BACK BEAT

Kolodner Gets the Gig

Robert KolodnerRobert Kolodner, M.D. — interim national coordinator for health IT in the Department of Health and Human Services since Sept. 20, 2006 — has been named to that position on a permanent basis.

As national coordinator for health IT, Kolodner will serve as principal advisor to HHS Secretary Mike Leavitt on all health IT initiatives. He will also continue to develop, maintain, and direct the implementation of the strategic plan to guide nationwide adoption of interoperable health IT.

Kolodner joined HHS from the Department of Veterans Affairs'(VA) Veterans Health Administration (VHA), where he was chief health informatics officer. In that role, he was chief advisor to the VA's under secretary for health on information technology issues and oversaw the development of the VA's electronic health record, VistA.

AHIP's Proposal

A new strategy to improve the safety and quality of medical care has been released by the Board of Directors of America's Health Insurance Plans (AHIP).

Key elements of AHIP's Quality and Safety Proposal include:

• Establishing a new national entity to evaluate and compare the safety, efficacy and cost effectiveness of new and existing healthcare treatments and technologies, including prescription drugs and medical devices.

• Reforming the Food and Drug Administration (FDA) to improve its ability to assess the long-term safety and effectiveness of newly approved drugs and devices.

• Setting a national research agenda that addresses known gaps in evidence and makes communication regarding ongoing research studies a national priority.

IRS Rules on EMRs

The Internal Revenue Service has stated that not-for-profit hospitals can subsidize their affiliated physicians' costs of acquiring and implementing electronic medical records without violating Stark anti-kickback laws.

The ruling covers both software and technical support for physicians to connect to their hospital's EMR.

Physician financing of EMRs has been identified as a stumbling block to adoption. Last year, the National Alliance for Health Information Technology and the American Hospital Association called attention to the potential tax issues faced by non-for-profit hospitals when providing their doctors with IT funding.

Reviewing Privacy Rule

According to a report, “On the Front Lines of Healthcare Privacy,” issued by the American Health Information Management Association (AHIMA), the role of privacy officers in healthcare has changed due to the evolution of health information exchanges, state-level privacy and security standards that are more stringent than HIPAA, and numerous high-profile security and privacy breaches.

In the report, AHIMA spoke with four privacy professionals, all of whom provided insight on how privacy officers:

• Now play a broader role within their healthcare organizations.

• Do work that has become more complex, with the introduction of health information exchanges and increased interest from the public.

• Face challenges that still exist with some HIPAA standards.

• Deal with the long-standing task of educating consumers about their privacy rights.

A Perspective on Payers

Philadelphia-based CIGNA received top marks in a recently issued ranking of the nation's insurers, conducted by Watertown, Mass.-based athenahealth Inc. and Baltimore-based Physicians Practice journal.

Findings from the 2007 PayerView Rankings:

• Hartford, Conn.-based Aetna moved from a ranking of fourth in 2006 to second in 2007.

• The rankings indicate an increased burden put on physicians in having to manage patient collections due to consumer-directed health plans, co-insurance, co-pays, and high-deductible plans.

• DAR for processing claims decreased close to 5 percent for national payers and 3 percent for regional payers from the 2006 rankings.

• Blue Cross and Blue Shield Rhode Island had the lowest DAR of any payer in the nation.

• Patient liability is on the rise. Blue Shield of California was the lowest ranked payer in the nation with a percent patient liability of 16.9 percent.

The ranking is designed to quantify the “ease of doing business with the payer,” according to athenahealth. All data used for the rankings came from actual claims performance data of athenahealth providers.

HHS Reports on e-Prescribing

Michael Leavitt In a report to Congress, HHS Secretary Michael Leavitt announced the results of an electronic prescribing pilot project that support the adoption of new standards.

The pilot project demonstrated that three initial standards — for transactions that provide physicians with patients' formulary and benefit information; medication history; and the fill status of medications — are already capable of supporting e-prescribing transactions in Medicare Part D.

The report also found that, with some adjustments, e-prescribing can work successfully in long-term care settings.

Standards in need of further development include those used to convey structured patient instructions, a terminology to describe clinical drugs, and messages that convey prior authorization information.

Quality Improvement Report

There are “vast differences” in the way local and regional healthcare markets use information technology, publicly reported performance measurements, and other key initiatives that drive improvements in the care of people with chronic illnesses, according to a new report from the Robert Wood Johnson Foundation (RWJF) and the Center for Health Improvement (CHI).

Findings underscore the need to account for community variations in any national attempt to improve health care quality, the study emphasizes.

RWJF and CHI researchers also drew four broad conclusions from their findings:

• There are multiple opportunities for intervention to improve quality at the local level.

• All healthcare is local (or at least regional), and differences among market shapes form the single most important driver of how individuals receive healthcare from their doctors.

