80% in the UK and the Netherlands. In the US 57% of PCPs communicate with patients via email (within and EHR software) and 60% allow patients to access their medical records online, but only 52% of doctors say that they are satisfied with their EHR system. 80% of Americans who needed to see a specialist were seen in less that 4 weeks compared to 41% in Canada. The US is in 7th place in regards to the percent of adults (57%) who can see a doctor or nurse the same day that they need care, with 19% of adults having to wait 6 or more days to see a healthcare professional. 1 in 3 American adults skipped a doctor's visit, didn’t pick up a prescription or get other care in the past year (survey done in 2009) because it costs too much. The US had the highest rate of poor primary care coordination out of 11 countries at 9.8%. Poor primary care coordination was more likely to occur among patients with chronic conditions and those younger than 65. Patients with poor care coordination were more likely to be hospitalized and more likely to visit the emergency department. 59% of US physicians said that their patients often have difficulty paying out-of-pocket costs for medical care, higher than all other 10 countries. US and German physicians are the most negative about their healthcare systems. More than half of US respondents (physicians) said that they or their staff spend too much time getting patients care because of coverage restrictions on treatment or medications. In the Health Affairs surveys in 2012, all countries in the survey (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Switzerland, UK and the US) besides the US and Canada, have policies for after-hours coverage and access to primary health care services. The countries in the survey stated above all provide universal coverage (besides the US), and with the exception of Switzerland have little or no cost sharing for primary care and essential medications. As well as all of the other countries limiting out-of-pocket expenses to levels well below those typical in US insurance. In Sweden and in the US 1 in 6 physicians reported that their practice was not well prepared for patients dealing with mental health or substance abuse issues. A larger percentage of doctors in the US provide their patients online access to view, download, or transmit information from their medical record; with the US at 60% and all other countries at 28% or below. Therefore there is a larger use, and transitions to using EHR systems in the US. Some takeaways from these studies have shown that the US healthcare system needs reform, including enhanced access to care for all patients. The US primary care practices are behind other countries in their readiness to manage the care of high-needs patients and that we need to strengthen our primary care infrastructure to be able to ensure affordable and high-quality health care for our sick and complex patients as well as all patients. US consumers have better access to speciality care but have a harder time seeing a doctor on the day they need help and paying their medical bills than consumers in other countries. We need to figure out a way to make it easier for patients to get care on nights and weekends and be able to enable access to social services. The only area that the US exceeded in, compared to the other countries was the fact that our primary care physicians are using and implementing EHR systems in their practices much more than physicians in other countries. Using EHR systems benefits us because it helps our physicians coordinated care more efficiently, although we are still behind other countries because they have other tactics to help increase care coordination such as always getting notified when one of their patients is seen in the Emergency Department and when their patients are discharged from a hospital. In these surveys better care coordination was associated with having an established relationship with a regular physician, indicating the ongoing benefits of strengthening of primary care and another reason why we should be focusing on the enhancement of primary care practices.

David Burke
August 21, 2017

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AMIA submits recommendations to improve interoperability

In April 2017, the Office of the National Coordinator (ONC) for Health Information Technology (IT) released the Proposed Interoperability Standards Measurement Framework. The framework was designed to “to determine the nation’s progress in implementing interoperability standards in health information technology (health IT) and the use of the standards as a way to measure progress towards nationwide interoperability.” Interoperable electronic health records (EHR) allow the electronic sharing of patient information between different EHR systems and healthcare providers, improving the ease with which doctors can provide care to their patients and patients can move in and out of different care facilities. On publishing the document, ONC requested “public comments on its proposed interoperability standards measurement framework and how to best engage data holders and other relevant stakeholders in implementing the proposed framework.”  The American Medical Informatics Association (AMIA) submitted their response in July 2017, in a 10-page letter addressing the various areas of the proposed framework. AMIA, which represents “more than 5,400 informatics professionals, representing researchers, front-line clinicians and public health experts,” supports the development of a measurement framework for interoperability standards. In their response, AMIA emphasized the need to have the benefits outweigh the costs and to limit the reporting burden. The letter recommends that measurement and measure reporting: Be automated wherever possible; Initially, target high-value standards/use cases; and Deliver value to those stakeholders being measured. AMIA recommended that the proposed framework’s Objective 2: Use of Standards by End Users to Meet Specific Interoperability Needs, should have both quantitative and qualitative measures. Quantitative measures should be automated, according to the AMIA, which added that “ONC must understand which standards are used to facilitate interoperability for clinical use cases that are widely considered to have high-value for patients.” AMIA also urged the ONC to further determine where interoperability is not occurring: Rather than try to develop measures for the myriad of ways interoperability may be occurring, we recommend an approach that looks to understand where interoperability is needed, and then assess whether it is occurring. In publishing the proposed framework, ONC stated that it wants to engage stakeholders in the process and “hopes to develop a measurement framework that is realistic to implement while providing an accurate assessment.”

Roy Steiner
August 18, 2017

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Health IT groups respond to ONC's interoperability framework

Reducing the burden on providers and ensuring that measurements have the biggest impact are two of the major themes running through the responses provided by health IT groups to a recently published interoperability framework. The Office of the National Coordinator (ONC) for Health Information Technology (IT) released the Proposed Interoperability Standards Measurement Framework in April 2017. In the document, the ONC requested feedback, in particular on “how to best engage data holders and other relevant stakeholders in implementing the proposed framework.” A number of organizations, including the Healthcare Information and Management Systems Society (HIMSS), the American Medical Informatics Association (AMIA), the Electronic Health Record Association (EHRA), the College for Health Information Management Executives (CHIME), and Health IT Now offered their comments and concerns. EHRA urged the ONC, in its response, to “carefully consider and take into account the potential burdens and opportunity costs on providers and developers associated with additional measurement.” The organization also suggested that “any volume measurements should be meaningful and easily obtainable from metadata already available on the transactions, rather than involving separate surveys collecting these or other data.” Health IT agreed that “the barriers to interoperability can best be solved by private-market developed standards and initiatives.” The group encouraged “ONC to involve patients and patient advocates in interoperability measurement.” AMIA suggested that “Focusing on high-value use cases and associated standards will constrain the measurement options and limit the reporting burden.” They gave the example of “LOINC for moving lab orders and results information between EHRs and lab systems, as well as sharing across institutions.” HIMSS emphasized the “importance of pursuing a measurement framework that will not produce undue burden on the industry.” CHIME’s response to the proposed interoperability framework was more resistant than the other IT organizations. As reported in Fierce Healthcare, the group cited “patient matching as one of the biggest hurdles to interoperability and called the measurement standards ‘premature.’" Elation Health will continue to monitor the proposed interoperability framework responses, as part of our mission to support independent physicians, enabling phenomenal care for everyone.

Nick Dealtry
August 17, 2017

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What is value-based care?

The Centers for Medicare & Medicaid Services (CMS) is transitioning from fee-for-service reimbursement to value-based care. What does that mean and why are they making the move? CMS says it is part of a larger strategy to “reform how health care is delivered and paid for.” They have tied incentive payments to the quality of care physicians provide their patients. According to CMS, value-based care supports their three-part aim of: Better care for individuals Better health for populations Lower cost Value-based care focuses on the quality, rather than the quantity, of a physician’s patient-related activity. While measuring value-based care can be challenging, patient outcomes are the true gauge of success for both the provider and the patients. Rather than relying on the number of patient visits per day as a measure, the provider can look to the value of the care provided and the resulting patient health status as a determinant of value-based care. CMS states that value-based programs are part of its Quality Strategy, which is focused on: Using incentives to improve care. Tying payment to value through new payment models. Changing how care is given through: Better teamwork. Better coordination across healthcare settings. More attention to population health. Putting the power of healthcare information to work. Quality measures are put into place to help measure processes, outcomes, patient perceptions, and other elements associated with the physician’s ability to provide high-quality health care. The goals of quality measures, as outlined by CMS, include effective, safe, efficient, patient-centered, equitable, and timely care. Elation Health is dedicated to helping independent physicians provide value-based care to their patients. Our electronic health record (EHR) solution enables the physician to focus on patients rather than on paperwork during a visit. Physicians can access patient records, including visit notes from other providers, lab results, and medication orders, with just one click.

