E-prescribing 'could cut cost of human negligence'

Electronic prescribing systems that reduce the possibility of human error could cut clinical negligence claims by more than 70 per cent, according to US hospital chain Banner Health.

The company, which has worked with national IT programme supplier Cerner to evaluate the impact of its electronic prescribing system, said systems that reduced the possibility of human errors such as illegible handwriting or misrecorded doses had led to a 72 per cent reduction in the cost of clinical negligence claims at one of the group’s hospitals.

The National Patient Safety Agency has estimated that 9 per cent of patient safety incidents relate to medication errors, which together constitute some 20 per cent of all clinical negligence claims against the NHS.

In 2007-08, the NHS Litigation Authority paid out approximately £64m in damages for cases involving misprescribing.

Banner Health’s system director for care transformation Judy Van Norman told HSJ: “Some clinical leadership in the hospitals are interested and enthused about being involved but the resources at the individual hospital level to really lead the adoption of this is a frustration.”

Health IT execs meet to boost e-prescribing

Health and Human Services Department officials looked to spark the adoption of e-prescribing at a conference this week attended by some 1,400 health care professionals and industry representatives.

The meeting, held in Boston and sponsored by the Centers of Medicare and Medicaid Services, was put together in six weeks in preparation for the planned launch of the federal e-prescribing incentive program, set for January. Incentive payments for physicians who institute e-prescribing will initially be set at 2 percent.

We need to raise awareness in plenty of time to be ready for Jan. 1 said Kerry Weems, acting CMS administrator. We have a very short period of time to begin and end the education process.

The next milestone in the adoption push will come in November, when CMS plans to publish its final rule regarding incentive payments to providers. That rule will lay out definitive guidelines on what constitutes complete and successful e-prescribing, Weems explained. He said CMS continues to formulate that guidance and will use the conference to obtain feedback as it prepares the final rule.

Barry Straube, CMS chief medical officer, said the rule for qualifying for bonus payments is potentially reachable by many physicians’ offices.  He said the likelihood of qualifying is quite high for those offices obtaining an e-prescribing system.

HHS officials said they believe the bonus payments will provide the financial driver to accelerate adoption. There is a lot of money on the table here, said HHS Secretary Mike Leavitt.

Leavitt cited a $1 billion estimate as the dollar value of prescriptions that fall under the Medicare incentive.

Some physicians, however, remain skeptical of e-prescribing. Questioners during a conference session brought up the cost of adoption and the need for tort reform as issues affecting e-prescribing adoption.

Some anecdotal evidence, however, points to increased adoption.

Randy Boldyga, president and chief executive officer of RxNT, an e-prescribing vendor in Annapolis, Md., said 50 doctors implemented his company’s solution during one recent week, about double the usual number of installations. He said the Medicare incentives are playing a role in the increased activity.

CMS to test receiving quality data from electronic health records

The Centers for Medicare and Medicaid Services (CMS) plans to test its ability to accept selected clinical quality data directly from hospital electronic health record systems as early as July 2010.

CMS said it would seek volunteer hospitals to report stroke, blood clot and emergency department measures of care via EHR systems as part of the Reporting Hospital Quality Data for Annual Payment Update program, which provides higher Medicare payments to hospitals that report quality measures to the agency.

The agency detailed the plans in the Aug. 27 Federal Register in announcing changes to its rule for the Reporting Hospital Quality Data for Annual Payments Update. The program, a provision of 2003’s Medicare prescription drug legislation, required hospitals by 2010 to report on 42 quality measures to receive additional incentive payments.

Reporting to CMS is generally paper-based or through a mix of manual and automated systems.

Participating hospitals and their vendors will have to be able to transmit clinical EHR data that adhere to interoperability standards, such as cross document sharing, cross community access, clinical data architecture and Health Level 7 version 3, CMS said.

