California hospital's implementation of open-source EHR bears watching | EHR Watch

By the end of the year, Kern Medical Center, a county-owned 222-bed acute-care teaching hospital in Bakersfield, Calif., will have implemented Medsphere Systems’ OpenVista electronic health record (EHR). This deployment bears watching because it may become a trend in terms of providers adopting an open-source EHR.

 

For one, 2011 is the first year that providers can qualify for bonuses, or increased Medicare reimbursements, under ARRA. That’s shy of a year away from now. I think it’s virtually impossible to implement an EHR and derive meaningful use from it all within a year if you go the traditional, multi-million dollar, multi-year route. But KMC pointed out that the reason it chose OpenVista, which is the commercial version of the Dept. of Veterans Affairs’ VistA EHR, is for its ability to go live rapidly and its lower cost of implementation and maintenance.

 

In these tough economic times healthcare systems need to do more with less. KMC provides care for more than 16,000 inpatients annually, while its clinics provide care and services for more than 100,000 patients. Its emergency department handles some 43,000 visits per year. The data may be old (fiscal year 2001-2002), but they’re still relevant, especially for healthcare systems like KMC. Over the past three fiscal years prior to 2001-2002, the average daily patient census has increased. With nearly 75 percent of its patients either indigent or on Medi-Cal, KMC has to find ways to become more cost efficient in its delivery of care. On top of that, as a healthcare provider to county inmates and juvenile detainees the hospital system must also meet legal requirements for inmate and juvenile medical care. The KMC folks are banking on an open-source EHR to improve clinical outcomes in a cost-efficient manner.

 

What you’ll likely see in 2010 are resource-strapped healthcare systems that nonetheless believe in the clinical and financial benefits of health IT. The ARRA bonuses serve as an incentive to implement EHRs. The short timeline for qualification, however, is what will drive healthcare systems to choose EHRs that have a quick, inexpensive implementation.

 

The next step is achieving meaningful use. Stay tuned.

via ehrwatch.com

Open source systems are gaining acceptance in early phases of EHR adoption. Medicare reimbursement rates and whether choice of open source positively or negatively affects reimbursement policy will be the determinant of open source EHRs ultimate success/failure when 'meaningful use' guidelines are finally released in the coming months. Stay tuned...

Posted via web from Connected Care Solutions

Hilton Head Island Fire & Rescue STEMI Program - Understanding the Prehospital 12-lead ECG

Check out this SlideShare Presentation: South Carolina Regional Prehospital STEMI Network outlined from the perspective of the emergency responder. 12-lead ECG procedures and criteria for analysis in the prehospital setting is outlined in detail. Includes very informative breakdown of actual ECG strips; indentifies characteristics of a STEMI Alert and outlines clinical reasoning behind the interpretation of the ECG taken by paramedics. Great resource for developing understanding of data captured by 12-lead ECG and the implications of this data on the acute nature of the patient's condition.

HHIFR STEMI Program - September 2009 Case Study

View more presentations from Tom B..

HHIFR STEMI Program - October 2009 Case Study

View more presentations from Tom B..

Related articles by Zemanta

• ACC/AHA focused update for STEMI and PCI (ems12lead.blogspot.com)
• EMS delay in man's death preventable: ministry (cbc.ca)
• 81 yof CC: ICD shocks x6 (ems12lead.blogspot.com)
• STEMI Alert protocol (ems12lead.blogspot.com)
• "Time is muscle" (timesunion.com)

GE Healthymagination Fund - Investment Platform

Investment Platform

The Healthymagination Fund draws on capabilities from across GE Healthcare, GE Capital and GE Global Research and has a global footprint. The investment committee is comprised of senior leaders of these groups.

via healthymaginationfund.com

Exciting new $250mm HIT investment fund launched by GE Capital offers unprecedentedly aggressive and bullish HIT private equity joint venture. Ideas abound...

Posted via web from Connected Care Solutions

KeithHennessey.com » The legislative landscape for health care after House passage » Print

The legislative landscape for health care after House passage

Posted By kbh On November 9, 2009 @ 12:45 pm In budget, featured, health | 8 Comments

The House passed their version of health care reform Saturday night on a 220-215 vote.  Today I’m going to update my projections and analysis, and focus on upcoming “pivot points” in the health care debate.

1. Pass a partisan comprehensive bill through the House and through the regular Senate process with 60, leading to a law this year; (was 50% –> 40%)
2. Pass a partisan comprehensive bill through the House and through the reconciliation process with 51 Senate Democrats, leading to a law this year; (was 10% –> 20%)
3. Fall back to a much more limited bill that becomes law this year; (was 10% –> 20%)
4. No bill becomes law this year Congress.  Process continues into next year. (was 29.99% –> 20%)

I have adjusted the scenarios based on two assumptions, making the new numbers not precisely comparable with the old:

• I assume the Finance Committee bipartisan solution path is dead (I only had it at 0.01% chance last time); and
• I assume virtually no chance of a signed law this year, so I have adapted the timeframes accordingly.  I say this despite recent statements from the President and Leader Reid that they want/intend to get a law by 31 December.

Pivot points and the importance of recess

Pivot points (my term) are opportunities for legislative momentum to shift.  These opportunities are to some extent predictable.  This past week had four pivot points, which is extraordinary:

1. Election Day – loss of momentum for D’s;
2. the Senate Democratic Policy Lunch on Tuesday – loss of momentum for D’s;
3. Friday’s politically challenging employment report – loss of momentum for D’s; and
4. Saturday night’s House passage vote – momentum gain for D’s.

Sometimes a pivot point will pass without any noticeable change in the legislative outlook.  But to the extent these dates/events are predictable, it at least tells you when to look for important shifts.