Tyler Comstock
August 15, 2017

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Why it's beneficial for independent physicians to stay on top of health policy

Health policy is affecting the way physicians work and receive reimbursement now more than ever before, but there are other reasons why independent primary care physicians should care about health policy. While doctors are in their residency training they learn a lot about the workings of the human body in even more detail then when they were in medical school, but they are usually not exposed to health policy all that often. They are much more focused on serving and treating patients, and while that is the main part of their duties, they should be more informed about current health policies, especially when theses policies help or hurt their patients. A university in Washington D.C. is trying to change this; they have established a three-week fellowship in health policy for medical residents where they not only hear lectures from policy experts but also visit Capitol Hill, the Supreme Court, federal and local health-related agencies as well as local health care facilities. This point in a physician’s career is the best time to open their eyes to the workings of health policy in the U.S. In their residency they have had time to get up close and personal with the healthcare system unlike they have before, and with being in the midst of everything they’re able to see flaws that so many physicians have overlooked. When anyone is shown something new they assess it and think of ways in which the process or system can be fixed, it is in essence the equivalent of an outsider looking into a situation; they can see what others cannot. There is so much going on in the healthcare industry right now as well as the health policies in the U.S. and more independent primary care physicians are trying to familiarize themselves so that they can better serve their patients. Understanding these policies can help to improve them and to help out patients who may need support or something other than being treated. Physicians are currently trained to not worry about the cost of services when helping patients, even though doctors provide the most expensive services that any American spends their money on. Neel Shah, an OB-GYN in Boston and a health policy researcher at Harvard has said, “"Clinical training teaches you to be a terrible steward of health care resources in every way, when you're being chastised as a trainee, it's always for the things that you didn't do but could have. It's never for the things you did do but didn't have to do. When, of course, patients can be harmed both ways." There are other ways to help out patients besides treating them; pointing them in the right direction, maybe towards financial aid for their healthcare costs, to counseling, or to a healthcare clinic, can be exactly what they need. Learning about health policy and understanding how it works and what can be or needs to be fixed, can truly help out patients in another aspect of care.

David Burke
August 14, 2017

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Overlooked approaches to interoperability

Interoperability is all about accessibility. Interoperability allows the independent physician to access patient information, without waiting for a fax or a phone call from another provider. Likewise, any approach to interoperability has to start at that physician level. The interoperability crisis has often pointed to more high-level issues, but tackling interoperability in Health IT must focus on the reason it is needed - more efficient, more effective patient care. A patient-centered approach, putting the patient’s data at the center of the care ecosystem, is the much-needed catalyst for interoperability. Physicians need more than just an exchange of data. They need to be able to access patient information using a real-time, collaborative tool that gives them current, accurate test results, visit notes, and other information that has been input by a patient’s other healthcare providers. As Robert Wachter, MD, Chief of Hospital Medicine, University of California, San Francisco Medical Center, noted in 15 Thoughts on Interoperability from Healthcare Leaders, healthcare leaders “want a seamless flow of information around all the buildings they own.” They want collaboration and interoperability between their patients’ providers, labs, and pharmacies. They are not necessarily concerned about the issue or interoperability or the interoperability crisis that may exist anywhere else. The challenge is to approach interoperability from that patient-physician perspective. Solutions such as Elation’s Clinical First EHR  provide a provider-centric Clinical EHR that exists at the nexus of the clinical workflow, supports the physician-patient relationship, and drives outstanding patient outcomes. This approach reassures patients that they have access to their physician and their physician has access to the patient's’ complete medical picture, including visits to other providers, lab results, and medications. While the Office of the National Coordinator (ONC) for Health Information Technology (IT) has published a 10-year vision for addressing the interoperability crisis and achieving an interoperable Health IT infrastructure, the most innovative and effective approach starts in the “buildings” the independent physician owns. As the ONC Health IT vision points out, “physicians expect health IT to enable and support patient care.” Any approach to interoperability must stay focused on improving the quality of that patient care.

Roy Steiner
August 9, 2017

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New bipartisan coalition introduces policies to help fix Obamacare

Now that the revised healthcare plan that was proposed to replace the Affordable Care Act (ACA) has been voted down for the final time, the two parties are joining forces to form a new bipartisan coalition. The Problem Solvers Caucus, led by Reps. Tom Reed (R-N.Y.) and Josh Gottheimer (D-N.J.), is made up of 21 Republicans and 22 Democrats in the House of Representatives. Another Republican member is expected to join soon, evening up the members’ political affiliations. Gottheimer, as reported by CNN, stated on the Monday after the replacement bill defeat, “Instead of just focusing on killing the ACA, we're focused on how to fix it in a smart way. When (Sen. John) McCain said on the floor it's time to work together like the country wants -- that had a big influence on our group. It was a shot in the arm." Some of the recommendations and proposals that the Problem Solvers Caucus intend to focus on, according to Modern Healthcare, include: Securing appropriations for cost-sharing reduction payments, the roughly $7 billion in annual reimbursements insurance companies get for offering low-income customers reduced co-pays and deductibles without those costs being priced into premiums. Proposing that the federal government send states money for reinsurance and other strategies to reduce premiums. Asking HHS to revise guidance on Medicaid 1332 waivers, and issue clear guidance on ACA Section 1333. Recommending that the medical-device tax, which has been delayed the past two years, be repealed. Recommending that the employer mandate to provide insurance only apply to companies with 500 employees or more. Elation Health is committed to helping independent physicians understand policies and regulations that may affect them. We will stay on top of the latest news and updates regarding the changing landscape of the healthcare policy. Elation is focused on bridging the enormous chasm between the world of policy and payers, and the world of the front-line physician.

Parker Nieves
August 8, 2017

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Healthcare: What comes next after failed repeal and replace bill?

On July 27, 2017, the much-debated replacement for the Affordable Care Act (ACA) was dealt its final blow. Technically, the end came in the wee hours of July 28, when Arizona Senator John McCain cast a surprising and definitive vote against the proposed replacement bill. What comes next? The proposed replacement bill was essentially the work of the Republican party, primarily in the Senate. Now that the bill has been voted down for the last time, after months of revisions and multiple rounds of voting, attention is moving to a bipartisan effort of roughly 40 House Republicans and Democrats who want to focus on fixes, rather than replacement, for the ACA. The Problem Solvers Caucus is being led by Co-chairs Republican Rep. Tom Reed of New York and Rep. Josh Gottheimer, a Democrat from New Jersey. Reed stated that the coalition actually formed at the end of 2016, organizing officially with bylaws as a voting bloc in Congress. The group said “enough is enough … now we're taking a position on the health care bill to move it forward for the American people.” Going forward, the members of the Caucus plan to work together to improve the healthcare plan, reducing premiums for consumers and stabilizing the system. No timeline has been set yet for the plan developed by the Problem Solvers Caucus. Elation Health is dedicated to helping our clients understand the ramifications of any healthcare bill that may be proposed and/or passed. We will continue to monitor the situation regarding the Problem Solvers Caucus and changes to the ACA. At Elation, our philosophy has always been about bridging the enormous chasm between the world of policy and payers, and the world of the front-line physician. As such, we developed our electronic health record (EHR) solutions to help ease the administrative burden for independent physicians who are focused on the quality of the healthcare they provide to their patients.

Sam Peirce
August 8, 2017

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Explaining interoperability challenges for EHRs

Electronic health records (EHRs) that talk to each other help independent physicians provide quality care to their patients. Primary care physicians are able to collaborate with specialty providers and all providers caring for a patient are able to view patient data with one click. Often, though, EHRs are built with different interfaces, technical specifications, and capabilities; and interoperability becomes a challenge. The Office of Health Information Technology (IT) states that “standards are particularly critical in four areas of EHR technology: How applications interact with users (such as e-prescribing) How systems communicate with each other (such as messaging standards) How information is processed and managed (such as health information exchange) How consumer devices integrate with other systems and applications (such as tablet PCs)” Interoperability often poses challenges regarding the security of patient data as well. EHRs must be able to share information seamlessly and securely. Putting safeguards into place, per the HIPAA Security Rule, can ensure that all data transmitted between systems is protected. Technical Safeguards, one part of the Security Rule, concern the technological systems used to provide access to and protect electronic protected health information (ePHI). ePHI must be encrypted to the National Institute of Standards and Technology (NIST) standards if the ePHI leaves the organization’s internal firewall servers. Interoperability is crucial for the coordinated care that many patients need, particularly those with chronic or complex health issues. Rather than waiting for faxes or returned phone calls, all providers can easily access patient information when different EHR system communicate with each other, providing a higher level of quality care for that patient. Elation’s Collaborative Health Record (CHR) is a centralized dashboard with a patient’s story, notes, and test results, managed by all of the physicians treating a patient. Every time a patient sees another provider, that physician can add their report to the CHR and make it viewable to the primary care provider. With EHR interoperability, all providers can make more informed decisions about the patient’s health.