• The interplay, relationship and evolution of market attributes deserve further study.

• The public sector has a critical role to play.

CMS Proposes Rule

The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule to improve the accuracy of Medicare's payment under the acute care hospital inpatient prospective payment system (IPPS), while providing incentives for hospitals to engage in quality improvement efforts.

The payment reforms include a proposal to restructure the inpatient diagnosis related groups (DRGs) to account more fully for the severity of the patient's condition. In addition, the proposed rule includes provisions to ensure that Medicare no longer pays hospitals for their additional costs of hospital-acquired conditions (including infections), and includes an expanded list of publicly reported quality measures. The rule would also reduce payment for a DRG involving the implantation of a device, when a hospital replaces a device and the replacement is supplied to the hospital at no or reduced cost.

According to CMS, the proposed rule will add five new quality measures. The five proposed measures include 30-day mortality for Medicare patients with pneumonia, and four additional measures relating to surgical care improvement.

Comments on the proposed rule will be accepted until June 12, 2007 and a final rule, to be effective on or after Oct. 1, will be published later in the summer.

N.J. Hospitals Leap Forward

Seven additional New Jersey hospitals have recently joined The Leapfrog Hospital Rewards Program (LHRP), a nationally standardized method to assess patient care by measuring performance along two dimensions — the quality of care hospitals provide and how efficiently they deliver it.

The new institutions are:

• Hackensack University Medical Center

• Hoboken University Medical Center

• Hunterdon Medical Center

• Morristown Memorial Hospital

• Overlook Hospital

• Robert Wood Johnson University Hospital (Hamilton)

• University of Medicine and Dentistry of New Jersey Medical Center

Commitment to Consumer-Directed Healthcare

In a survey of 301 executives and officials from health plans and government health agencies, 90 percent of respondents said that a commitment to consumer-directed healthcare is a priority.

Key findings of the survey, conducted by Stamford, Conn.-based Thomson Corporation, include the the three most-cited reasons to offer consumer decision support tools:

• Reduce overall healthcare costs.

• Improve individuals' health.

• Increase beneficiaries' engagement in healthcare.

President of the Commonwealth

James Tallon, Jr., president of the United Hospital Fund of New York, was recently elected chairman of The Commonwealth Fund, New York, N.Y. He takes office on Nov. 14, succeeding Samuel Thier, M.D., who has served as chairman since 2002.

Tallon has served as a director of the Fund since 1996, and is a member of its Executive and Finance Committee. A member of the New York State Assembly for 19 years, he served as chair of the Health Committee from 1979 to 1987 and as majority leader from 1987 to 1993.

More recently, Tallon headed New York Governor Eliot Spitzer's Health Care Policy Advisory Committee during the gubernatorial transition period in 2006.

An HL7 Profile

Health Level Seven (HL7), a healthcare IT standards development organization, has put in place the Emergency Care Functional Profile (EC FM) as the first registered profile based upon HL7's EHR System Functional Model (EHR-S FM) standard.

HL7's Emergency Care Special Interest Group developed the EC FM for Emergency Department (ED) Information Systems to create an objective standard for the development, refinement, and evaluation of information systems employed in the ED.

The EHR-S FM and the Emergency Care Function Profile will facilitate solutions to underlying ED operational problems such as overcrowding, ambulance diversion and shortage of services.

The profiles below are a subset of the EHR-S FM, outlining the functions needed by clinicians using EHR systems for special purposes:

• Legal EHR

• Behavioral Health

• Child Health

• Long Term Care

• Regulated Clinical Research

CAQH Identifies Automated Identification

Automated systems to verify patient insurance eligibility and benefits information could significantly reduce administrative costs for both, according to a recent survey of health insurance plans and providers conducted by CAQH and supported by the California HealthCare Foundation (CHCF).

By moving from labor-intensive verification methods to automated HIPAA transactions, providers may reduce labor costs associated with verifying insurance coverage by as much as 50 percent, according to study findings.

The survey was part of CAQH's Committee on Operating Rules for Information Exchange (CORE) initiative. CAQH recently initiated a second CORE research project to quantify the cost impact on providers and health plans when patients do not provide health insurance identification numbers or when those ID numbers are later determined to be inaccurate.

P4P Program Discrepancies

According to the Framingham, Mass.-based consultancy, the survey's key findings include:

• 70 percent of respondents claim to have a P4P program that actively promotes physician technology adoption to improve healthcare quality and safety, yet only 33 percent actually implement physician technology adoption as a P4P incentive, with less than 37 percent reporting active investment or sponsorship of these initiatives.

• 35 percent of health plans implement P4P programs across all of their product lines.

• Of the single-product P4P programs, HMOs take the lead with 40 percent of respondents reporting a P4P program in place.