Here are obvious pivot points over the next few months:

• every Tuesday after the Senate Democratic Policy Lunch;
• whenever CBO releases its score of the Reid substitute amendment;
• the Monday/Tuesday after Thanksgiving recess;
• Friday, December 4th, when the next jobs report is released;
• Th/F December 17-18, the end of the week before the Christmas recess;
• the first week Members are back in DC after the holiday recess;
• late January, for the President’s State of the Union Address.

The most potentially significant consequence of the slower schedule is that Members will be home for two long recesses before a bill might be completed.  Will Members feel the same intensity of pressure they did in August?  If so, that could greatly shift momentum.

Will Leader Reid will  begin Senate floor consideration before Thanksgiving recess?  If he does, then he will probably have to show his amendment to the world before that recess, and expose his Members to pressure on specific text over that short break.  If he waits until after recess, his Members may have a slightly less painful Thanksgiving break, but at the expense of lost time on the backend and a lower probability of Senate passage before Christmas.  I would expect him to try to “back up” final passage before the Christmas recess, by in effect telling the Senate around December 18th “you can go home for Christmas only after we’ve finished the bill.”  The smell of jet fumes is usually enough to cause Members to vote aye on cloture to shut off a filibuster, but in this case I’m not so sure.

The three-part strategic question

In December Democratic leaders may face a two-part strategic question:

1. If we cannot hold 60 D’s, do we use reconciliation to pass a bill with 51, or instead go for 60 on a much more limited bill?
2. When do we make this decision?
3. Conference or ping pong?

My survey of (Republican) insiders is split on what Democrats may decide on (1), but nearly unanimous on question (2):  almost all say this strategic shift would come in January at the earliest.  The earliest projection was December 18th.

I assume liberals would prefer a reconciliation path that would probably produce a bill closer to the House-passed bill, at the price of painfully splitting off moderate Senate Democrats.  This is a slash-and-burn partisan path, but may be the highest probability path to a signed law.  I also assume moderate Democrats would prefer a scaled-back bill.  We know Democratic moderates would support the Finance Committee reported bill, so if Senate liberals could swallow hard and wait for the next step, this would be the easiest path to Senate passage.  Leader Reid tacked away from this when he announced his amendment would contain a strong public option.

If the Senate can pass a bill, Democratic leaders will need to wrestle with question (3).

Conference or ping pong?

Everyone knew the House would eventually pass something, given the enormous Democratic margin in the House.  House Republicans were more effective in their resistance than I anticipated.  This contributes to an apparent loss of momentum in the Senate.  There are now two games ahead:  Senate passage, and reconciling differences between the House and Senate.

In theory, if the Senate passes a bill, the chance of a law skyrockets.  But the House passed its bill with a left-edge coalition – most of the Democratic no votes were from moderates.  If the Senate passes a bill through regular order (with 60 votes), it will be relatively more moderate, and more compatible with an alliance on the other side of Pelosi’s caucus.  This could be quiet difficult.  How do Speaker Pelosi and Leader Reid work out differences between a bill that Lieberman, Nelson, and Lincoln support and one opposed by moderate House D’s?  Splitting the difference may alienate both sides of the Democratic caucuses.  We’re already starting to see lines drawn in the sand on abortion.

This is why some observers think Senate passage may lead to ping pong rather than a conference.  Normally after the House and Senate pass versions of a bill, the body that votes second requests a conference with the other body and appoints a handful of members to be conferees.  The second body then agrees to a conference and appoints its own conferees.  The conferees negotiate and produce pretty much whatever new text they want, although they generally stay within the scope of the contents of the two bills.  The conference report language must then be passed by both bodies to go to the President.

Ping pong is a colloquial term for skipping conference.  The House-passed bill will soon arrive in the Senate.  The Senate will presumably take up the House bill and amend it.  If and when the Senate passes its version, it would not request a conference, and would not appoint conferees, but would instead send the amended bill back to the House.  the House could then try to further amend the Senate bill, or just take it up and pass it.  This ping pong can go back and forth a few times.

Conventional wisdom seems to be that House and Senate Democratic leaders are intensely focused on the downsides of a conference.  It puts tremendous pressure on the leaders and conferees to resolve differences.  It also gives House and Senate Republicans certain procedural opportunities to cause mischief before and during conference.

But ping pong has its own downsides.  The minority, especially in the Senate, gets another crack at amending the bill.  Smart money would bet today on ping pong rather than a conference, but I expect this to be revisited often over the next couple of months.

My projections

It is highly likely the legislative process will continue at least into January.

I am still projecting a 60% chance that a comprehensive bill becomes law this year, but I have shifted some of that 60% from the regular order path to the reconciliation path.  By itself I’d never expect the Senate to shift to a reconciliation path after failing to get 60 – Senate-only logic says heck no, and the strain on Reid’s caucus would be too great.  But if Democratic leaders are forced to shift away from regular order on a comprehensive bill, I would guess that Speaker Pelosi would push hard for the Senate to use reconciliation to produce a bill more compatible with the House-passed bill rather than dialing back expectations.  This puts me at 40% regular order success, 20% reconciliation success, 20% fall back to a narrower bill, and a 20% chance the whole thing implodes.  It’s the slow pace and the two intervening recesses that give me hope.

Insiders:  Please send me your thoughts privately, especially if you disagree.

(photo credit: Speaker Pelosi’s site ^[1])

Article printed from KeithHennessey.com: http://keithhennessey.com

URL to article: http://keithhennessey.com/2009/11/09/after-house-passage/

URLs in this post:

[1] Speaker Pelosi’s site: http://www.speaker.gov/newsroom/photogallery?id=0009

Click here to print.

via keithhennessey.com

Analyzing the impact of the House vote to pass health reform this past weekend.