Roy Steiner
August 4, 2017

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Largest barriers to interoperability

Interoperability has been a known issue in healthcare for a while now - so why haven't we cracked the code yet? True interoperability enables the electronic sharing of patient information between different systems and different providers, for the benefit of the patient’s care. Given the huge benefits of interoperability to the independent physician and to the patient, what are the biggest roadblocks toward achieving that interoperability? The Office of the National Coordinator's Health IT Policy Committee reports that “true health information exchange won't happen until a critical majority of providers have installed and are successfully capable using EHRs.” Until more independent physicians opt in to solutions such as the Clinical First electronic health record, true interoperability will continue to be a challenge. The Health IT Policy Committee report also points out that “process innovation” is a barrier to those medical practices that need to incorporate technology into new processes, to reduce the impact on day to day activities. Although the independent physician may be taking advantage of EHR for interoperability, the office processes may not be keeping up with the advantage technology for effective practice management. HIPAA and security concerns are also large roadblocks toward achieving interoperability. Recent cybersecurity concerns are also a challenge to interoperability. Communication with patients and with other providers must be protected against cyber attacks. With a solution such as the Clinical First electronic health record, the independent physician can be assured that shared data is safe and is in compliance with all HIPAA regulations for electronic protected health information (ePHI). The Health IT Policy Committee report suggests that, for true interoperability to exist and to be successful, it will require “multiple stakeholders to act in a coordinated manner.” Additional, economic-focused incentives need to be evident for all providers. Beyond the benefits of coordinating care through the EHR, Health Information Exchange (HIE) payment incentives with specific timelines for implementation may encourage more participation.

Aviel Ettin
August 4, 2017

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Chronic conditions and interoperability

An independent primary care practice that takes advantage of advanced technology such as electronic health records (EHR) can improve its efficiency and its effectiveness with patient outcomes. When a patient requires coordinated care with specialty providers or healthcare facilities, that technology must be capable of interoperability with other systems to provide the seamless care that will most benefit those patients with chronic conditions. The Centers for Disease Control and Prevention (CDC), as reported in Managed Healthcare Executive, states that “half of Americans currently suffer from chronic conditions, and 25% of Americans have two or more chronic diseases.” Patients with chronic conditions generally see multiple providers, require additional lab tests and medications, and may require stays in healthcare facilities. These patients benefit significantly from the coordinated care that a primary care physician can provide through interoperability. Interoperability enables the primary care physician to share patient data with specialty providers, to more effectively provide the coordinated care that is so important to patients with chronic and complex illnesses. Otherwise, the primary care physician is often relying on the patient’s memory or waiting for paperwork to come through from the other providers. This can result in wasted time and potentially dangerous errors. EHR systems must be able to communicate with each other, for true interoperability. EHRs enable the independent physician to more easily view a patient’s records and chart progress; however, to coordinate with specialty providers seamlessly and securely, the primary care physician must be able to also see data input by specialty providers, labs, and healthcare facilities. Interoperability helps the primary care physician provide better quality care to those chronically ill patients who need coordinated care the most. Elation’s Collaborative Health Record (CHR) has as its goal the facilitation of cross-communication between providers. The CHR is a centralized dashboard with a patient’s story, notes, and test results, managed by all the physicians treating the patient. Every time the patient sees a doctor, the physician can add their report to the CHR and make it viewable to the primary care physician.

Roy Steiner
August 3, 2017

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CMS announces physician payment proposals for 2018

The Centers for Medicare & Medicaid Services (CMS) is seeking comments on a proposed rule for physician payments in 2018. The Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2018 contains a number of changes and requests for input. Some of the changes, as described in the CMS Fact Sheet, include: Overall Payment Update and Misvalued Code Target:  The overall update to payments under the PFS based on the proposed CY 2018 rates would be +0.31 percent. Care Management Services:  CMS is continuing efforts to improve payment within traditional fee-for-service Medicare for chronic care management and similar care management services to accommodate the changing needs of the Medicare patient population. CMS is proposing to adopt Current Procedural Terminology (CPT) codes for CY 2018 for reporting several care management services currently reported using Medicare G-codes. Physician Quality Reporting System (PQRS):  Under the PQRS, individual eligible professionals and group practices who did not satisfactorily report data on quality measures in 2016 are subject to a downward payment adjustment of 2.0 percent in 2018 to their PFS services. PQRS is being replaced by the Merit-based Incentive Payment System (MIPS) under the Quality Payment Program (QPP). The first MIPS performance period is January through December 2017. 2018 Value Modifier: In order to better align incentives and provide a smoother transition to the new Merit-based Incentive Payment System under the Quality Payment Program, CMS is proposing the following changes to previously-finalized policies for the 2018 Value Modifier: Reducing the automatic downward payment adjustment for not meeting minimum quality reporting requirements from negative two percent to negative one percent (-1.0 percent) for physician and non-physician solo practitioners and groups of two to nine clinicians; Holding harmless all physician groups and solo practitioners who met minimum quality reporting requirements from downward payment adjustments for performance under quality-tiering for the last year of the program; and Aligning the maximum upward adjustment amount to 2 times the adjustment factor for all physician groups and solo practitioners. Elation Health will continue to monitor and report on CMS updates regarding physician payments. We remain committed to bridging the enormous chasm between the world of policy and payers, and the world of the front-line physician. The deadline for submitting comments on the proposed rule is 5 p.m. on September 11, 2017.

Sam Peirce
July 31, 2017

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Learning more about interoperability through other industries

In a world of increasing technological capabilities, the idea of exchanging data across systems is becoming more acceptable and even expected in some industries. Information technology (IT) has advanced to the point that computers can virtually “talk” to each other, to share information and to enable streamlined, efficient processes within a number of industries. What can the healthcare industry learn from other industries that have had to tackle interoperability? The issue of healthcare interoperability involves the concern that EHR systems must be able to talk to each other. While patient data is much more complex with many more individual elements than most data in other industries, the healthcare industry can learn something about interoperability from other industries. As author Mary Butler writes in a recent article in AHIMA's HIM Body of Knowledge, the healthcare industry might look to the banking industry as an example in interoperability achievement. Noting that the “industries like finance and telecommunications solved [interoperability] ages ago,” she cites the example of individuals who withdraw money from ATMs. When someone uses a debit card to withdraw money from an ATM, the machine connects with that person’s bank account by using technology. The money is then automatically deducted from the bank account, regardless of which ATM is used and where the person and the bank account are located. The healthcare industry is learning and moving forward. To help further the efficiency and effectiveness of healthcare interoperability, standards are being put in place through the work of the Office of the National Coordinator for Health Information Technology (ONC). The Health IT ONC is rolling out initiatives and involving EHR vendors to promote and better coordinate more efficient interoperability. Although healthcare interoperability is focused on vendors and independent physicians, the patient is also a significant stakeholder in the process. Just as the bank customer wants to have ready access to the bank account, the healthcare patient must have a way to access records and communicate seamlessly with providers through the use of EHR. Elation is developing solutions, such as the Collaborative Health Record, that will promote healthcare interoperability as well. We are focused on providing independent physicians with the access to patient information they need to collaboratively reduce costs and improve patient results.

Dante Capozzola
July 31, 2017

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The potential of healthcare APIs

Application program interfaces (APIs) are a big driver for tackling interoperability. APIs essentially enable software systems to access each other’s information. In a healthcare setting, an API is a critical piece of clinical technology that enables independent physicians to readily access patient information, including crucial data that has been inputted by other providers the patient has seen for care. Interoperability between systems, using advanced clinical software, helps the independent physician focus more fully on providing quality patient care instead of wasting time searching for information. As noted by Kyle Murphy, PhD, in a recent Health IT Interoperability article, “many subject-matter experts and innovators continue to tout the potential of widespread API use in healthcare to enable health data exchange and interoperability.” Elation Health’s API functionality Elation’s API functionality and efforts have been noted recently by Wellness for Life, as a move toward innovation in healthcare delivery. Justin Leigh, Chief Operating Officer at Wellness for Life, in discussing a new partnership with Elation, noted that our clinical technology solutions are a “groundbreaking platform” that will enable them to deliver “phenomenal care.” APIs are designed to share healthcare information across clinical software systems. As such, concerns have been raised about cyber security and HIPAA conformity. To address these concerns, the Health IT Policy and Standards Committee has formed an API Task Force that has established three basic privacy and security criterion: Authentication, access control, and authorization Trusted connection Auditing actions on health information or auditable events and tamper resistance With these assurances in place, healthcare APIs can safely tackle the interoperability between systems that is so important to independent physicians and their patients. Many patients, particularly the chronically ill or elderly, visit multiple providers for treatment. Their care might include lab tests or diagnostics that must be readily available to the primary care physician, to ensure the highest quality care for the patient. APIs make it possible for both physician and patient to take advantage of easy, secure access to that patient’s healthcare information. Elation is excited to be at the forefront of the interoperability innovations that are made possible with APIs, enabling independent physicians to focus on patient care instead of on paperwork.

