Spotlight On ARRA

Blumenthal’s CHIME address falls short

So what is “meaningful use” and when will we know what the process to be a certified EHR system will be?  These two critically important questions were left largely unanswered by Dr. David Blumenthal during his keynote address to the CHIME Fall Forum 2009 this past week in Palm Springs.  Hundreds of attendees – largely CIO’s, CMIO’s, and IT related vendors that support the CHIME Foundation – were left to ponder the non-answers and to speculate what the uncertainty will mean to their organization’s future direction.
 
As the Obama Administration’s front man for ARRA, one would have hoped for more.  These are the colleagues in the industry that helped propel his healthcare career to the prominence that he currently enjoys. Why worry?  Oh, I don’t know, maybe because patient lives and the financial future of physicians and hospitals lay in the balance. These ballyhooed payment incentives represent real money and are critically important for the future and that by extension includes the economy as healthcare.
 
So how could a physician not share the diagnosis, establish a prognosis, or describe any treatment regimen for those hanging on the results of their metaphorical work-up or test results?   Do no harm. See one, do one, teach one.
 
Government, heal thyself!

Kevin Burchill, Esq., Director,
Beacon Partners

Will Democrats push nuclear option?

Recent newspaper articles have discussed “Obamacare” and steps that Democrats may be considering to get this signature bill passed before the end of the Congressional year. The most drastic step being discussed right now is the parliamentary procedure known as “reconciliation,” a step even Democrats refer to as a “nuclear option.” The speed with which this landmark proposal may be passed must be weighed against the longer-term impact of forcing legislative change down the throats of Americans still reeling from a recession, a group that may become increasingly vocal in their opposition.

Reconciliation is a little-used Congressional procedure whereby a “simple majority” of 51 senators can pass budget-related bills. It has been used twice in recent years, once under Clinton and once under Bush. It allows the controlling party to pass legislation specific to budgetary spending without mustering the normally required 60-vote majority. The potential use of reconciliation comes up in light of several key items. First is the growing public discord seen in local “town hall” meetings across the country. Second, and just as important, is the fact that there is no consensus among the Democrats that comprehensive change is the correct thing to pursue at this time. And third, the recent passing of Ted Kennedy and the lack of any true “across the aisle” commitment from the Republicans leaves Democrats with only 59 potential votes.

So where does that leave some 47 million Americans currently uninsured? And what would be the impact on currently insured Americans? Funding for national Medicare and state-led Medicaid programs lays in wait for any new direction and spending commitments. The private insurance marketplace also must watch carefully as “single-payer” or government-led reform packages are being debated by various House and Senate sub-committees.

While it may be understandable to pass landmark legislation fulfilling Senator Kennedy’s lifelong commitment to healthcare, we cannot spend what we do not have. The President is about to embark on a “campaign” to push his healthcare agenda to the public in the same type of grassroots manner that propelled him to the White House. Americans can listen to the rhetoric, but must ground their opinions in the reality of today. We can hope for a better tomorrow and wish that it would include healthcare as a right, and not merely a privilege, but someone has to pay for it today.

It was not a “simple majority” that elected President Obama; rather it has been called a referendum for change from the old way of doing business. Let’s hope that Congress hears the public plea, and does not utilize reconciliation to pass healthcare this year.

Kevin Burchill, Esq., Director,
Beacon Partners

What is the economic stimulus package stimulating for healthcare anyway?

Debate, division among the Democratic majority, and discussion about definitions and timelines for implementation may capture much of what we’re seeing in the industry and hearing from the field.

The debate has taken on a larger impact to the GNP. With healthcare now inching up towards 18%, obviously, the efforts focused within the context of overall market improvement have taken on an even greater meaning for the country. The current division with the Democratic majority seems to show how the solution to healthcare is not simply coverage. It is tied to talk of right versus privilege and guised under topics such as tax credits, incentives, and income guidelines. And from the field, folks are continuing to struggle with the now-awaited definitions of “meaningful use” and “certified EHR system”.

Where does all this stimulation leave us? Hopefully, it leaves us more centered than ever around creating the best possible places for employees to work, physicians to practice medicine, and patients and their families to receive care. Paper or electronic, high touch beats high tech when it comes to making patients feel better. If we start with the patient, the system can only evolve and improve.

Kevin Burchill, Esq., Director,
Beacon Partners

Healthcare: Staying Above the Fray

A recent USA Today article summarized the plight of Sac-Osage Hospital in Osceola, Missouri with the headline: “Hospital hinges future on federal incentive for electronic records.” The story details the CEO’s bet of $1M to convert their paper record to a state-of-the-art EHR in order to garner a $3M “windfall of federal incentives to go digital.” In addition, after layoffs and still faced with a $370k operating deficit projection, the hospital is also pushing for a local property tax to keep its ER open and ambulances running or risk “dozens of deaths”.

Wow, in healthcare? Did we learn nothing from the Wall Street bailout or the GM receivership efforts? Or, even from the little boy that cried wolf or the chicken that said that the sky was falling in the bedtime stories of our childhood?

You can’t just throw up your arms and announce that this is the last chance for your local community hospital to survive any more than you can simply throw money at a problem and hope that it will go away. My guess, like the “clunker for cash” incentives to encourage more green automobile purchases, is that we’re trying to solve more than one problem at the same time with the same old spend-and-tax-and-spend mentality of a big government that is getting bigger.

We need a new mindset and healthcare should stay above this type of fray. We’re a business, yes. But, it is the most sacred business in the world. People put their faith in us to heal them when they’re sick, to maintain their health and wellness through prevention efforts, and, in the final view, to provide hope for a better outcome even when it may only be hope. This is not simply a double-down bet at the local craps table. This is a community trust that we are talking about, and leadership is required now more than ever—from the Board Room and certainly in the C-Suite.

Economic stimulus incentives payments are not enough of a reason to do the right thing for patient care. EHRs save lives–let’s focus on that first, foremost and always. Let’s support the federal policy committee of hard-working, knowledgeable industry executives that are defining “meaningful use” and developing the process to obtain a “certified EHR system.” And, by all means, let’s not resort to the rhetoric that lives and jobs will be lost if these payments are not realized.

Assumptions are never a good idea, however strong Policy development is!

Many facilities are currently reviewing their HIPAA policies and procedures. This is a good start; however, it is extremely important that the information and revised information is disseminated throughout the organization.

In most situations the people who write the policies are not the people who are responsible for compliance in the every day type encounters. Facilities take for granted that the employees on the front lines are as well versed in the regulations and compliance thus relying on a false sense of security.

Training and competency documentation along with clearly defined expectations should be presented to the staff on a regular basis to ensure compliance. Training can consist of webinars, lectures, documentation or classroom training and should consist of all areas of Administrative requirements, Physical requirements, Technical safeguards, policies, procedures and documentation.

By:

Kathleen LePar,
Vice President of Professional Services,
Beacon Partners

Lack of HIPAA Compliance will cost you and the enforcement is on its way!

The enactment of the HITECH Act (Health Information Technology for Economic and Clinical Health Act) has also introduced an extensive tiered table of fines for violations. HITECH has also cleared the way for Attorney Generals of each state to pursue civil monetary penalties when there have been allegations of a privacy breach of the health record.

I invite organizations to pay particular attention to the Privacy and Security Spend Plan section of the ARRA Implementation plan. It specifies that $24.285 million of the federal dollars made available through ARRA would be spent on HIPAA activities, which includes an estimated $9.5 million for audits. More specifically, the Plan indicates that the ARRA funding "will enable the Centers for Medicare and Medicaid Services (CMS) and the Office for Civil Rights (OCR) to carry out mandated audits, make modifications in their case and document management systems, and train State Attorneys General on their new enforcement role." The Plan’s goal is to have State Attorneys General trained and ready to enforce HIPAA and HITECH by the end of the Third Quarter of 2009. When this goal is met, the new HIPAA/HITECH enforcement “police” should be on the ground and ready when the interm final regulations for implementing breach notification for covered entities and business associates are released on August 18, 2009. This is for real!

By:

Kathleen LePar,
Vice President of Professional Services,
Beacon Partners

The Money Will Not Wait!

The June 22, 2009 cover of Modern Healthcare is entitled “On the Clock” and is sub-captioned “The longer providers wait to adopt IT, the harder it will become to pass the ‘meaningful use’ test to qualify for economic stimulus cash.” And when you turn to the page of the cover story, it is entitled “Under the Gun” and sub-captioned “Providers would have to jump through higher and higher hoops to qualify for IT payments the longer they wait.”

Well, that certainly tells the story on the front page that the Economic Stimulus monies require real work to be done in real time in order to qualify for payments in outer years. So: 

Where is your organization positioned?

What questions are being asked of you by your governing boards?

How are your medical staffs reacting to EHR roll-outs?

Who can help you figure this out?

Why are you waiting to act?

The MH article now talks about the $34B in funding available for physicians and hospitals that adopt a certified EHR, and meet the criteria outlined for “meaningful use.”  Podcasts, webinars, seminars, position papers, experts, associations and the like have all talked about the impact this landmark legislation will have since it was signed on February 17^th by President Obama. The time for talking is over, the time to take action is upon us.

The money will not wait, and as the article comments, it will only get harder to qualify the longer that you wait!

New requirements mean you have to act now!

Waiting for the interpretation and all the final rules to put your plan together? Well, that is one strategy (not one I would recommend), but you still have the new and significantly more stringent HITECH privacy and security requirements that apply whether or not you accept  the stimulus funds.

Yes, the security and privacy requirements (HIPAA 2 with big teeth) are just around the corner. When I say just around the corner, I mean late this year and early next year. It is May, which means now is the time to start the process of analysis, planning, and remediating your current and new security privacy programs. 

Why is this so important? The new requirements have significant penalties and additional administrative functions. It affects breach notification, accounting of disclosures, business associates agreements, marketing’s use of PHI, access restrictions, limited data set/minimal use and enforcement penalties (including civil penalties).

With all the hope and optimism that the stimulus funding presents the industry, the security and privacy requirement should scare us back to a sense of reality. This is definitely a dual path to compliance: one for stimulus reimbursement and one to ensure that we don’t go to jail. 

By:
Russ Branzell,
Vice President, Beacon Partners

Is healthcare still recession proof: what will it take to move forward again?

The economic stimulus package has stirred more questions than provided answers for healthcare organizations seeking to capture the touted $2M per hospital and/or $44k per physician of incentive payments.

Healthcare is in large part a science; although management and alignment strategies with physicians are more of an art. The ARRA waived the $19B of funding in front of these concrete thinkers and moved on to the Iraq/Afganistan War on Terror, the American automobile industry, education reform and a score of other top priorities of the new Obama Administration. In its wake, planners are trying to plan, financials folks are trying to calculate, Boards are trying to adapt strategies, executives are trying to keep their heads above water and CIOs are rightfully at the table and involved in the discussion. But, the government has left us with questions to ponder: what is a “meaningful user” and will our “certified HIT system” be on the approved list.

And, along with ARRA, the lesser-discussed topic of HITECH looms with its February 17, 2010 deadline. The most sweeping changes to security and privacy since the original adoption to HIPAA, these, too, have left organizations scrambling for answers while deadlines loom. Simply, perfunctory annual audits under HIPAA are now being dusted off, updated and voted on by Boards to meet new criteria and uncertain regulatory oversight. Related to this is the May 1, 2009 implementation of the FTC’s Red Flag Rules—HIPPA for creditors is a common term used to describe these regulations. A creditor is anyone that does not accept payment at the time of service. The time to check-in on your overall Information Governance efforts is right now.

By:
Kevin Burchill, Esq
Director, Beacon Partners

The Obama Administration at the 100-day cross roads: is healthcare any better off?

The First 100 Days has been the measure of every President since FDR. For healthcare, the answer, regrettably, is mixed. On the IT side, the $19B in the Economic Stimulus Package for “certified EHR systems” and based upon “meaningful use” is a real step forward. However, the Clinton-like healthcare reform is languishing in Congress. Hailed as Ted Kennedy’s signature bill, the Democrats appear to be nearing a seldom-used “reconciliation” process that would allow a 51 majority vote to carry the Senate and send the bill on to the President for signature. After a much bally-hooed “reaching across the aisle” campaign strategy, the maneuvering to avoid a 60 majority vote shows how much further this Administration will need to go to gain cross-over votes.

Recession-like trends abound in healthcare—uninsured is up, volumes are down (except for ER care), bottom lines have evaporated and layoffs/reductions/benefit take-backs are the norm across the country. Healthcare is now touted as a leading indicator for the turnaround. First quarter results, and a recent AHA survey, point to the long lead-time still ahead for this industry.  The plans are out there for folks to read and consider. But, to paraphrase Tip O’Neill, all healthcare is local. Stability on Main Street will dictate the turnaround for healthcare.

By:
Kevin Burchill, Esq
Director, Beacon Partners