Posted via web from Connected Care Solutions

KeithHennessey.com » The legislative landscape for health care after House passage » Print

The legislative landscape for health care after House passage

Posted By kbh On November 9, 2009 @ 12:45 pm In budget, featured, health | 8 Comments

The House passed their version of health care reform Saturday night on a 220-215 vote.  Today I’m going to update my projections and analysis, and focus on upcoming “pivot points” in the health care debate.

1. Pass a partisan comprehensive bill through the House and through the regular Senate process with 60, leading to a law this year; (was 50% –> 40%)
2. Pass a partisan comprehensive bill through the House and through the reconciliation process with 51 Senate Democrats, leading to a law this year; (was 10% –> 20%)
3. Fall back to a much more limited bill that becomes law this year; (was 10% –> 20%)
4. No bill becomes law this year Congress.  Process continues into next year. (was 29.99% –> 20%)

I have adjusted the scenarios based on two assumptions, making the new numbers not precisely comparable with the old:

• I assume the Finance Committee bipartisan solution path is dead (I only had it at 0.01% chance last time); and
• I assume virtually no chance of a signed law this year, so I have adapted the timeframes accordingly.  I say this despite recent statements from the President and Leader Reid that they want/intend to get a law by 31 December.

Pivot points and the importance of recess

Pivot points (my term) are opportunities for legislative momentum to shift.  These opportunities are to some extent predictable.  This past week had four pivot points, which is extraordinary:

1. Election Day – loss of momentum for D’s;
2. the Senate Democratic Policy Lunch on Tuesday – loss of momentum for D’s;
3. Friday’s politically challenging employment report – loss of momentum for D’s; and
4. Saturday night’s House passage vote – momentum gain for D’s.

Sometimes a pivot point will pass without any noticeable change in the legislative outlook.  But to the extent these dates/events are predictable, it at least tells you when to look for important shifts.

Here are obvious pivot points over the next few months:

• every Tuesday after the Senate Democratic Policy Lunch;
• whenever CBO releases its score of the Reid substitute amendment;
• the Monday/Tuesday after Thanksgiving recess;
• Friday, December 4th, when the next jobs report is released;
• Th/F December 17-18, the end of the week before the Christmas recess;
• the first week Members are back in DC after the holiday recess;
• late January, for the President’s State of the Union Address.

The most potentially significant consequence of the slower schedule is that Members will be home for two long recesses before a bill might be completed.  Will Members feel the same intensity of pressure they did in August?  If so, that could greatly shift momentum.

Will Leader Reid will  begin Senate floor consideration before Thanksgiving recess?  If he does, then he will probably have to show his amendment to the world before that recess, and expose his Members to pressure on specific text over that short break.  If he waits until after recess, his Members may have a slightly less painful Thanksgiving break, but at the expense of lost time on the backend and a lower probability of Senate passage before Christmas.  I would expect him to try to “back up” final passage before the Christmas recess, by in effect telling the Senate around December 18th “you can go home for Christmas only after we’ve finished the bill.”  The smell of jet fumes is usually enough to cause Members to vote aye on cloture to shut off a filibuster, but in this case I’m not so sure.

The three-part strategic question

In December Democratic leaders may face a two-part strategic question:

1. If we cannot hold 60 D’s, do we use reconciliation to pass a bill with 51, or instead go for 60 on a much more limited bill?
2. When do we make this decision?
3. Conference or ping pong?

My survey of (Republican) insiders is split on what Democrats may decide on (1), but nearly unanimous on question (2):  almost all say this strategic shift would come in January at the earliest.  The earliest projection was December 18th.

I assume liberals would prefer a reconciliation path that would probably produce a bill closer to the House-passed bill, at the price of painfully splitting off moderate Senate Democrats.  This is a slash-and-burn partisan path, but may be the highest probability path to a signed law.  I also assume moderate Democrats would prefer a scaled-back bill.  We know Democratic moderates would support the Finance Committee reported bill, so if Senate liberals could swallow hard and wait for the next step, this would be the easiest path to Senate passage.  Leader Reid tacked away from this when he announced his amendment would contain a strong public option.

If the Senate can pass a bill, Democratic leaders will need to wrestle with question (3).

Conference or ping pong?

Everyone knew the House would eventually pass something, given the enormous Democratic margin in the House.  House Republicans were more effective in their resistance than I anticipated.  This contributes to an apparent loss of momentum in the Senate.  There are now two games ahead:  Senate passage, and reconciling differences between the House and Senate.

In theory, if the Senate passes a bill, the chance of a law skyrockets.  But the House passed its bill with a left-edge coalition – most of the Democratic no votes were from moderates.  If the Senate passes a bill through regular order (with 60 votes), it will be relatively more moderate, and more compatible with an alliance on the other side of Pelosi’s caucus.  This could be quiet difficult.  How do Speaker Pelosi and Leader Reid work out differences between a bill that Lieberman, Nelson, and Lincoln support and one opposed by moderate House D’s?  Splitting the difference may alienate both sides of the Democratic caucuses.  We’re already starting to see lines drawn in the sand on abortion.

This is why some observers think Senate passage may lead to ping pong rather than a conference.  Normally after the House and Senate pass versions of a bill, the body that votes second requests a conference with the other body and appoints a handful of members to be conferees.  The second body then agrees to a conference and appoints its own conferees.  The conferees negotiate and produce pretty much whatever new text they want, although they generally stay within the scope of the contents of the two bills.  The conference report language must then be passed by both bodies to go to the President.

Ping pong is a colloquial term for skipping conference.  The House-passed bill will soon arrive in the Senate.  The Senate will presumably take up the House bill and amend it.  If and when the Senate passes its version, it would not request a conference, and would not appoint conferees, but would instead send the amended bill back to the House.  the House could then try to further amend the Senate bill, or just take it up and pass it.  This ping pong can go back and forth a few times.