Roy Steiner
July 31, 2017

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5 care coordination obstacles to overcome

Coordinating care is extremely beneficial to patients who see multiple providers. The primary care physician must be able to collaborate and communicate with specialty providers, labs, and healthcare facilities, to provide the most effective care for a patient. When that patient has a chronic or complex condition, care coordination becomes even more important. However, there are a number of obstacles faced by independent physicians as they attempt to coordinate that care seamlessly and productively. A recent article in Medical Economics outlines five obstacles to care coordination: 1. Interoperability Independent physicians who use EHRs to maintain their patients’ data need their systems to be able to talk to other EHR systems. The seamless and secure digital exchange of patient information is essential to proper care coordination. 2. Working with specialists Referrals can be a challenge when a primary care physician is attempting to coordinate care with a specialty provider. There have been some disagreements between primary care and specialty physicians regarding who is responsible for providing the patient’s information to the other. However, the responsibility for the patient’s quality of care ultimately lies with the primary care provider. 3. Payments Proper coding will be necessary to ensure the primary care provider is reimbursed for care coordination efforts. Many practices are finding they are not being reimbursed as much as they think they should be for coordination services. According to Medical Economics, “Medicare’s Quality and Resource Use Report is a good source for determining how effectively a practice is delivering coordinated care compared to its peers.” 4. Medication coordination Harmful polypharmacy, negative interactions that are caused by medications prescribed by multiple providers, can certainly be an obstacle to effective care coordination. EHR interoperability becomes very important for patients who need multiple prescriptions. Providers and their electronic records systems need to talk to each other to avoid interactions that could prove to be severe in their patients. 5. Patients Yes, patients themselves need to be actively involved in their care coordination for it to be effective. Patients often meet with obstacles such as financial challenges, transportation difficulties, and other issues that keep them from being able to follow up with specialty providers or lab tests. Primary care providers can help by providing a list of resources to their patients who need extra help in these areas, including local public transportation providers or options for financial assistance.

David Burke
July 31, 2017

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Elation's provider network and the power of physician collaboration

When independent primary care physicians are able to collaborate with other physicians providing care to their patients, everyone benefits. The primary care physician can coordinate a care plan without replicating tests or medical procedures, reducing costs and improving patient outcomes. Physician collaboration is powerful. Brennan Bosch and Holly Mansell, BSP, PharmD, write that collaboration “has been shown to improve patient outcomes such as reducing preventable adverse drug reactions, decreasing morbidity and mortality rates, and optimizing medication dosages.” When collaboration is done efficiently, the physician also benefits, as the stress and added work are reduced. Of course, physician collaboration is not as easy as it may seem. Often, it is quite challenging. Physicians may rely on a patient’s memory or struggle with obtaining records from other providers. Endless phone calls and faxes waste time and may even endanger the quality of the patient’s healthcare. Elation is focused on helping independent physicians achieve collaboration in a way that empowers them to provide the highest quality patient care in the most efficient and effective manner. Elation's Provider Network (EPN) is a service built inside of Elation’s Clinical EHR that benefits the independent physician and the patient. Elation’s Provider Network works by automatically identifying the providers who have cared for patients based on clinical interactions. After identifying relevant collaborators, the EPN verifies providers’ contact information to make it easy for physicians to connect with past and present collaborators. Physician collaboration requires communication. The Elation Provider Network enables the independent physician to reliably communicate and share patient information in just three clicks — even with providers that don’t use Elation’s Clinical EHR. Speed and accuracy are very important factors when a patient’s diagnosis and treatment plan depends on test results or observations made by specialty providers. EPN gives the independent primary care physician and the patient the confidence that collaboration is just a few clicks away.

Nick Dealtry
July 31, 2017

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How can EHRs help with coordinated care?

When a patient has a condition that must be treated by specialty providers, a referral is generally made by the primary care physician. Typically, the referral is faxed over. After the patient sees the specialty provider, the primary care physician may have to wait for visit notes or test results to be faxed back. Occasionally, it is actually up to the patient to relay to the primary care doctor the information that resulted from the specialty visit. The typical process takes time. It may result in errors or omissions. Mistakes can be made when all the relevant information is not shared professionally and in a timely basis. Fortunately, physicians using electronic health records (EHRs) have all of the patient data they need at their fingertips, without wasting what could be very precious time and without fear of missing data. Coordinated care between the primary care physician, specialty providers, labs, pharmacies, and healthcare facilities is crucial for the quality of a patient’s care. Those patients with chronic or complex conditions, especially, need to know that their doctors are coordinating care plans, medications, and tests, for the best possible healthcare outcomes. As the Office of Health Information Technology (IT) points out, “EHRs have the potential to integrate and organize patient health information and facilitate its instant distribution among all authorized providers involved in a patient's care.” The information contained and easily accessed in an EHR allows for better information sharing and provides all physicians with accurate and current medication lists. Errors and duplications can be virtually eliminated when all physicians caring for a patient have access to that patient’s EHR. In an emergency situation or when a patient’s condition is in need of immediate treatment, time can be a significant factor in the quality of that patient’s care. Physicians who use EHRs can depend on immediate and accurate information available to all physicians involved in a patient’s care, so they can focus on the quality of that care rather than wait for paperwork or depend on the patient’s memory for their coordinated care efforts.

Aviel Ettin
July 27, 2017

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What is the government doing about interoperability?

Care coordination is achieved through the sharing of patient information, between medical providers and between physicians and their patients. Interoperability between electronic health records (EHR) systems enables that care coordination to become seamless, efficient, and more effective. How is the public sector responding to the growing need for interoperability between health systems? In Connecting Health and Care for the Nation - A Shared Nationwide Interoperability Roadmap, the Office of the National Coordinator (ONC) for Health Information Technology (IT) lays out a plan for building upon the success of recent health IT advances. The ONC recognizes the need for interoperability and the need “to create an open, person-centered health IT infrastructure.” Interoperability goals for the future ONC’s vision is a “learning health system … where providers have a seamless ability to securely access and use health information from different sources.”  In its roadmap, the ONC states its goals on the following timeline: 2015-2017: Send, receive, find and use priority data domains to improve health care quality and outcomes. 2018-2020: Expand data sources and users in the interoperable health IT ecosystem to improve health and lower costs. 2021-2024: Achieve nationwide interoperability to enable a learning health system, with the person at the center of a system that can continuously improve care, public health, and science through real-time data access. In 2015, the ONC also published its Interoperability Standards Advisory, which represents the model in which the office “will coordinate the identification, assessment, and determination of the best available interoperability standards and implementation specifications for industry use toward specific health care purposes.” The ONC recognizes that more needs to be done in the way of establishing policies, updating technology, and changing the culture toward care coordination, in order to achieve true interoperability. The move toward electronic health records for every patient is a step in that direction. Patient-centered health care is a priority shared by independent physicians, the ONC, and Elation Health. Contact us to learn more about how we can help you!

Nick Dealtry
July 27, 2017

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5 health policy predictions

Healthcare is a major topic of discussion in the news, in politics, and among physicians and their patients. Debate continues around the future of the Affordable Care Act (ACA), whether it will be replaced with any version of a new plan, and when any changes might occur. Issues of coverage, premiums, taxes, and the state of Medicaid are points of contention that have made healthcare and its policies uncertain. Still, experts can make health policy predictions, based on the current healthcare IT environment and how it is moving forward. John Halamka, MD, CIO of Boston-based Beth Israel Deaconess Medical Center, is optimistic about healthcare IT and has offered five predictions about its future: Stakeholders need to “focus on enhancing interoperability technology and policy in support of care coordination, population health, precision medicine, patient/family engagement, and research.” Care coordination, in particular, will become more important as the patient population ages. In regard to electronic health records (EHRs), “usability of the IT tools in the marketplace needs to be enhanced.” Independent physicians can take advantage of these technology tools to streamline their practices and focus more on patient care, but the tool itself must become more user-friendly. EHR vendors are progressing in this area, as they are working on usability improvements. A number of organizations “in industry, government, and academic are thinking about patient identity strategies.” Whether that identifier is biometrics, a voluntary national identifier, or an innovative software solution, the focus will be on building a “consensus on a framework that accelerates the availability of such an identifier for multiple purposes.” To simplify patient privacy protections, organizations are researching “how best to converge our heterogeneous state privacy policies, specifically focusing on the role of the patient as data steward.” In a move toward improved patient outcomes and a value-based payment structure, there will be “an overwhelming sentiment that the concept of certification and prescriptive IT policy should be replaced by an outcomes focus.” Dr. Halamka predicts the future of healthcare will be a “great time” for patients, as IT systems improve through market-driven innovations and low-cost, cloud-based systems help physicians focus more on quality outcomes for their patients.