CMS has encouraged hospitals to adopt EHRs that can report quality data directly to a CMS data repository. Ideally, the use of EHR systems would improve the quality of care by providing physicians with pertinent clinical data as they were treating patients.

“The testing of EHR submission is an important and necessary step to establish the ability of EHRs to report clinical quality measures and the capacity of CMS to receive such data,” the agency said in the published interim rule.

The reporting of selected quality measures is also a key provision of the stimulus law. The Health IT Policy Committee, led by Dr. David Blumenthal, the national coordinator for health IT, has recommended that quality reporting be a part of the criteria providers must meet to demonstrate meaningful use of electronic health record systems, CMS said.

Chopra seeks outside advice on health IT standards

The Health IT Standards Committee today said today it would bring together experts from outside the healthcare field to share ideas about best ways to apply new workflow and information sharing standards across organizations.

Aneesh Chopra, the White House’s chief technology officer and chairman of the panel’s newly formed standards implementation group, said he wants to mine the lessons of other industries in using information handling standards successfully and then apply them broadly to healthcare.

“There is an interest in how other industries have adopted standards, and I think we’re going to take that feedback to heart,” Chopra said after the meeting. The panel will host a hearing on Oct. 29 to share best practices, Chopra said.

Additionally, Chopra will open a two-week online forum to seek feedback from a wider audience on a series of structured questions and information posts on standards usage. The implementation workgroup will report on its findings at the next standards committee meeting Nov. 19

Dr. David Blumenthal, the national health IT coordinator, cautioned against confusing the adoption of standards with the adoption of electronic health record technologies.

“This is not about the adoption of technology but the adoption of standards,” he said. Health IT vendors will be able to solve most of the technology problems, he said.

Standards are at the heart of healthcare reform, Blumenthal noted, as reform will depend on standards and infrastructure being available to exchange health information anytime.

“Congress might not know it or realize it, but you are at the center of their effort to improve the healthcare system,” Blumenthal said in praising the standards committee’s work.

Blumenthal also said the Nationwide Health Information Network project, a public-private sector project that has been in progress for years, is essentially a set of standards.

“The goal has always been not to develop a thing or a network that is closed or a physical representation of a network, but to create a resource in the form of protocols, standards and specifications that are available in the public domain, he said.

“They are available to anyone who wishes to use the Internet to exchange information in a private and secure and effective way.”

Blumenthal said his office has also been considering how to accelerate the availability of the standards, protocols and specifications that comprise the NHIN as well as how to provide consumers and small practices access to the NHIN toolset.

“We think [that] is a laudatory goal just as we think that individual physicians and small physician groups should” have access. Blumenthal said. “This is a public resource whose broadest use is our goal.”

In other areas, the Committee’s clinical quality workgroup said it would create a sub-group to focus on gaps in the transition of vocabulary standards along the health IT adoption path.

For instance, providers will have to migrate from using ICD-9 to ICD-10 to SNOMED CT by 2015 to record physician’s clinical observations in an electronic health record.

“We need to enable that conversion to the adoption process, and that’s where these gaps are,” said Jamie Ferguson, co-chairman of the work group and executive director of Kaiser Permanente’s health IT strategy and policy.

Blumenthal: Officials Working To Boost EHR Connectivity, Security

In an interview published in the New York Times’ “Pogue’s Posts,” National Coordinator for Health IT David Blumenthal discussed federal efforts to promote electronic health record interoperability and ensure the security of heath data.

Interoperability

Blumenthal said his office is undertaking efforts to help different EHR systems connect and share data. He said, ‘We’re gonna be helping states to create interoperability capability, capabilities to link records, to link institutions.”

In addition, Blumenthal said federal officials are developing nationwide standards and certification criteria that will support EHR interoperability. He added that the standards discussions “will all be a very open and transparent process.”

Privacy and Security

Blumenthal also addressed concerns about whether EHR systems would compromise the privacy and security of personal health data.

He said regulations are in place to ensure that any health data used for research purposes are stripped of all individually identifiable information.

Blumenthal also said his office plans to work with President Obama’s new cybersecurity initiative to ensure that EHR systems have advanced encryption capabilities and other data protections.

Medical Billing – Do You Know The Key Performance Metrics For Effective Management?

Outsourced Medical Billing has a remarkable potential to increase your collection rates by forty percent or more. However, how do they do it? Good metrics are the key to effectiveness of a medical billing service. Like any high performing business, they measure their performance with dependable metrics.

Collecting medical bills is an onerous task. The billing rules are extremely complex, terminology difficult and the deadlines very strict. There is no single billing procedure that could be applied throughout the billing process. Additionally, the medical insurance companies are notorious for trying to avoid paying the bills. Due to such complexity, reliable metrics become even more important to optimize the medical bill collections

If you are considering outsourcing your medical claims, carefully evaluate the performance measurement system of the medical billing company, and the process used to respond to any payment issues or holdups that may arise for collecting the bills.

Following are some of the most important performance measurement metrics that an effective medical billing service should track and report to you.

• Gross and Net Collection Ratio

Gross collection ratio is the amount paid to the practice divided by the total charges billed. This does not include any write-offs. This ratio depends on the practice and the payer mix. A higher payer mix consisting of Medicaid and Medicare may result in lower gross collection ratio. It is best to compare this ratio to practices that are similar to yours. Net collections is the ratio of payments to charges after the adjustments due to write offs. For a high performing service, this ratio is typically over 90%.

• Days in Accounts Receivable

Time elapsed between billing and collection is an important metric to evaluate efficiency of a billing service. Number of days it takes to collect a bill depends on the medical specialties but a billing service can affect it by timely follow up with the payer and quick rectification of any issues that may arise.

• Percent of Bills Past Due

It is important to track past due bills. Billing service should report this as number and percent of accounts that are 60, 90, 120 days past due. It should have effective analysis process to troubleshoot the reasons for accounts falling in past due status. A good billing service would constantly improve upon its processes to shrink the accounts getting past due.

• Patient Liability

Percent of Patient Liability is the ratio of patient responsibility to total billed charges. This is roughly equal to the patient deductibles. This metric is important to track the effectiveness of the front office function since the co-pay is generally collected by the doctor’s office before the service is rendered.

• First pass pay rate

This indicates the percentage of filed claims that are paid without any need of follow up. Obviously, higher the percentage, more efficient is the medical billing service. This metric should steadily show improvement. Any dip in first pass pay rate is a red flag and should be properly investigated.

• Denial Rate

Denial rates tell you about the claims that required a follow up during a given period. Billing service should regularly monitor this metric and troubleshoot the causes of denial to keep the denial rate as low as possible.

Medical billing is just too complex, a convoluted process that makes it almost impossible to measure efficiency unless there are good tracking metrics in place. Additionally, it is important to respond quickly to any inefficiency or deterioration in performance. Therefore, in this digital age a monthly paper statement listing the performance metrics is not an acceptable means of reporting. An efficient medical billing service will be able to track these performance metrics via a web portal and promises continuous improvement in performance. Hire an effective and transparent billing service and you would definitely see an improvement in collections. Remember to compare price quote from multiple medical billing companies before selecting the right vendor for your needs.

HHS Awards $17 Million in a New National Initiative to Fight Health Care-Associated Infections

HHS Secretary Kathleen Sebelius announced the award of $17 million to fund projects to fight costly and dangerous health care-associated infections, or HAIs.

“When patients go to the hospital, they expect to get better, not worse,” Secretary Sebelius said. “Eliminating infections is critical to making care safer for patients and to improving the overall quality and safety of the health care system. We know that it can be done, and this new initiative will help us reach our goal.”