Conventional wisdom seems to be that House and Senate Democratic leaders are intensely focused on the downsides of a conference.  It puts tremendous pressure on the leaders and conferees to resolve differences.  It also gives House and Senate Republicans certain procedural opportunities to cause mischief before and during conference.

But ping pong has its own downsides.  The minority, especially in the Senate, gets another crack at amending the bill.  Smart money would bet today on ping pong rather than a conference, but I expect this to be revisited often over the next couple of months.

My projections

It is highly likely the legislative process will continue at least into January.

I am still projecting a 60% chance that a comprehensive bill becomes law this year, but I have shifted some of that 60% from the regular order path to the reconciliation path.  By itself I’d never expect the Senate to shift to a reconciliation path after failing to get 60 – Senate-only logic says heck no, and the strain on Reid’s caucus would be too great.  But if Democratic leaders are forced to shift away from regular order on a comprehensive bill, I would guess that Speaker Pelosi would push hard for the Senate to use reconciliation to produce a bill more compatible with the House-passed bill rather than dialing back expectations.  This puts me at 40% regular order success, 20% reconciliation success, 20% fall back to a narrower bill, and a 20% chance the whole thing implodes.  It’s the slow pace and the two intervening recesses that give me hope.

Insiders:  Please send me your thoughts privately, especially if you disagree.

(photo credit: Speaker Pelosi’s site ^[1])

Article printed from KeithHennessey.com: http://keithhennessey.com

URL to article: http://keithhennessey.com/2009/11/09/after-house-passage/

URLs in this post:

[1] Speaker Pelosi’s site: http://www.speaker.gov/newsroom/photogallery?id=0009

Click here to print.

via keithhennessey.com

Analyzing the impact of the House vote to pass health reform this past weekend.

Posted via web from Connected Care Solutions

GE Healthymagination Fund - Investment Platform

Investment Platform

The Healthymagination Fund draws on capabilities from across GE Healthcare, GE Capital and GE Global Research and has a global footprint. The investment committee is comprised of senior leaders of these groups.

via healthymaginationfund.com

Exciting new $250mm HIT investment fund launched by GE Capital offers unprecedentedly aggressive and bullish HIT private equity joint venture. Ideas abound...

Posted via web from Connected Care Solutions

GE Healthymagination Fund - Investment Platform

Investment Platform

The Healthymagination Fund draws on capabilities from across GE Healthcare, GE Capital and GE Global Research and has a global footprint. The investment committee is comprised of senior leaders of these groups.

via healthymaginationfund.com

Exciting new $250mm HIT investment fund launched by GE Capital offers unprecedentedly aggressive and bullish HIT private equity joint venture. Ideas abound...

Posted via web from Connected Care Solutions

Stimulus creates huge demand for HIT professionals | FierceHealthIT.com

With all the new money flowing into health IT, particularly with the $35 billion or so in federal money (a net $19 billion after accounting for expected efficiency savings) for electronic health records, someone's going to have to build, install, deploy and train people to use the systems, right? Studies estimate that there was a need for 10,000 to 15,000 new health IT professionals nationwide, but those were conducted before the enactment of the federal stimulus back in February. So there's clearly a huge demand for a health IT workforce, Health Leaders Media reports.

More recently, the an American Hospital Association survey found that 25 percent of responding organizations are shorthanded when it comes to IT staff and expertise. However, the economic downturn that has left so many talented IT professionals unemployed could provide an unprecedented opportunity for healthcare. "We have to figure out a strategy to take IT professionals from other disciplines and orient them to healthcare, and then look at the educational system and the places where they are training people who are specializing in healthcare issues to beginning to look at healthcare IT as a piece of the curriculum," says AHA spokesman Rick Wade.

While these seasoned IT pros can be of immediate help in building secure infrastructure, they will have to be trained for the unique needs of healthcare. "It's all about understanding clinical business processes," says Alex Rodriguez, CIO of St. Elizabeth Healthcare in Edgewood, Ky. "That is the separation-being able to have the communication skills to dive into how the business processes work, the communication skills and the thinking skills to determine how the new technology applications are going to be used," he explains to Health Leaders.

While the increased demand could drive up salaries, Rodriguez says people are looking for professional growth and stability in these trying times, so hospitals may not have to break the bank when augmenting their health IT staff.

For more on the staffing implications of the stimulus:
- take a look at this Health Leaders Media story

Related Articles:
Blumenthal: Conversion to EMR will create 50,000 new HIM jobs
Economic woes or not, it's full speed ahead for AHIMA '09
Many more HIT pros needed as EMRs roll out

via fiercehealthit.com

Musings on HIT, health reform message management and the twenty-second amendment...

Health IT is not getting the attention in needs from the senior White House officials and it must be elevated to a central issue during the next phase in the legislative process to pass health reform - The Senate. Health IT has always been the most directly attractive core element of the president's plan, but it has been missing from the fundamental arguments made directly to the American people, a critical error in strategy as it may be the only idea with little resistance on either side of the aisle. Not only is health information technology politically popular, its also one of the very few threads of the larger and infinitely more complex health reform debate that nearly every consumer can understand at a high level.

'Connected Care' and 'Telemedicine' provide the most obvious opportunity to create an emotional investment among voters in the "meat and potatoes" of how Obama's reform initiative will accelerate the modernization medical business. Rahm would be wise to shift debate whenever possible on Sunday circuit away from the billion dollar price tags that currently dominates the discussion and onto the opportunities available for jobs, higher quality health care, and a "smarter" society - steal it from IBM's most recent commercials if you must.

If voters believe that a plan exists that would achieve hyper-saturation of new bioinformatics-driven hardware and software products for consumers - mobile hardware and software needed to facilitate telemedicine services at the level of individual practices and regional health systems - re-election is a slam dunk and the twenty-second amendment (Presidential Term-Limits) could be justifiably revisited. While a lifetime of Barack is a nausating thought, the twenty-second amendment was a mistake and a strong argument could be made that it has prevented the most qualified man in America from re-entering public service - Bill Clinton. Without any legitimate reasoning as to why ambition and uncharacteristic success at a young age should somehow deprive great leaders from leading. Nobody benefits from suppression of genius under any circumstances.