Dante Capozzola
July 26, 2017

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Are independent physicians prepared for MACRA?

The Medicare Access and CHIP Reauthorization Act (MACRA) focuses on value-based reimbursement, moving providers away from the traditional fee-for-service payments. The MACRA Quality Payment Program (QPP) offers two tracks for independent physicians: Advanced Alternative Payment Models (APMs) or The Merit-based Incentive Payment System (MIPS) A majority of the independent physicians participating in a recent survey conducted by the American Medical Association (AMA) and KPMG, Inc., an audit, tax, and advisory firm, indicated they were not prepared for MACRA requirements. The survey, involving 1,000 practicing physicians, also revealed that: 56 percent plan to participate in the Merit-based Incentive Payment System (MIPS) in 2017, a payment system with variable incentive payments or penalties based on certain quality and efficiency measures, while 18 percent are expecting to qualify for higher and more stable payment as an Advanced Alternative Payment Model (APM) participant. In regard to their knowledge level, 51 percent of the survey participants indicated they were “somewhat knowledgeable about MACRA and the QPP” and only 8 percent were “deeply knowledgeable” about the program requirements. Those independent physicians responding to the survey who were in very small practices and those who did not have experience with value-based reporting systems stated they were “significantly more likely to view requirements as ‘very’ burdensome” and that they “feel less well prepared for long-term financial success.” Just as significantly, 90 percent of the physicians participating in the survey stated they felt that the “reporting requirements were ‘somewhat’ or ’very’ burdensome, with the time required to report performance being the most significant challenge.” MACRA recently released a new proposed rule designed to ease some of those restrictions on independent physicians. Elation Health understands the needs of independent physicians and will continue to work to help providers as they work to improve the quality of healthcare services they provide their patients while also managing their practices effectively. Our team of experts will stay on top of the latest regulations and guidelines provided by the Centers for Medicare & Medicaid Services (CMS) to keep our providers well informed!

Nick Dealtry
July 26, 2017

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What are the health policy priorities for the ONC in 2017?

The Office of the National Coordinator (ONC) for Health Information Technology (IT) wants to see more patient-provider interaction and wants providers to realize more benefits from their electronic health records (EHRs). The newly appointed National Coordinator, Donald Rucker, M.D., held a press conference recently to discuss the ONC’s priorities for independent physicians and health policy. Dr. Rucker expressed his empathy for very small practices, particularly in regard to reporting and documentation requirements. EHR usability is one of the ONC’s priorities. Realizing that the administrative requirements may be excessive for independent physicians, the ONC will work toward reducing the regulations and reporting requirements that keep physicians from being able to spend more time with their patients. The Office is focused on helping providers and their patients get the most from their EHRs. The ONC is also working with the Centers for Medicare & Medicaid Services (CMS) to ease some of the reporting burdens coming from that office. They will work on reducing reporting requirements and have already issued a proposed rule that will reduce the administrative strain on independent physicians. CMS has moved toward a value-based payment system that encourages physicians to spend more time with patients providing quality healthcare services. However, many small practices have found the reporting requirements for the new reimbursement system to be quite stringent, and they actually now have less time to spend with patients. A second ONC priority is interoperability. Ensuring that systems can talk to each other, to provide secure and seamless data exchange between providers, is crucial to the quality of a patient’s healthcare plan. To that end, Dr. Rucker stated that the ONC should have EHR efficiency and interoperability as a focus going forward. Interoperability is particularly important for independent physicians providing coordinated care for patients with multiple providers. EHRs that enable each provider to immediately input and then view data for a patient are much more beneficial and useful for those providers as well as their patients.

Sam Peirce
July 26, 2017

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Participating in an APM? Elation is perfect for you!

Medicare for more than $30,000 a year), have the option of selecting between Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APM) for receiving Medicare reimbursements. If you have decided to participate in an APM you also know that they reward practices who take on added risks when treating their patients; and to be qualified to participate in an Advanced APM there are three criteria, one of them being that the practice must use a certified EHR technology. Although there are many certified EHRs out there, you want your EHR to support you and your practice during this extensive reporting and reimbursement change. The success of MACRA depends on independent physicians and those on the frontlines of providing patient-centered, value-based care. Supporting these physicians is one of Elation's priorities. We’ve created online resources, live webinars, informative videos, email newsletters, detailed articles, and on-call health policy specialists to give specific guidance and support to help physicians maneuver MACRA. We’re committed to making the transition to value-based care as uncomplicated as possible for every type of practice. Elation is here to support you and is equipped with the resources to enable independent practices to participate in APMs stress-free.

Nick Dealtry
July 21, 2017

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Interoperability and EHR use are among the most talked about topics in healthcare

Are interoperability and EHR just buzzwords or are they an integral part of your independent primary care practice? Interoperability and EHRs have been in the news alot lately, but what are they and what do they mean to you? They are actually very important topics that you need to know about, particularly in regards to care coordination. EHR, or electronic health record, enables you to update and maintain your patient’s health information electronically. No more paper forms. No more shuffling through a file trying to find notes from a previous visit. All of your patient’s data is in one place and is easily accessible. Interoperability happens when different EHR systems play well together, enabling you to electronically share information with other providers. Care coordination within an EHR happens with interoperability. When you have a patient who sees a specialty provider, visits a lab for tests, or has medical services provided in another facility, you can coordinate care for that patient with the help of interoperable EHR systems. Interoperability improves the quality of your patient’s care Interoperability can also improve patient safety. Medications can be coordinated. Human error in completing paperwork is virtually eliminated. Waiting for test results to be faxed or called in becomes a thing of the past. These advances are being discussed widely in the healthcare field because they are that important to the practice of an independent primary care physician. As reported in an EHR Intelligence article, “Organizations left and right are recognizing the need for seamless transfer of health data between disparate systems and are working together to do something about it.” EHR and interoperability are becoming particularly important for the independent physician as the healthcare industry moves toward a patient-centered, value-based system. Independent physicians are always focused on the care of their patients and care coordination with an EHR becomes even more seamless through true interoperability. Want to learn more? Contact us today! We can help you maneuver through these terms and show you how they can benefit your practice - and your patients.

David Burke
July 21, 2017

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Possibilities for passing a bipartisan healthcare bill

The plan designed to replace the Affordable Care Act (ACA) has faced numerous debates and delays. In the Republican-controlled Senate, there are not yet enough votes to pass a new healthcare plan. Even though Senate Majority Leader Mitch McConnell plans another vote on yet another version of the plan sometime during the week of July 17, many speculate that it will take bipartisan cooperation to see positive results. Many Republican Senators heard from their constituencies over the July 4 break and are now either expressing concerns or are noncommittal. A number of lawmakers have proposed securing bipartisan support for fixing certain parts of the ACA while leaving the basic structure intact. Dick Durbin, the second-ranking Senate Democrat agreed that there is “a bipartisan appetite to tackle this issue." In fact, Reuters reports that on Friday, July 14, the American Medical Association (AMA) “called the new bill inadequate and said more bipartisan collaboration is needed in the months ahead to improve the delivery and financing of healthcare.” At the heart of the debate is whether those covered by Medicaid and by health plan subsidies will be adversely affected. Another significant aspect of the growing resistance reflects on the Congressional Budget Office (CBO) prediction that 22 million people would lose their healthcare insurance coverage under the proposed new plan. The AMA, medical advocacy groups, and independent physicians are all concerned with the impact that the new healthcare plan will have on patients who will no longer seek care if they have no coverage. At Elation, we are committed to continuing our goal of helping independent physicians focus on their patients’ positive outcomes, regardless of the outcome of the possible bipartisan healthcare bill. We recognize that certain healthcare trends will move forward, including the use of electronic health records (EHRs) to simplify medical records, improve communication, and enable independent physicians to provide the quality care necessary for their patients. [ximagination] © 123RF.com

Dante Capozzola
July 18, 2017

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What is a health information exchange?

