In this blog post / article, Dr. Douglas G. Burnette Jr. expresses his concerns over Radiology reimbursement cuts, and bundled payment in particular. Provides a good perspective of how those affected by policy are feeling these days.
Policy
Article – HIStalk Interviews Keith Figlioli, SVP Healthcare Informatics, Premier
A friend shared this interview with me. Worth the read.
Some thoughts…
- Keith (BTW, I have never met him) has a unique perspective having spent time on the vendor side, then the provider side, and is now also involved in policy. I think his points are spot on.
- I believe that some of the EMR monolith disruption will come from HIE vendors. They are slowly taking more parts of the EMR, and generally have newer architectures than most EMR systems. This will allow them to adapt to new standard APIs and protocols, such as those being defined in HL7 FHIR. They are also more open—they have to believe in openness, because without data sharing, they have no business.
- HIE vendors also typically have some form of clinical data repository, which can act as the data warehouse that Keith mentions. Adding moderns APIs to these can open the door to information freedom (without compromising security and privacy, BTW), without waiting for EMR vendors to do it.
- I like the analogy to the transformation that the travel industry went through. I make this comparison often. I also look at how banking and telecommunications have transformed themselves to provide new and improved services. The lessons for healthcare are all out there—we just need the leadership.
Article – CHIME presses HHS for HIE certification
This makes sense.
If we are going to certify EMR technology, HIE should be held to the same standard. Especially as more physicians turn to their HIE to provide basic EMR-like access to patient records (mostly because the HIE interface is better than their own EMR’s, the collaboration tools are better, and there is more of their patient’s data from more sources in the HIE).
Article – Patient Steerage Could Harm Radiologists, Confuse Patients
This article explores the trend of “patient steerage”—a practice of payers directing patients to lower-cost imaging providers.
Some thoughts…
- The article also touches on the idea of patients with high-deductible insurance plans, and awareness of costs, steering themselves to lower cost options. How long until consumer-driven review web sites rating costs and quality (like a travel review and booking site) become ubiquitous? The site could even broker the scheduling across involved facilities, like a travel site does this for airlines.
- The frequent mention of quality of service as a method for imaging providers to differentiate themselves ties into the blog post I did on the SIIM web site here. The ability to offer services at a lower cost ties into my commentary on Productivity.
- This trend could have another implication on the management of results. Often, referring physicians will refer to an imaging provider that not only provides quality of service (summarized in the article as “scan quality, turnaround time, communication with referrers and patients”), but convenient results access. So, I might send my patients to Imaging Provider A because they provide me with a secure portal to access the report and images, and send me notifications when the results are available. If my patients are steered to an imaging provider with lesser capability (just faxes reports out), I would not be as productive (or happy). If patients are steered to several imaging providers in the area, how results are accessed may vary significantly from one exam to the next. Referring physicians in regions that have an operational HIE, capable of managing both reports and images, and providing a so called “EMR Light” portal function will likely experience less of a negative impact from patient steerage when accessing results.
Article – MITA: Obama Budget’s Imaging Provisions Threaten New Medical Technology Development and Patient Care
The medical device manufacturers’ industry association, MITA, says Obama Budget’s Imaging Provisions Threaten New Medical Technology Development and Patient Care.
Key notes…
- President Obama’s proposed 2014 budget …includes a recommendation for a prior authorization system through for-profit radiology benefit managers (RBMs).
- Several recent independent analyses have shown a decline in utilization of imaging technologies. The Medicare Payment Advisory Commission’s (MedPAC) annual report to Congress in March 2012 confirmed that imaging services fell by 2.5 percent in 2010, while non-imaging utilization increased 2 percent. These data are consistent with an analysis commissioned by MITA which found that Medicare spending per beneficiary in the field has dropped 13.2 percent since 2006 and imaging utilization declined by 3 percent. This contrasts markedly with the overall Medicare program, in which spending per beneficiary increased by 20 percent and non-imaging utilization rose by 2 percent.
UK study: Telehealth not cost effective
UK study: Telehealth not cost effective …I have two thoughts on this.
One, telehealth is not only about cost reduction—it is also providing patients access to scarce resources, such as a cardiac specialist. Patients with chronic disease in rural or otherwise under served areas can use telehealth to get services where they otherwise would go without. In this case, telehealth costs equal to, or even a premium above, standard costs may be warranted (or, at least, a comparison to average costs is unfair considering the inflated costs to provide equal services in an area where resources would need to travel to the patient).