Posted via web from Connected Care Solutions

E-Bridge East Baton Rouge EMS Telemedicine Overview

Check out this SlideShare Presentation on East Baton Rouge Parish EMS Dept's Wireless Pre-hospital Telemedicine Pilot Program.

E Bridge Ems Telemedicine Overview

View more presentations from Brian Edwards.

American Recovery and Reinvestment Act : Unprecedented Opportunity for Health IT

Image via Wikipedia

Health Information Technology and Economic and Clinical Health Act of 2009 (HITECH Act)

It has long been legislative practice in Washington, DC to package many large spending bills together in an omnibus package that gets passed with one vote by all members, rather than debate and vote on each measure independently. These practices are especially popular when one party has the near invincible majority in both houses, not to mention an overwhelmingly popular president in the White House. Obama's American Recovery and Reinvestment Act (ARRA) is essentially an omnibus spending bill  under the guise of a "stimulus package". The bundling of the HITECH Act, which radically alters the framework for implementing and managing electronic health records and general health care policy, into a spending bill sold to the American people as an "investment" in modernizing the national infrastructure and creating jobs is clever and near the top of early administration accomplishments.

Obama's first 100 days could easily be described by the phrase penned by Latin poet Hoarce carpe diem, popularly translated to mean "seize the day". The complete excerpt from the original poem reads, carpe diem quam minimum credula "seize the day and have no trust in tomorrow". I believe this completely captures Obama's mindset as he proactively spearheads efforts from the Oval Office to regain control  during a time of economic crisis and reinstate confidence in the capitalist system. The purpose driven and institutionally significant changes embedded in the fine print of the ARRA shows quite clear that Obama and his Chief of Staff Rahm Emanuel seek to swiftly and indefinitely create a system that functions in a fundamentally different manner across all aspects of society and government.

Related articles by Zemanta

• ARRA - HITECH: Health Care Information Breach Notification Regulations Now In Effect (healthcarebloglaw.blogspot.com)
• Strassel: The Chicago Way (online.wsj.com)
• Trumka Takes Push for Public Option to the White House (blogs.wsj.com)
• White House Says Stimulus Money Still Kicking In (abcnews.go.com)
• Federal Digital Health Stimulus Program's Rising Costs: Fuzzy Math? (huffingtonpost.com)
• AP IMPACT: Stimulus Jobs Overstated by Thousands (abcnews.go.com)

Telemedicine: CMS definition and reimbursement guidelines

 Quoted directly from Centers for Medicare and Medicaid Services website:

Telemedicine

For purposes of Medicaid, telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient's health. Electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment permitting two-way, real time interactive communication between the patient, and the physician or practitioner at the distant site. Telemedicine is viewed as a cost-effective alternative to the more traditional face-to-face way of providing medical care (e.g., face-to-face consultations or examinations between provider and patient) that states may choose to cover. This definition is modeled on Medicare's definition of telehealth services located at 42 CFR 410.78. Note that the Federal Medicaid statute (Title XIX of the Social Security Act) does not recognize telemedicine as a distinct service.

Distant or Hub Site means the site at which the physician or other licensed practitioner delivering the service is located at the time the service is provided via telecommunications system.

Originating or Spoke site means the location of the Medicaid patient at the time the service being furnished via a telecommunications system occurs. Telepresenters may be needed to facilitate the delivery of this service.

Asynchronous or "Store and Forward" means transferring data from one site to another through the use of a camera or similar device that records (stores) an image that is sent (forwarded) via telecommunication to another site for consultation. Asynchronous or "store and forward" applications would not meet the above definition of telemedicine--see telehealth.

Reimbursement/Billing—Reimbursement for Medicaid covered services, including those with telemedicine applications, must satisfy federal requirements of efficiency, economy and quality of care. With this in mind, States are encouraged to use the flexibility inherent in federal law to create innovative payment methodologies for services that incorporate telemedicine technology. For example, States may reimburse the physician or other licensed practitioner at the distant site and reimburse a facility fee to the originating site. States can also reimburse any additional costs such as technical support, transmission charges, and equipment. These add-on costs can be incorporated into the fee-for-service rates or separately reimbursed as an administrative cost by the state. If they are separately billed and reimbursed, the costs must be linked to a covered Medicaid service. While telemedicine is not considered a distinct Medicaid service, any State wishing to cover/reimburse for telemedicine services should submit a State Plan Amendment to the Centers for Medicare and Medicaid Services for approval.

Medical Codes—States may select from a variety of HCPCS codes (T1014 and Q3014), CPT codes and modifiers (GT, U1-UD) in order to identify, track and reimburse for telemedicine services.

Telehealth (or Telemonitoring) is the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across distance.

Telehealth includes such technologies as telephones, facsimile machines, electronic mail systems, and remote patient monitoring devices which are used to collect and transmit patient data for monitoring and interpretation. While they do not meet the Medicaid definition of telemedicine they are often considered under the broad umbrella of telehealth services. Even though such technologies are not considered "telemedicine," they may nevertheless be covered and reimbursed as part of a Medicaid coverable service under section 1905(a) of the Social Security Act such as laboratory service, x-ray service or physician services.

Other Considerations:
Medicaid guidelines require all providers to practice within the scope of their state practice act. Some States have enacted legislation which requires providers using telemedicine technology across state lines to have a valid state license in the state where the patient is located. Any such requirements or restrictions placed by the State are binding under current Medicaid rules. Medicare Conditions of Participation (COPs) applicable to settings such as long-term care facilities, and hospitals may also impact reimbursement for services provided via telemedicine technology. For instance, the Medicare COPs for long-term care facilities require physician visits at set intervals. Current regulations require that the physician must be physically present in the same room as the patient during the visit. This requirement must also be met for Medicaid to pay for services provided to Medicaid eligible patients while in a Medicare or Medicaid certified facility. Similarly, federal regulations require face-to-face visits for home health, and telemedicine cannot be used as a substitute for those visits. However, a telemedicine encounter may be used as a supplement to the required face-to-face visits.

Anyone eager to make a business out of remote care and telemedicine technologies must carefully read, re-read, and ultimately memorize the one-page guidelines above if they hope to remain a sustainable investment in the current environment. In my estimation, the most valuable by-product of a Billion-dollar US Connected Health sector will be its utility as a stimulant of hyper-innovation. Without a business plan and patient care protocols/procedures that achieve 75-100% reimbursement rates from CMS, any telemedicine program is doomed to be a money-pit regardless of the altruistic motives of its proponents. The entrepreneur who will emerge best-of-breed in telemedicine will be he/she who finds the shortest path to demonstrating "Meaningful Use" in the form of real improvement in patient outcomes.

Posted via web from Connected Care Solutions

Image via Wikipedia

  

Related articles by Zemanta

• In Health Care Today, It's Electronic All the Way (nlm.nih.gov)
• CMS Publishes Proposed Medicare Home Health Payment Changes for 2010 (medicareupdate.typepad.com)
• Waves of New Fund Cuts Imperil US Nursing Homes (abcnews.go.com)
• Healthcare Spending Varies Widely by Region (edkimmd.blogspot.com)

Telemedicine allows for long-distance diagnoses

Link: Telemedicine allows for long-distance diagnoses - The Washington Times.

As mentioned in an earlier post, 4 years ago Telemedicine was in its infancy, perhaps used for monitoring status of patients with pacemakers... Now, according to this article in the Washington Times, Dr. Kenneth Bird, a Harvard professor affiliated with Massachusetts General Hospital, innovated an approach to patient care using monitors and remote access to hospitals to examine, diagnose and treat his patients.

Also, according to the article, patients are wearing monitors that can be remotely tracked and physicians can be notified and/or paged when necessary. Telemedicine (a.k.a. Telehealth) is not a substitute for direct patient care, but rather, it is an augmentation to the existing delivery of care. That said, installation/implementation can be a huge expense (ranging between $2.5 and $3.5 million), so larger hospitals are more likely to implement remote monitoring.

The article continues with explanation of "concierge" medicine approaches, which are light years ahead of the status quo. The benefits to patients is purportedly rapid care from providers, from home or within a specialized, technology enabled facility.

It's an interesting thought, and another example of how technologies can be used to improve patient care if used appropriately. That said, there are likely significant privacy and security issues related to the "transaction" between patient and providers. For more information about HIPAA Requirements, The HIPAA Privacy Rule, The Security Rule, or The HITECH Act visit The Online HIPAA Survival Guide.

And, if you are interested in keeping current on the issues, sign up for the FREE HITECH/HIPAA Compliance Newsletter.

via feedproxy.google.com

Courtesy of Healthcare & Technology Blog (By: Deborah Leyva): http://www.myhealthtechblog.com/2009/10/telemedicine-allows-for-long-distance-diagnoses.html

Telemedicine (Telehealth) is starting to get the attention it deserves, but innovation will not occur in a vacuum of unsustainable business models. Until self-sustainability for for telemedicine initiatives is achieved and replicated on a widespread basis it will not be as significant in the provision of care as it should be.

Posted via web from Connected Care Solutions

AHRQ Report: Consumers Need to be Empowered in Health IT Debate

via scribd.com

A new study out the Agency for Healthcare Research and Quality (AHRQ) suggests that by excluding consumers from the broader implementation of health information technologies, the medical community is marginalizing themselves and prolonging the time it will take to reach high levels of consumer adoption. Just another reason to add to the list of flawed approaches/perspectives on information technology among health professionals, though quite possibly the one issue that if addressed effectively could make all of the other impediments to ubiquitous adoption of highly advanced IT systems evaporate in the face of overwhelming consumer demand.

Posted via web from Connected Care Solutions

BreakThrough: Teletherapy startup gaining some mainstream popularity, but business model is very misleading

From the website of telemedicine startup BreakThrough:

Overview

BreakThrough connects mental health professionals with clients through secure video, phone, and web.

We have a mental health epidemic

More than 57 million Americans – one in four adults – have a diagnosed mental illness. Tens of millions more struggle with stress and relationship issues. Institutions such as hospitals, prisons, schools, companies, health plans, and veterans centers are overcrowded with patients needing help, but growing costs and shrinking budgets are decimating quality of care.
Even though seventy to eighty percent of patients with mental illness improve with treatment, patients remain woefully underserved. Two–thirds of Americans with a mental illness do not receive treatment due to cost, stigma, inconvenience, and low access, particularly in rural areas. This is despite Americans spending $121 billion on mental health and substance abuse treatment.

The solution of telemedicine

Telepsychiatry and teletherapy – mental health services delivered through secure video, phone, and web – have emerged as effective, affordable, convenient, and safe methods of treating stress and mental illness. Telemedicine has several substantial benefits:

Effectiveness:

over fifteen years of research confirm that telemedicine is as effective as in–person treatment. This is particularly true in psychiatry and clinical psychology where much of the treatment is doctor–patient communication. Click here for a list of research studies on the effectiveness of telemedicine.

Convenience:

fifty percent of therapy clients drop out after a few sessions, but research shows teletherapy can boost retention to over ninety percent. Because clients can hold sessions anywhere with phone or internet access, they are much more likely to go and stay in treatment. BreakThrough supports sessions via video, phone, email, and live chat.