Patient health information often needs to be shared between multiple providers, laboratories, testing sites, and healthcare facilities. When that information is maintained in paper files, the primary care provider must call or fax a request to the other providers or rely on the patient to bring the records to a visit. Sometimes, information from another specialty provider visit is dependent on the patient’s memory. All of these strategies can result in delays, duplications, omissions, and errors. Health information exchanges (HIEs) are more efficient and accurate ways for “health care providers and patients to appropriately access and securely share a patient’s vital medical information electronically,” as stated by the Health Information Technology (IT) office. Data that is transferred via HIEs is typically then incorporated into the patient’s electronic health record (EHR) so the primary care physician has immediate access to critical information regarding that patient. Patient information that is shared using advanced tools such as Collaborative Health Records (CHR) is more dependable and can be transferred in a timelier manner. Elation’s CHR solution enables primary care providers to automatically share updates directly from the Clinical EHR. Other providers get immediately notified so they can take action based on the most up-to-date clinical information. The Health IT office describes three key forms of health information exchange: Directed Exchange – ability to send and receive secure information electronically between care providers to support coordinated care Query-based Exchange – ability for providers to find and/or request information on a patient from other providers, often used for unplanned care Consumer Mediated Exchange – ability for patients to aggregate and control the use of their health information among providers Efficient, accurate information is made available to all providers and healthcare facilities caring for a patient through HIEs. Electronic communication between providers and between the patient and providers can be a useful tool in expediting requests for information as well. HIEs can significantly improve the data a provider has available regarding a patient’s care and, subsequently, improve the level of care that physician is able to provide the patient.

David Burke
July 18, 2017

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What is the MIPS-APM track?

As the Centers for Medicare and Medicaid Services (CMS) moves toward a value-based payment plan, many independent physicians are growing concerned about their practices’ financial risks. Under the Merit-based Incentive Payment System (MIPS), providers are penalized for poor performance scores.  With the shift towards value-based care, a portion of an independent physician practice’s Medicare payments are at risk and this share will grow over time. However, another option, known as the Advanced Alternative Payment Model (APM), may be available. The third track, the MIPS-APM track, is described in an article in Modern Healthcare, as being “available for physicians participating in Track 1 of the Medicare Shared Savings Program,” and as one that “doesn't punish physicians for low scores in MACRA performance categories.” This model is only available, though, to those physicians participating in an Accountable Care Organization (ACO). ACOs are formed by physicians who are concerned with providing coordinated care to their Medicare patients.  Modern Healthcare further explains that “establishing an ACO requires healthcare organizations to build data analytics tools, enhance information technology and hire care coordinators and additional staff to oversee the venture. “ CMS lists the following three criteria to determine whether a practice qualifies as an Advanced APM: 1)      Practice uses certified EHR technology. 2)      Practice employs quality measures similar to those used in the MIPS quality performance category to provide payments 3)      Practice takes on an increased financial risk for monetary losses, in forms such as reduced rates or withheld payments. The MIPS-APM track helps transition the independent physician into value-based care, particularly those who are concerned about the financial ramifications of the new reimbursement strategy. One of the MIPS-APM’s goals, according to CMS, is to “reduce eligible clinician reporting burden,” which will also, in turn, help reduce the financial burden on the independent provider.

Sam Peirce
July 17, 2017

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Care coordination v. care management

The terms “care coordination” and “care management” are often used interchangeably. In reality, though, they are considerably different. While both are obviously focused on patient care, there are varying implications in regard to billing, reimbursement, patient management tools, and patient outcomes. Yet the two activities are interconnected. The Agency for Healthcare Research and Quality (AHRQ) describes care coordination as: deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient's care to achieve safer and more effective care. The AHRQ emphasizes that care coordination necessitates communicating the patient’s needs and preferences at “the right time to the right people.” The information must be shared and used in a secure manner and in a way that provides “effective care to the patient.” Further, the AHRQ describes care management as: a promising team-based, patient-centered approach designed to assist patients and their support systems in managing medical conditions more effectively. Care management is a more episodic approach that has, according to AHRQ, “emerged as a leading practice-based strategy for managing the health of populations.” Given the shift toward value-based reimbursement structures, independent physicians are investing in tools that help them more effectively direct their efforts toward the specific and immediate needs of their patients, in a move toward care management. The primary care physician actually has more control over the care management of patients, as care coordination requires the involvement of all stakeholders, including specialty providers and healthcare facilities. The need for care coordination continues to be an important factor in patient outcomes, however. As the population ages and develops chronic or complex conditions, coordinating care between multiple providers will become even more critical to those patients’ well-being. Care management can encompass those care coordination activities. Likewise, care coordination is often included as part of the patient’s care management strategy.

Nick Dealtry
July 17, 2017

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Who could benefit the most from highly-coordinated care?

Independent primary care physicians know that coordinated care is important for all of their patients. They also realize that some patients have a greater need and benefit more from care coordination in primary care plans. Patients with complex needs and chronic conditions tend to benefit the most from highly-coordinated care, for a number of reasons. Research published by the Agency for Healthcare Research and Quality (AHRQ) describes those with complex health needs as having not only medical issues but quite often social support needs as well. These patients typically are the most costly, primarily due to the wide range and the intensity of the services they require. Patients with complex needs tend to have more emergency room and hospital visits. They receive care in a number of medical facilities, in addition to undergoing a variety of lab tests and other procedures. As such, “they are more vulnerable to fragmented care.” The AHRQ research report points out, though, that primary care providers who “can effectively coordinate the full range of medical, mental health, and social services may have special benefit” for these patients. Patients with chronic conditions also benefit from care coordination in primary care. As the AHRQ research report states, “these patients generally use more health services and receive care from more and different health professionals than do people without chronic conditions.” Coordinated primary care can be the difference for chronically ill patients who see multiple specialty providers. Primary care physicians need accurate and timely information from all providers involved in the patient’s care, to ensure everyone is collaborating effectively. The more efficiently the primary care physician is able to access this information, the more the patient benefits. Highly-coordinated care benefits patients with complex needs and chronic conditions, as well as those patients who are not chronically ill. When independent primary care physicians have the ability to know which providers have cared for their patients, they no longer have to rely on their patients’ memories or to shuffle through paperwork to find that information. The physicians are able to do what they do best and that is to focus on providing the highest quality care to all of their patients. [alexraths] © 123RF.com

Roy Steiner
July 17, 2017

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The bipartisan way lawmakers are trying to improve healthcare

Today’s healthcare environment has been referred to as a debate over money rather than a discussion of the actual quality of healthcare. In fact, many of the most contentious points of the Affordable Care Act (ACA) and its potential replacement focus on patient payments and insurance reimbursements. Author Adam Davidson, writing recently in The New Yorker, points out that there has long been a bipartisan solution that actually contributes to the improved quality of healthcare itself. Capitation is, in Davidson’s words, “an ungainly name for a system in which a medical provider is paid a fixed amount per patient.” The payment is typically made monthly or annually and covers all the services a patient would need over that period of time. The system of capitation payments has been around for many years and enjoys bipartisan support. Even though the cost of healthcare has not been a topic of much political discussion, the payment structure itself is changing. Today, there is bipartisan support for moving away from a fee-for-service system. The ACA created the Center for Medicare and Medicaid Innovation, which was charged with exploring alternative payment systems. Value-based payments have since been adopted by the Centers for Medicare and Medicaid Services (CMS) as an incentive for providers to focus on the quality of the healthcare they deliver rather than the frequency with which they see their patients. Whether payment for a patient’s healthcare services is made through a capitation system or reimbursed with value-based payments, lawmakers are recognizing that these types of payment structures do contribute to improved patient outcomes. There are incentives on the physician side, in particular, to focus more on healthcare quality and less on multiple visits and procedures. Physicians are also better able to manage their practices efficiently with known revenue streams. The costs of healthcare itself could potentially be reduced with value-based or capitation payments. Patient visits can become more effective and more efficient.  Most importantly, the quality of healthcare itself can certainly be improved with these bipartisan moves.

Sam Peirce
July 13, 2017

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Care coordination and value-based care

Now that healthcare has shifted to value-based care and reimbursement, the importance of care coordination has been elevated. How are these two concepts related? Value-based care focuses on the quality of care provided to the patient, rather than on the number of times a patient is seen by a provider. When a patient is seen by multiple providers, such as a primary care physician and one or more specialty providers, that patient’s care must be coordinated between those providers to ensure that the care provided by all is efficient and effective. Lack of proper care coordination can be costly, both in terms of financial expenses and in terms of patient health. Value-based care coordination entails proper communication and sharing of medical information. As an independent primary care physician, you need to know which physicians are caring for your patient as well as which lab tests or medications other physicians have ordered. Otherwise, costly mistakes can be made and the level of care you are able to provide your patient can be diminished. Financially, value-based care coordination can help reduce costs incurred both by the patient and the independent physician. When reimbursement is based on the quality of care rather than the quantity, your emphasis has to be on optimizing each patient visit and ensuring that your patient is knowledgeable, leaving your office with the appropriate treatment plan. Otherwise, time and money can be wasted on unnecessary repeat office visits, lab tests, and even hospital admissions. Surprisingly, while “the move toward value-based care is gaining momentum in the healthcare industry, many health systems are still in the early stages of implementing this model,” according to a recent article in Becker’s Healthcare. The articles also states that the transition to value-based care involves using technology to support informed decisions. Elation’s EHR solution offers you the ability to use that technology to coordinate care seamlessly and efficiently so that you can provide the quality of coordinated care your patients need. Explore a sample chart to see how our cloud-based technology can help you and your patients make the informed decisions that are so important to value-based care.

