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.

Healthcare execs see EMR data as their most valuable asset

More than three-quarters of healthcare executives surveyed by PricewaterhouseCoopers say that information contained in EMRs could become their most valuable asset over the next five years as “secondary use” of EMR data takes off. But this won’t happen until technology improves, more standards get harmonized and, most importantly, the healthcare industry resolves lingering privacy concerns, according to a PwC survey released early this morning.

With billions of dollars in federal health IT stimulus funds set to flow into healthcare in the next few years, secondary use of electronic health data will “grow exponentially,” PwC says, citing a finding that 65 percent of healthcare executives expect their data-mining activity to spike within two years. About 90 percent of respondents believe that secondary use of EMR data will help their organizations make significant improvement to the quality of care.

There may be some legal barriers to overcome, however, before healthcare organizations can unleash the full power of patient-specific healthcare data. Also of concern to healthcare executives are privacy implications of data mining and the bad PR that could result from unauthorized use. This study literally just hit the wires, but we can’t wait to hear Dr. Deborah Peel’s thoughts on this last point.

Electronic Health Record Systems Will Require 'Some Form of Oversight,' Government Advisor Says

As more healthcare providers move to implement electronic health records by 2011, the technologies for storing and managing these vast data sets will need to be regulated, an advisor to the federal government said at a conference here this week.

“There is some form of oversight necessary,” John Glaser, senior advisor of the Office of the National Coordinator for Health Information Technology, said at a colloquium on personalized medicine hosted by the American Association for the Advancement of Science. He acknowledged that a regulatory process would be necessary to handle the limitations of EHR systems and managing malfunction issues.

Glaser noted that ONC met with FDA this week to discuss regulation of EHR-related technologies. “Is it a formal device or not? I don’t know,” Glaser said, adding that he wasn’t sure whether regulation of EHR systems would necessarily fall under FDA oversight.

“However, to a large extent human aptitude plays a huge part in how well the software works,” said Glaser, who is also the chief information officer of Partners HealthCare System.

EHRs have been proposed as a key component of personalized healthcare, and Glaser noted at the meeting that they could be a powerful tool for picking up post-marketing drug risk information and relative risk data. At the meeting, other officials from government and academia outlined several efforts to use EHR systems to look for genes associated with disease predisposition and drug response

The Certification Commission for Healthcare Information Technology, a private organization, conducts one-day testing of EHR systems. But currently no federal oversight of EHR systems exists.

Earlier this year, an article titled “Finding a Cure: The Case for Regulation and Oversight of Electronic Health Record Systems,” published in the Harvard Journal of Law and Technology, advocated for federal oversight of EHR systems. Although the authors did not feel that oversight responsibilities should necessarily rest at the FDA, they recommended that EHR systems should be monitored for as long as they are operational so technical problems are detected and the system is continually improved.

The regulatory oversight for EHR systems is a looming question as hordes of healthcare providers will be moving to electronic record systems in the next five years, urged by the promise of federal funding. The stimulus package offers incentives to hospitals and physicians for the “meaningful” implementation of electronic health records. Glaser is helping the federal government implement its programs.

Physicians who accept Medicare and use EMRs can receive up to $44,000 over a five-year period between 2011 and 2016. Doctors who see more than 30 percent of patients receiving Medicaid benefits are eligible for up to $64,000 beginning in 2011 if they adopt the technology.

Furthermore, there are penalties proposed for non-adopters. Healthcare providers who have not shown “meaningful use” of a certified EHR system by 2014 can see a decrease of up to 1 percent in the Medicare fee schedule for 2015. The Medicare fee payment reductions will continue for every year of non-compliance. The deduction rate can go up to a maximum of 5 percent if total EHR adoption is under 75 percent of eligible providers by 2018.

In a recent study, researchers from the Harvard School of Public Health, Massachusetts General Hospital, and George Washington University found that less than 2 percent of hospitals had implemented comprehensive EHRs; and less than 8 percent had basic EHRs in place.

EMR vs. EHR

According to this report: The National Alliance for Health Information Technology Report to the Office of the National Coordinator for Health Information Technology on Defining Key Health Information Technology Terms, there is a distinction between EMR (electronic medical record) and EHR (electronic health record). I don’t think that most people will argue that PHR (personal health record) is its own entity. However, there’s a debate out there as to whether EMR should be interchangeable with EHR.

Although EMR and EHR are very familiar terms, there are some distinct differences between these two terms. Let me bold those differences:

Electronic Medical Record (EMR)

An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization.

Electronic Health Record (EHR)

An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization.

OK, for the sake of completeness, I’ll throw in this definition as well: