Seven Significant Things We Learned in 2015

Dec. 22, 2015
The year 2015 has been a truly eventful, indeed tumultuous, year in healthcare and healthcare IT in the United States. What have we collectively learned in healthcare? Here are a few things.

The year 2015 has been a truly eventful, indeed tumultuous, year in healthcare and healthcare IT in the United States. From the policy end of the spectrum of developments to the technology end, this was a year of constant, often jarring, change. And it would be impossible to chronicle in detail everything that healthcare leaders learned collectively in 2015, not to mention individually.

But, looking back at this year that has been, below are a few thoughts on seven things that were learned by many in U.S. healthcare in 2015.

#7: We learned that the ICD-10 transition would finally happen after all: and that the world would go on.

After multiple delays in the actual transition date, and constant Chicken Little-esque “sky is falling” warnings from the American Medical Association and others, on October 1, the mandated deadline for the transition to the new ICD-10 coding system (well, new to clinicians in the U.S.—countries like Canada and Australia have been operating with ICD-10 for decades already) finally actually happened. And the world did not collapse. Indeed, as Managing Editor Rajiv Leventhal found in interviews with leaders at patient care organizations, there has been little drama, and we’ve so far heard of no apocalyptic disasters.

As Rajiv noted in his December 8 report, “Despite all this perplexity and trepidation, the implementation deadline was not moved and the industry made it through Oct. 1 sans disaster. At the end of October, the Centers for Medicare & Medicaid Services (CMS) reported that claims have been processing normally since the transition, with 10 percent of claims being rejected and only .09 percent rejected due to invalid ICD-10 codes.”

And in his Dec. 16 report, in which he interviewed provider leaders, Rajiv quoted Michael Lee, M.D., director of clinical informatics at the Newton, Mass.-based Atrius  Health as saying that his organization’s three-year  preparation for the transition had ensured that Atrius would not be devastated by the transition when it occurred. As Dr. Lee told Rajiv, “We spent a ton of time on mapping tables, getting diagnoses files correct, and the majority of time after that was on the revenue side testing transactions coming out of our systems, then testing those transactions arriving at our insurer systems, and then testing responses. We had that back end pathway worked out so we could get paid. We were working on this for a long time so we were comfortable that we would be reasonably okay with the conversion.”

#6: We learned that Chicago will never host HIMSS again.

Well, at the very least, not at any time in the foreseeable future. HIMSS CEO Steve Lieber confirmed to me on the last day of the annual HIMSS Conference in April that he and his colleagues had decided that their annual conference would no longer be held at Chicago’s vast McCormick Place Convention Center, because of what they consider the excessive labor costs affecting exhibitors. No mention was made of the exorbitant costs imposed on vendors by the HIMSS organization, according to numerous sources. In any case, for the foreseeable future, the HIMSS Conference will be limited to old standbys Orlando and Las Vegas, despite their far-from-universal popularity among attendees.

More broadly, we’ve been hearing a raft of complaints from all types of attendees about the HIMSS Conference—from vendors, who have been feeling overcharged and underappreciated, from provider attendees who have felt themselves lost in the heavily commercialized shuffle, and from all types of attendees, who still feel drawn by the opportunity to connect with fellow healthcare IT leaders and professionals, but who feel that the bottom line has been driving so many decisions about how the conference is organized and managed. It will be interesting to see what future HIMSSes are like, and whether the HIMSS organization begins to address attendee complaints and concerns before disaffection becomes more widespread.

#5: We learned that when it comes to RSNA attendance, what goes up can indeed go down.

After reaching a peak of 61,980 attendees in 2007, the annual RSNA Conference, sponsored by the Oak Brook-based Radiological Society of North America, has been sliding steadily in past years, with this year’s registration figure (final, audited numbers will not be available until at least January, according to RSNA senior executives) of only 47,060, for a drop of 14,920 attendees, or a decrease of more than 24 percent off the 2007 peak. There are doubtless numerous reasons for the ongoing decrease, among them the shifting landscape around radiology and imaging informatics. Whereas 20 years ago, the average RSNA attendee was a practicing radiologist, a chief of radiology, or a radiology department manager, these days, that attendee is as likely to be a CIO, CMIO, or CMO.

Long-term attendees of RSNAs past and present agree: the RSNA Conference is changing. And the changes at that annual conference reflect some of the broader shifts in U.S. (and international, too, for that matter) healthcare. So what’s happening in the world of radiology and imaging informatics is no longer so distant and detached from what’s happening in the rest of healthcare, after all. And that in itself has been an ongoing revelation for many.

#4: We learned that Epic is not snagging all the big EHR contracts after all.

In late July, our Rajiv Leventhal reported that  “The winner of the U.S. Department of Defense (DoD) massive Department of Defense Healthcare Management Systems Modernization (DHMSM) electronic health record (EHR) contract is a team headed by the Kansas-City based EHR vendor Cerner Corp., according to a report in the Washington Post. Epic Systems, Cerner and Allscripts Healthcare Solutions were the three vendor finalists for the contract, each with its own team aimed to upgrade the military’s EHR system: Allscripts with Computer Sciences Corporation (CSC) and Hewlett-Packard (HP); Epic [Systems Corporation] with IBM Corp, Impact Advisors and others; and the winning team Cerner with Accenture Federal Services and Leidos.”

As Rajiv noted in his breaking-news report, “The new contract will cover more than 9.5 million Defense Department beneficiaries and the more than 205,000 care providers that support them. The DoD and the Veterans Administration (VA) are interoperable now, said Undersecretary of Defense for Acquisition, Technology and Logistics Frank Kendall, but this contract ensures it will continue by including future software upgrades.”

The news caused rather a sensation in the healthcare IT world. After all, not only had the Verona, Wis.-based Epic been steamrolling over most of its EHR vendor competitors recently; it had been widely predicted specifically that Epic would win this competitive bid. And yet the Epic juggernaut was not unstoppable, as this epic (with a small “e”) win on Cerner’s part so robustly proved.

#3: We learned that the ongoing rush of hacks and data breaches is not making healthcare IT leaders feel any more prepared.

On June 18, The Los Angeles Times reported that the UCLA Health System had experienced a massive hacking attack, one that had exposed the electronic health records of perhaps 4.5 million people. That hack was the latest in a series of spectacular hacks, including one that had exposed potentially more than 80 million Anthem health plan members’ records in February, and one that exposed the health information of perhaps 10 million members of Excellus Blue Cross Blue Shield in September.

Yet the increased awareness of cybersecurity vulnerability has done nothing to reduce the fear element: As Assistant Editor Heather Landi reported this month, a survey conducted by Privacy Analytics, a de-identification technology vendor, found that “more than two out of three healthcare organizations lack complete confidence in their ability to share data without putting patients’ privacy at risk.” Indeed, the survey, called the “State of Data Sharing for Healthcare Analytics 2015-2016,”uncovered the fact that, while more than half of those surveyed planned to increase the volume of data stored or shared within 12 months and two-thirds currently release data for secondary use, “[I]ndividuals lack familiarity with advanced methods of de-identifying data, and, as a result, these individuals release information that has been stripped of its usefulness or share data in a way that puts them at an unacceptably high risk of a breach.”

In other words, even as healthcare IT leaders are becoming more and more aware of the deepening environment of crisis around cybersecurity, many CIOs and others are still feeling profoundly unprepared to master an increasingly challenging situation. Not surprisingly, data security remains one of the top concerns of healthcare IT leaders everywhere.

#2: We learned that provider leaders are disgruntled when it comes to some aspects of CMS’s Pioneer ACO Program.

On Nov. 7, I wrote this: “When the Boston Globe reported on November 3 that two Massachusetts healthcare organizations—the Boston-based Steward Health Care System and the Brighton-based Mount Auburn Cambridge Independent Practice Association (MACIPA)—were leaving the Pioneer ACO Program, that dual development became the latest in a series of worrisome developments around what had started out as a showcase program for innovative accountable care organizations (ACOs).