HAIs are one of the most common complications of hospital care. Nearly 2 million patients develop HAIs, which contribute to 99,000 deaths each year and $28 billion to $33 billion in health care costs. HAIs are caused by different types of bacteria that infect patients being treated in a hospital or health care setting for other conditions. The most common HAI-causing bacteria is methicillin-resistant Staphylococcus aureus, or MRSA. The number of MRSA-associated hospital stays has more than tripled since 2000, reaching 368,600 in 2005, according to HHS’ Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project.

Of the $17 million, $8 million will fund a national expansion of the Keystone Project, which within 18 months successfully reduced the rate of central-line blood stream infections in more than 100 Michigan intensive care units and saved 1,500 lives and $200 million. The project was originally started by the Johns Hopkins University in Baltimore and the Michigan Health & Hospital Association to implement a comprehensive unit-based safety program. The program involves using a checklist of evidence-based safety practices; staff training and other tools for preventing infections that can be implemented in hospital units; standard and consistent measurement of infection rates; and tools to improve teamwork among doctors, nurses and hospital leaders.

Last year, AHRQ funded an expansion of this project to 10 states. With additional funding from AHRQ and a private foundation, the Keystone Project is now operating in all 50 states, Puerto Rico and the District of Columbia. The new funding announced today will expand the effort to more hospitals, extend it to other settings in addition to ICUs, and broaden the focus to address other types of infections. Specifically, the new $8 million in funding will provide:

• $6 million to the Health Research & Educational Trust for national efforts to expand the Comprehensive Unit-Based Patient Safety Program to Reduce Central Line-Associated Blood Stream Infections. The funding will allow more hospitals in all 50 states to participate in the program and expand the program’s reach into hospital settings outside of the ICU. The Health Research & Educational Trust will also use $1 million to support a demonstration project that will help fight catheter-associated urinary tract infections.
• $1 million to Yale University to support a comprehensive plan to prevent bloodstream infections in hemodialysis patients.

AHRQ, in collaboration with the Centers for Disease Control and Prevention (CDC), also identified several high-priority areas to apply the remaining $9 million toward reducing MRSA and other types of HAIs. These projects will focus on:

• Reducing Clostridium difficile infections through a regional hospital collaborative.
• Reducing the overuse of antibiotics by primary care clinicians treating patients in ambulatory and long-term care settings.
• Evaluating two ways to eliminate MRSA in ICUs.
• Improving the measurement of the risk of infections after surgery.
• Identifying national-, regional- and state-level rates of HAIs that are acquired in the acute care setting.
• Reducing infections caused by Klebsiella pneumoniae Carbapenemase-producing organisms by applying recently developed recommendations from CDC’s Healthcare Infection Control Practices Advisory Committee.

Secondary use of EMR data seen reducing costs, improving quality

One of the biggest untapped benefits of electronic medical record adoption is the secondary uses of the data that are being collected, concludes a study by PricewaterhouseCoopers.

The study, “Transforming Healthcare through Secondary Use of Health Data,” found that practices and hospitals have seen aggregated data from their electronic medical records identify patterns that have allowed them to improve outcomes, reduce errors and increase revenue opportunities.

But the number of institutions using the aggregated, or secondary, data in this way is very small, though it is expected to grow in the next two years.

“Almost every constituent in the [health care] industry that has to make a decision around what type of health care to deliver and when could use this kind of data and the information that aggregating it can produce,” said Dan Garrett, health IT practice leader at PricewaterhouseCoopers.

The report found that among those organizations already using some form of secondary data, 59% have seen quality improvements, 42% have achieved cost savings, 36% have seen patient/member satisfaction improve, and 29% have increased revenue. The biggest users of secondary data are hospitals and physicians, while health plans are the farthest behind.

The survey found that although 95% of physicians are not opposed to using secondary data, many are sensitive to how it should be used. Patients also are concerned.

“We all know we need to use this data, but they also know we can’t risk security,” Garrett said.

The PricewaterhouseCoopers report came from an e-mail survey conducted in June of 732 health care executives, 482 physicians, 136 payers and 114 pharmacy/life sciences organizations.