Aviel Ettin
July 11, 2017

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The growth of ACOs and APMs in 2017

Quality care is the focus of accountable care organizations (ACOs), groups of physicians who voluntarily join together to more effectively coordinate care for their Medicare patients. Quality care is also the focus of alternative payment models (APMs), including ACOs, that provide incentive payments for high quality and cost-efficient care. The Accountable Care Learning Collaborative (ACLC), partnering with Leavitt Partners, has been tracking the growth of ACOs and APMs and has found a significant increase recently. ACLC counts an increase of 2.2 million lives covered by an ACO in the past year, for a current total of “923 active public and private ACOs across the United States, covering more than 32 million lives.” There have been some ACOs that have dropped their contracts in the past year, but there has been a net increase of 92 additional ACOs. According to ACLC’s numbers, “since the first quarter of 2016, 138 new ACOs began operation, and 46 ACOs dropped their accountable care contracts.” The organization adds that during the same timeframe, “the number of contracts has grown by 166, as many ACOs have expanded the number of accountable care contracts in which they participate.” ACLC reports that “other APMs with accountability for person- or episode-level outcomes and costs are also expanding.” The growth in APMs undoubtedly has been impacted by the Medicare Access and CHIP Reauthorization Act (MACRA), which provides incentives for physicians to become part of an APM. APMs, including APOs, focus on improving the quality of patient care through financial incentives. Elation Health is also focused on helping independent physicians provide the highest quality patient care. Our electronic health record (EHR) system gives primary care providers the tools they need to collaborate with other providers, communicate with patients, and spend more time with their patients. We bridge the gap between the worlds of policy and payers, so providers can focus on what they do best, for the benefit of their patients and their practices.

Nick Dealtry
July 11, 2017

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Healthcare costs will grow in 2018 according to new report

The state of healthcare is in flux, as the Affordable Care Act (ACA) is potentially being replaced and reimbursement is moving away from fee-for-service to value-based payments. Even the cost of healthcare delivery has been fluctuating for the past several years and is predicted to once again be on the increase for 2018. PwC’s Health Research Institute (HRI) has released its annual report on the cost of healthcare that also identifies factors impacting the increase. The report includes three key points: HRI projects 2018’s medical cost trend to be 6.5%—the first uptick in growth in three years. Price continues to be a major driver of healthcare costs. Businesses will have to tackle the price of services as well as the rate of utilization to reduce medical cost trend in the future. According to the report, healthcare costs were at 11.9% in 2007 and steadily decreased from there, reaching 6.5% in 2014. In the years since, however, the percentage has risen and fallen several times and is expected to rise again in 2018. The report indicates that “structural changes such as the push toward paying for value, greater emphasis on care management and increased cost sharing with consumers are taking a stronger hold, pulling back against rapid healthcare spending growth.” Independent physicians, in particular, will need to find a way to streamline their practice management, to provide more value to their patients at a lower cost. Optimizing patient care will become an integral piece in healthcare delivery going forward. Patients will look toward their providers to utilize technology such as electronic health records (EHR) to reduce their overhead costs and become more efficient with their coordinated care, particularly for those with chronic conditions. As the costs of healthcare continue to rise, independent physicians will need to be more focused on providing quality care management to manage costs more effectively for their practices and their patients.

Dante Capozzola
July 10, 2017

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ONC seeks input on interoperability progress

For independent physicians, interoperability is a hot button issue, as improved access to a patient’s full longitudinal profile is essential to providing personalized, high quality care.  Physicians seeking an opportunity to get involved in this policy issue can take advantage of a recent request from the Office of the National Coordinator (ONC) for Health Information Technology (IT), regarding feedback on framework they recently created for measuring interoperability standards. Interoperability measurement objectives The Proposed Interoperability Standards Measurement Framework is a move toward standardizing interoperability measurements and establishing consistent standards for the exchange of health data. By engaging with independent physicians and other healthcare providers, the ONC states that it “hopes to develop a measurement framework that is realistic to implement while providing an accurate assessment.” The ONC is “at the forefront of the administration’s health IT efforts and is a resource to the entire health system to support the adoption of health information technology and the promotion of nationwide health information exchange to improve health care.” The ONC has identified two measurement objectives for their framework, which they state will support their ability to measure nationwide interoperability progress. These measurement areas are: Implementation of standards in a health IT product; Use of standards, including customization of the standards, by end users to meet specific interoperability needs. As an independent physician who needs to be able to offer that coordinated care for your patients, you now have the opportunity to give the ONC feedback that may affect your specific practice.  Interoperability enables the electronic sharing of patient information between different EHR systems and healthcare providers. The ease with which different health care facilities can provide coordinated care, interacting with each other to share patient information can significantly impact the quality of care provided to that patient. At Elation Health, we are focused on coordinated care. Our philosophy includes a focus on bridging the chasm, to improve the doctor-patient relationship and to improve the level of interoperability that independent physicians can provide your patients. Contact Elation Health to learn more about our revolutionary, cloud-based EHR system that can help you offer your patients quality, coordinated care as an independent provider.

Dante Capozzola
July 10, 2017

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Organizations encourage HHS Secretary to adopt equitable incentives for Medicare Advantage advanced APMs under MACRA

As of now, the Centers for Medicare & Medicaid Services (CMS) has determined that MACRA will include traditional Medicare, but not Medicare Advantage as part of its APM track. However, starting in 2021, Medicare Advantage plans could qualify under the APM option. The delay in having Medicare Advantage plans qualify as an advanced APM has created a plea from ten organizations asking HHS Secretary Tom Price to expand the options under MACRA for physicians and physician groups. The organizations, which include both physicians and payers, sent a letter to Price asking him to accelerate the movement from volume to value-based payment, by accepting reasonable incentives for the physicians that are taking risks in Medicare Advantage contracts with health plans. The final rule released last October that excluded the Medicare Advantage plans to qualify as advanced APMs for multiple years was not happily accepted by the insurance industry. “Recognizing the advantages of alternative payment models in MA, we call on the administration to level the playing field and afford risk arrangements in MA the same credit under MACRA as risk arrangements in traditional Medicare,” the letter said. The main objective of the letter and the organized plea is to get more physicians away from the Merit-Based Incentive Payment System (MIPS) and into advanced APMs. “Providing APM credits for doctors participating in advanced payment models under Medicare Advantage will encourage value-based arrangements and advance the nationwide movement to reward clinicians for the value of the care they provide, rather than the volume of care,” said National Committee for Quality Assurance (NCQA) President Margaret E. O’Kane. This petition, if granted, can help speed up the process of transforming the way physicians get reimbursed for the care they provide, taking a larger step into value-based payment models. Along with the NCQA, other groups that signed the letter were: CAPG, Healthcare Leadership Council, America’s Health Insurance Plans, Health Care Transformation Task Force, Pacific Business Group on Health, Direct Primary Care, Alliance of Community Health Plans, National Coalition on Health Care and the Blue Cross Blue Shield Association.

Sam Peirce
July 7, 2017

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ONC chief discusses focus on interoperability

The Office of the National Coordinator (ONC) for Health Information Technology (IT) has emphasized the need to adopt the usage of electronic health records (EHR) for many years. In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act charged the ONC with promoting both the adoption and the meaningful use of EHRs. At a recent meeting in Washington, new ONC chief Donald W. Rucker, MD, said that now “adoption is out and usability and interoperability are in as health IT becomes more fully developed and new healthcare laws take full effect,” according to an article in Healthcare IT News. The ONC chief is focused on ensuring that EHRs are usable for the physicians as well as for the patients. Dr. Rucker also emphasized the need for interoperability, ensuring that EHR systems are able to talk to each other seamlessly and securely. In fact, the article states, the “ONC is considering incentives for both providers and patients to share medical records in order to boost interoperability.” True interoperability involves a single patient record that can be shared by all providers, enabling independent primary care physicians to spend less time inputting data and more time with their patients. Elation’s Collaborative Health Record, for example, enables all providers involved in a patient’s care to take action based on that patient’s most up-to-date clinical information. At Elation, we are committed to reducing the independent physician’s burden when it comes to maintaining and sharing patients’ healthcare records. Our EHR solution provides physicians the information they need at the touch of a finger. As adoption numbers increase among independent physicians, the ONC has turned its focus to usability and interoperability. At Elation, our focus has always been on providing physicians the advanced technology they need to ensure they are working together seamlessly for better patient outcomes. [Vasin Leenanuruksa] © 123RF.com