As I wrote on Nov. 7, “[T]he news this week was probably quite bitter for CMS officials, given that, with the departure of Steward and Mt. Auburn, the Pioneer ACO Program is now down to 16 participating organizations, or precisely half of the cohort of 32 that had started out in the program in 2012. Like several other ACOs, these folks in these two ACOs are switching programs, not dropping out entirely: both Mt. Auburn and Steward are shifting over to the new Next Generation ACO program, beginning on January 1, 2016.”

Way back in September 2014, I wrote this: “As reported online in California Healthline, the San Diego-based integrated health system announced on Tuesday, Aug. 26 that it had dropped out of the Pioneer MSSP program. What’s more, Sharp HealthCare’s departure follows by one year the departure of nine other patient care organizations and collaborative that have withdrawn from the program...” Later, I was able to meet Alison Fleury, CEO of Sharp’s ACO, in person, and she confirmed for me that some elements of the Pioneer financial model are simply not conducive to success or satisfaction on the part of many providers. In Sharp’s case, the core problem had to do with the San Diego area’s wage index, and the Pioneer ACO model’s failure to account for its exceptionally high wage index.

The fact is that CMS officials need to rethink the Pioneer ACO Program, both for intrinsic reasons, to save the program, and also because Pioneer is symbolically the leading-edge program among the now-three ACO programs the agency is sponsoring and managing, and its failure would do major damage to the ACO movement in the U.S. Let’s hope the feds are listening to the legitimate complaints of provider leaders from organizations like MACIPA, Steward, and Sharp, and will fix the problems with what is fundamentally an excellent and laudable program.

#1: We learned that, despite all the challenges, more providers are leaping into accountable care and population health than ever before—and are being driven by the data.

According to the Agency for Healthcare Research and Quality (AHRQ), more than 500 accountable care organizations (ACOs) are being funded either by the federal government, via the Medicare program, or by private health insurers. That statistic underscores the lure of the ACO model for care delivery and payment reform in U.S. healthcare. What’s more, hundreds of patient care organizations are plunging into population health management, in its broadest definition, and altogether, perhaps a majority of U.S. residents (or at least, a robust plurality) are being cared for by clinicians affiliated with an organization involved in accountable care or population health management. And those numbers can only increase in the future, as the U.S. healthcare system evolves forward (some would say, lurches forward!) in its progress towards a more sustainable, effective, and people-centric healthcare system.

What’s more, healthcare IT leaders are in an unprecedented position right now to help lead their organizations forward into data-driven population health management, accountable care, and vision-driven care delivery and operations. Of course, the complexities are endless, as a panel that I moderated at iHT2-New York agreed, back in September. On that panel, consultant Jay Srini and CIO Luis Taveras spoke eloquently about what they’re doing these days. As I wrote later, “Srini pointed out that ‘The Triple Aim is really about experience, cost, and value. And you can really triangulate it to provide the best value. And rather than letting the perfect be the enemy of the good, if you can get things to be 80-percent accurate, you can get amazing results.’ For example, she noted, at one patient care organization, ‘Using data we had available to us, including claims data, lab data, and so on, we were able to predict who our pre-diabetics were, at a rate of 98-percent accuracy.’ So, she said, ‘While it’s a large and complex problem’ to robustly apply analytics to patient care process improvement, ‘there are quick wins.’”

And as Barnabas Health’s Taveras noted, he and his colleagues have been achieving considerable success with alerts around emerging sepsis for inpatients. “We’ve implemented the sepsis algorithm and sepsis alert in the last six months,” he told the iHT2-New York audience, “and we’ve had many cases where the team was not aware that a patient was becoming septic. But the vitals and all the lab results are a part of the data being sent to the team. And it’s not just the predictive but the prescriptive, because the system will tell the care team what to do.” As a result of that analytics-facilitated clinical improvement work, he noted, “We’ve had a 30-percent mortality rate from sepsis in all our facilities, and now we’re saving a lot of lives. And now the question is, what do we do next?”

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