Two, costs will come down. And, an 80% reduction in costs (as cited in the article) is not that difficult to achieve if one compares dedicated enterprise solutions to consumer solutions (e.g. smartphone apps). The cost of a widely shared set of web services in the cloud accessed by off-the-shelf, multipurpose consumer devices, like smartphones and tablets, is much lower than deploying and maintaining dedicated vendor-proprietary solutions.
10 hospitals rated best in Canada
…for my Canuck friends: 10 hospitals rated best in a CBC report (it also lists some of the lowest rated)
Article – Mostashari, policy committee take critical look at CommonWell
Mostashari, policy committee take critical look at CommonWell
Something to watch as it evolves in the coming months and years, but here is an excerpt of the alliance’s goals…
- Enabling providers to unambiguously identify patients – but not with a national patient identifier;
- Providing a way to match patients with their healthcare records as they transition through care facilities;
- Using existing unique identifiers (salted/hashed) such as cell phone number, email addresses or driver’s licenses for identity management;
- Enabling patients to manage consent and authorization;
- Creating a HIPAA-compliant and patient-centered means to simplify management of data-sharing consents and authorizations, focusing initially on the most common treatment situations;
- Helping providers to find the location of patient records across care locations via a secure nationwide records locator service;
- Enabling providers, with appropriate authorization, to issue targeted (directed) queries that provide for peer-to-peer (e.g., EHR to EHR) exchange.
Article – Imaging centers hit with surprise 30% cut for MRI codes
Full article is here, but requires (free) registration. A short summary (no registration required) is also available here.
The full article is worth a read as it goes into several reimbursement changes happening and pending.
An excerpt…
Because of adjustments made by the Centers for Medicare and Medicaid Services (CMS) in its assumptions about room use time for 2013, reimbursements for CPT code 73721 (lower extremity joint MRI) and 73221 (upper extremity joint MRI) have been cut dramatically, according to Mike Mabry, executive director of the Radiology Business Management Association (RBMA).
“To calculate [relative value units (RVUs)], Medicare estimates labor, medical supply, and equipment costs associated with every procedure,” Mabry told AuntMinnie.com. “For these two codes, CMS decreased its estimate of the amount of time the room would be used, from 63 minutes to 33 minutes. They cut the room time in half for those two codes, which results in lower equipment and direct costs and a lower technical component. That’s why freestanding centers are seeing cuts in the range of 30% for these two MRI codes.”
Rick Davis, vice president of Palm Coast Imaging, a freestanding center in Palm Coast, FL, was shocked when he saw his center’s Medicare explanation-of-benefits report.
“In 2012, reimbursement for CPT code 73721 was $427.21,” Davis told AuntMinnie.com. “This year, the Centers for Medicare and Medicaid Services reduced the reimbursement to $297.58. If managed care companies follow suit, freestanding centers will find it difficult to remain open.”
Articles on Mobile Health Applications and FDA Regulation
Check these out…
Dear FDA: Qualcomm’s Robert Jarrin lists his wishes for FDA regulatory action
Where is the ‘fine line’ between safety and free rein for mobile development?
Some thoughts…
- At risk of ending up on some government list of subversives, I question how often FDA (or equivalent agency in other countries) regulations actually result in protecting patients when they are applied to health IT products. Yes, good design, development, and validation practices are necessary for quality products. And, yes, health IT products are managing very important, not to mention legally protected, information that—when misused or when a defect affects its operation—can result in improper actions being taken …sometimes with adverse effects. But, for those that have worked for a registered medical device manufacturer, we spend more time with our eyes on paperwork than we should be. Time we could be spending on better design, or additional testing before launch. Too much of the paperwork is about evidence creation, and not about actual quality. Many process and method innovations developed in general IT product development are often difficult to adapt to the expected models in the FDA’s so called good manufacturing practices (GMP), and therefore do not achieve the same benefits/results.
- If the U.S. government is generating revenue from the new medical device excise tax, is it possible that the FDA may be motivated to determine that more, not fewer, mobile apps are medical devices, and therefore subject to taxation? OK, I may have crossed the line into full-fledged conspiracy theory there. Sorry about that.
Don K Dennison 