Affordability:

telemedicine sessions can cost ten to fifty percent less due to reduced overhead, travel time, and staffing needs. On BreakThrough, providers set rates that are almost always more affordable than in–office visits.

Access:

research shows the fit between clients and mental health providers is essential to positive outcomes. Most people will not travel to a provider beyond fifty miles, but telemedicine lets clients work with the best licensed provider regardless of location. BreakThrough clients can find providers on a wide variety of criteria, including price, reputation, location, gender, experience, credentials, and more.

Confidentiality:

eighty percent of therapy clients worry about the stigma of treatment. To protect clients, BreakThrough requires minimal information, enabling treatment with a level of discreteness and security not possible with in–person treatment.

Peer support:

the support of friends, family, and other patients is essential to long–term recovery. BreakThrough offers forums, group sessions, and seminars to enable peers to support each other no matter where they live.

Telemedicine is legal and expanding

Telepsychiatry and teletherapy are legal and regulated by state–specific guidelines. Government and licensing boards are also rapidly evolving legislation to expand telemedicine access.
To protect providers and meet the highest levels of regulatory compliance, we currently allow providers to see clients only in states where the provider is licensed. Providers can typically apply for licensure in multiple states, either directly through state licensing boards or third–party services that streamline the application process.

Telemedicine is reimburseable

Since 2004, Medicare and the AMA have issued CPT codes to identify and reimburse telepsychiatry and teletherapy services. A list of eligible services and codes include:

• Individual psychotherapy: CPT 90804 – 90809
• Consultations: CPT 99241 – 99255
• Office or other outpatient visits: CPT 99201 – 99215
• Pharmacologic management: CPT 90862
• Psychiatric diagnostic interview examination:CPT 90801
• Neurobehavioral status examination: CPT 96116

CPT code descriptions can be found on the American Medical Association's CPT directory. The modifier GT may be necessary to identify that services were delivered via telemedicine. For Medicare reimbursement, clients generally must receive treatment at an eligible originating site, such as a doctor's office, hospital, nursing facility, mental health clinic, or similar facility. Private payers often do not have the same locality restrictions. More details on reimbursement are available through the American Telemedicine Association.

via breakthrough.com

The premise underlying the business model for BreakThrough may well be sound, particularly the evidence presented supporting the positive impact of teletherapy on psychiatric patient outcomes. However, the increase in quality of treatment via telemedicine is irrelevant without a method for sustaining the provision of treatment through reimbursement of attending psychiatrists.

The assertion that "Telemedicine is reimbursable" made in the final section above, while accurate technically, is misleading in that eligibility to be reimbursed and actually recouping fees for services provided are two entirely different issues. The CPT codes provided by the BreakThrough founders are a distraction from the real challenge of processing and collecting payment, which is overcoming the fact that CPT codes are very often (more often than not) ignored because of the GT modifier and the advanced standards of practice that must be met to be eligible under Medicare reimbursement policy.

Medicare mandates clearly that telemedicine services are only eligible for reimbursement when there is a two-way video transmission that allows doctor and patient to each see the other. Any health professional will tell you that private insurers will always follow Medicare's guidance when it comes to establishing standards of eligibility for reimbursement.

This is going to create a major obstacle for the well intentioned and otherwise exciting startup to achieve widespread adoption amongst mental health providers, as they are not likely to adopt therapeutic practices without demonstrable evidence that reimbursement above a significant percentage of total consults is achievable. I wish the BreakThrough team the best of luck!!

Posted via web from Connected Care Solutions

'Connected Health' Could Trim Costs by 40 Percent

A new survey released by the Massachusetts Medical Device Industry Council (MassMEDIC) and Cambridge Consultants, a technology product design and development firm, finds that a patient-centered and coordinated approach to healthcare could save billions of dollars. The survey also indicates care coordination will reduce wasteful spending in defensive medicine, inefficient claims processing, medical errors and emergency room services.

http://www.healthcareitnews.com/news/survey-connected-health-could-cut-healthcare-costs-40-percent

via healthcaregoesmobile.com

It makes little sense to me that the current debate in DC about health reform presupposes that the health care business is fundamentally unsustainable, as it has yet to adopt many of the most widely recognized enhancements in operational efficiency that have redefined nearly every other information intensive industry in America since the early 1990's. If 40-percent of costs can be trimmed without totally overhauling the system, which would leave 1/6th of our economy to exist in a vacuum for several years as we wait to see if our blind overhaul worked, I think this must be allowed to play itself out as it did in every other market. If any policy measures are useful at this stage in the modernization of health care, they are gradual, incentive-based measures that would help break-through barriers created within the medical community by undefined guidelines and a perception that such innovative activity would involve too much risk. Several programs launched through the stimulus package were a good start, but will be much less consequential if too much is done too soon by politicians focused not on patient care, but rather on their personal legacies.

Posted via web from Connected Care Solutions

National Coalition for Health Integration (NCHI): Bringing order to the chaotic health information technology through grid computing

via scribd.com

The National Coalition for Health Integration (NCHI) initiative is an ambitious attempt to establish a truly interoperable environment for linking independent health information technology projects around the US through an open framework. With an all-star team of business and scientific directors funded entirely through private donations made by its principal founder, billionaire pharmaceutical entrepreneur Patrick Soon-Shiong, M.D., NCHI seeks to establish "virtual organizations" which combine numerous disparate health organizations across all sub-specialties and functional purposes (i.e. billing, administration, health records, etc.) without concern for traditional geographic constraints. It utilizes in an unprecedented fashion institutes of higher education and their leading academic innovators in bio-informatics and grid computing. Truly a revolutionary initiative which will undoubtedly emerge as a major foundational element of any long-term improvement in the delivery of quality care. (www.nchiconnect.org)