Nick Dealtry
July 7, 2017

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CMS Reviews PQRS reporting from 2015

The Physician Quality Reporting System (PQRS) was initiated by the Centers for Medicare and Medicaid Services (CMS) to encourage “individual eligible professionals (EPs) and group practices to report information on the quality of care to Medicare.” The last program year for PQRS was 2016. CMS has since transitioned to the Merit-based Incentive Payment System (MIPS) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS recently released their findings on participating providers’ reporting experience for the 2015 PQRS. In their report CMS “assessed existing quality programs, provider participation, and rates of satisfactory reporting to gain insight into aspects of PQRS proving most challenging for providers,” according to a summary published in EHR Intelligence. Their report provided data on the number of providers who were satisfactorily able to participate in PQRS, to determine which reporting methods were most effective. In their study, CMS found that “for registry, EHR and QCDR, 100% of eligible professionals who participated were able to satisfactorily report at least one measure while only 80% of eligible professionals who participated through claims were able to do so.” In addition, “eligible professionals reporting via EHR and QCDR were most likely to report 9 or more measures (96 percent of those using EHR and 86 percent for QCDR), compared to only 38 percent of those participating via registry and 4 percent of those reporting via claims.” As the agency transitions to MIPS, part of the Quality Payment Program (QPP) under MACRA, their PQRS report may provide some insight into physicians’ ability to be successful with the new payment program. However, CMS did stress in their report that “program eligibility and quality measure requirements (are) areas where MIPS diverges significantly from the previous federal incentive program.” Quality reporting requirements should be “significantly less burdensome and complex” in MIPS. Elation’s EHR solution also helps reduce the burden of everyday practice management, billing, and reporting for independent physicians. At Elation, we are focused on bridging that enormous chasm between the world of policy and payers, and the world of the front-line physician, to enable physicians to focus on quality patient care.

Sam Peirce
July 7, 2017

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AAFP recommends CMS simplify MACRA for primary care physicians

MACRA, a reporting program that streamlines current fee-for-service Medicare programs (Meaningful Use, Physician Quality Reporting System, and Value-Based Payment Modifier) into a single program, went into effect January of this year. However, now that MACRA is underway, one of the biggest physicians groups is calling for more streamlined rules for primary care physicians. The American Academy of Family Physicians (AAFP) has submitted a letter to CMS suggesting ways they can simplify MACRA implementation requirements for providers. They raised concerns regarding severe MACRA requirements and the negative effect current policy could have on patient care. “The AAFP sees a strong and definite need for CMS to step back and reconsider the current approaches to MACRA, which we view as overly complex and burdensome to physicians.” AAFP even included ways to simplify current requirements and improve MACRA implementation for both CMS and physicians: Remove the financial risk standards from regulatory definitions of Medical Home Model. Remove arbitrary size restrictions limiting AAPM participation on Medical Home Models. Eliminate all documentation guidelines for evaluation and management codes for primary care physicians in both the MIPS and AAPM pathways. Jettison the complicated and entirely uncalled-for MIPS APM category. Eliminate administrative claims population health measures. Use consistent terms from proposed to final rulemaking to avoid confusion in the physician community. MACRA meant to reduce burdens on practices The final MACRA ruling was meant to greatly reduce the burden on small and independent practices. While drafting MACRA, CMS received a great deal of feedback from physicians on the potential impact of this new reimbursement program. They later announced changes in the final rule reflecting that the feedback was heard; one of these changes being the ability to join virtual groups. In the future (as early as 2018), solo and small practices of 10 or fewer clinicians will have the option to combine MIPS reporting by forming “virtual groups” Still, it wasn’t enough, AAFP pushes that the new changes may have done more harm to provider productivity than good. AAFP members argue that the current MACRA implementation policy only adds to the intricacy of Medicare payment, quality improvement, and performance measurement programs. Independent physicians that feel overwhelmed by the demands of MACRA can lean on partners like Elation to help them navigate payment reform. We are committed to equipping you with resources like our health policy blog, as well as providing 24/7 health policy support and personalized webinars to answer any of your questions along the way. With our clinical first EHR, you can always be sure that you have an EHR system equipped with powerful quality care measures and intuitive reporting tools. Combined with our health policy support, physicians can put all their attention on strengthening the physician-patient relationship and enabling phenomenal care for all. Contact us to learn more about Elation’s Clinical EHR and what it can do for your practice.

Nick Dealtry
June 21, 2017

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Why coordinated care is important for independent primary care physicians

Patient safety and quality of care are the highest priorities for any independent physician. Independent primary care physicians understand that patients see specialty physicians, have lab tests and screening tests done, and may even be seen in other healthcare facilities. Coordinated care between all of these medical providers plays a large role for primary care physicians and can be a challenging task. Why is coordinated care important? When providers do not communicate with each other about a patient’s care, it can lead to errors in medication doses or care plans, repetitive tests, and even more serious consequences. Chronically ill patients, in particular, benefit from coordinated care between their providers. A recent study published in the Annals of Family Medicine found that patients under 65 years and patients with chronic conditions were the most likely to experience poor primary care coordination. The study also found that the “rate of poor primary care coordination” was highest in the United States, out of the 11 countries involved in the study. Frustrations of poor care coordination As an independent primary care physician, the task of coordinated care can be a frustrating challenge. You may struggle with receiving timely, accurate information from other providers regarding your patients. Too often, you may have to rely on the patients themselves for that communication piece. Patients are not medical professionals and should not be expected to relay the necessary information between their providers. Given human nature, it is also quite probable that patients will not always remember everything they’ve been told by all of their medical providers, therefore would not be able to share it accurately. Even though your focus is on providing quality care, the lack of coordination can become an issue for your patients’ health as well as for the costs involved in providing that care. At Elation Health, we understand your concerns. We are also focused on quality patient care. That’s why we introduced the Elation Provider Network (EPN), a smarter and more effortless way for providers to connect and share patient information with one another so they can provide better care for their patients. Contact us today to learn more about providing quality coordinated care for your patients.

Roy Steiner
June 21, 2017

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Bipartisan CHRONIC Care Act of 2017 aims to improve chronic care coordination

In April, new legislation was introduced in the Senate that seeks to streamline chronic care coordination and strengthen treatments for patients struggling with chronic illnesses. On Tuesday, the Senate Finance Committee passed the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, a bipartisan bill to strengthen and improve the health outcomes of Medicare beneficiaries living with chronic conditions. Some of the bill's provisions include allowing Medicare Advantage plans to adjust chronic care coordination and coverage for specific types of patient like those with diabetes. It also would allow accountable care organizations (ACOs) make incentive payments to help patients with chronic conditions obtain primary care services. Another major provision widens use of telehealth among Medicare Advantage beneficiaries, ACOs and individuals with stroke. "Today's passage of the CHRONIC Care Act is an important step forward for people suffering from debilitating diseases in Colorado and across the country," said Colorado U.S. Senator Michael Bennet. "Chronic conditions strain families and increase healthcare costs. By modernizing the Medicare program, we can address both of these challenges. We'll work to advance this bill, so we can improve the health and well-being of families, reduce costs, and improve patient outcomes."

Sam Peirce
June 20, 2017

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What is interoperability, and how can independent practices benefit from it?

For independent providers, providing coordinated care can be a huge challenge. When your patients see specialty providers, or have lab tests, or receive services at other healthcare facilities, the primary care provider can be left in the dark. For high quality, coordinated care, this information is essential in making the right decisions to care for patients. So, can independent physicians count on this level of interoperability? It’s become a huge healthcare buzzword. But is it available, easy to do, and making a difference in your patient care? True interoperability would give physicians the ability to actually use the information that is being shared. As an independent physician, you need to be able to interpret data quickly and easily to provide your patients with quality coordinated care. There are some existing ways to provide information - so in some ways, interoperability is already happening every day. Faxes, emails, and even phone calls provide ways to share patient information. However, digital interoperability, where electronic systems are in sync, is more elusive. Taking advantage of digital interoperability Step 1 is using a cloud-based system of updating and maintaining your patient’s health records. This provides the building block of interoperability, putting your notes, the patient’s information, lab results, and other critical clinical data into digital format that can be shared with your patient’s care team. Step 2 is to use a networked EHR.  Elation’s Collaborative Health Record provides connectivity between all of the providers on a patient’s care team, enabling autonomy for each provider over their own version of the patient chart along with the ability to pull in updates from collaborating physicians when applicable. This enables truly coordinated care among all of the providers caring for a patient. In essence, interoperability means that different systems are talking to each other, and that helps to ensure that all providers involved have access and can actually use the information they are sharing. As an independent physician, you need access to information and effective technology to be able to focus on your patient’s care.

Aviel Ettin
June 15, 2017

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