Posted via web from Connected Care Solutions

Related articles by Zemanta

• Implementation of health information technology (HIT) and health information exchange (HIE) is critical both nationally and in NH. - NH Citizens Health Initiative (stevensreeves.posterous.com)
• Practice Fusion funnels electronic health records to BioReference Labs (digital.venturebeat.com)
• $1.2 billion In Grants Becoming Available for Hospitals and Providers in 2010 - Mentors Still Needed (ducknetweb.blogspot.com)
• Bits: Digital Health Records: The Hard Road Ahead (bits.blogs.nytimes.com)
• Digital Health Records: The Hard Road Ahead (bits.blogs.nytimes.com)

Larry Summers: "The average supermarket has more information technology than the average doctor's office"

Larry Summers made this point on Meet the Press this morning while defending the American Recovery and Reinvestment Act (ARRA) and the massive investment made by several federal agencies over the next five years. Sadly, he is not exaggerating at all. What a sad reality, but why overhaul the entire system from the foundation up without first assessing the impact of this $58B+ investment on the physicians and their willingness to adapt to the 21st century? 

Why is "insurance reform" more important that tort reform? You cannot even put the health care business in the same league as the grocery sector when it comes to information technology adoption, the single greatest factor in the cost savings and productivity increases across nearly every other sector of the American economy for the last 15 years, but we can somehow call it a failed industry and support wholesale restructuring?? I cannot believe anyone still supports Obama's nonsense.

Dept of Labor Grant Announcement: Training a 21st Century Health Care Workforce

The Department of Labor (DoL) has released $225 million in the form of grants for job training in emerging and in-demand health care sectors such as health information technology, nursing and applied care. Below you will find a summary of the grant opportunity as well as the full text of the DoL guidelines issued in the Federal Register.  The money is part of the American Recovery and Reinvestment Act, popular known as the "stimulus", which was passed by Congress in February and was among the first official acts of the Obama Administration. 

Little detail of how the funds were to be spent was provided in the original legislation and federal agencies have largely sought to direct money toward areas of the economy determined to have the greatest potential return on investment. The decision to use stimulus funds to retrain an American workforce that is currently experiencing levels of unemployment not seen since the early 1980's makes a lot of sense, particularly when that retraining is focused on jobs in technology-intensive industries.

The industry in the greatest need of skilled information technology and otherwise technically proficient new workers is the health care sector, which has been the slowest of the major American industries to adopt information technology into its best practices in a meaningful way. This failure to keep pace with the general rate of innovation across the economy as a whole, especially across other similarly information intensive industries such as banking, is a significant contributor to the unrelenting rise in the cost of care at the center of the current health care reform debate in DC. Before radical industry restructuring is undertaken, it would be wise to wait and see how the major investments currently under deployment in innovating and modernizing the industry impact escalating costs. One need look no further than the experiences of other American industries to see the cost-benefit of ubiquitous IT adoption and the tremendous impact this cost savings has had on innovation generally.

Summary - Dept of Labor ETA HC HG Grants Fact Sheet

ARRA - Dept of Labor Grant Notice (SGA-DFA-PY-09-01-1)

Tech Tags: Stimulus ARRA Health+Policy Health+IT Grants Jobs Health+Care

Related articles by Zemanta

• Update On HIT Policy and Standards Committees (healthcarebloglaw.blogspot.com)
• Department of Labor (DOL) Announces Health Care Sector Grants (tissuepathology.typepad.com)
• American Health Care--Posner's Comment (becker-posner-blog.com)
• Ap Fact Checks Obama ... No, Really (healthcarebs.com)
• Obama tries to convince American public that health care reform is in their best interest. (slate.com)

HR 3200: America’s Affordable Health Choices Act of 2009 (Full Text)

(Cross-posted at The World We'll Inherit)

Below is the final proposal for health care reform issued by the Democratic House of Representatives today, which Speaker Nancy Pelosi confidently asserted she could pass by the end of the summer session. That's right, we only have about four weeks to digest, debate, amend and vote on this 1018-page piece of legislation which seeks to fundamentally redefine the rules of our nation's largest industry. Turns out "change" sucks a whole lot more than the status quo sometimes.

Would love to hear everyone's thoughts...

HR 3200 - America’s Affordable Health Choices Act of 2009

Related articles by Zemanta

• Madame Pelosi Thinks You Lowly Serfs Have No Business "Minding Her Business" (dequalss.com)
• Panetta: CIA Misled Congress 'For a Number of Years." We Are Shocked! (crooksandliars.com)
• White House Threatens Veto Of Bill To Alter National Security Briefings (huffingtonpost.com)
• Abortion Enters the Health Care Debate (dailykos.com)

Tech Tags: Health+Policy Health+Reform Health+Care Connected+Care Health+Blogs HR+3200

Report to the President on Guidelines for Upcoming Comparative Effectiveness Research Grants

The Annual Report on Comparative Effectiveness Research contains information describing current Federal activities on comparative effectiveness research and recommendations for such research conducted or supported from funds made available by the Recovery Act (Full Text). $1.1B in grant funds, allocated to the Dept of Health and Human Services in the ARRA, will be released shortly under RFP through the NIH, AHRQ and HHS.

DHHS Comparative Effectiveness Plan

Related articles by Zemanta

• Health IT Policy Committee Appoints 3 (medicineandtechnology.com)
• CBO Scores Affordable Health Choices Act at $611 Billion Over 10 Years (medicareupdate.typepad.com)
• Healthcare Information Technology Standards Panel (medicineandtechnology.com)
• Americans turn to technology to manage chronic ailments at home (techburgh.com)
• AHRQ Study Finds Mixed Evidence on Use of Radiofrequency Catheter Ablation for Treating Atrial Fibrillation (ahrq.gov)

Tech Tags: AHRQ HHS NIH Comparative+Effectiveness+Research Stimulus ARRA Health+Policy