Looking back, looking ahead.

As we near the end of January and the predictions for 2012 have subsided, I hope you'll pardon me if I remain so impressed with Dr. Farzad Mostashari that I want to direct you again to his blog. There are two posts in particular I deem must-reads for all kinds of us: the doubters, the latecomers, Eligible Professionals and would-be thought leaders for eye care EHRs. We can all benefit from taking stock of what's really happening in the health care reform world around us.


The first is Farzad's January 7 post, in which the National Coordinator looks back at "12 Months of Health Information Technology". Let me whet your appetite by just listing the top ten highlights of the year. If you want to read the full post, click here. (I hope you will.)

1. January: Launch of the Medicare and Medicaid EHR Incentive Programs
2. February: Launch of DIRECT
3. March: The National Quality Strategy
4. April: Launch of the Standards “Summer Camp”
5. June: Spurring Health Information Technology  Innovation
6. July: Health Information Technology Workforce
7. September: Breach Reporting and Increasing Security Awareness
8. September: Consumer eHealth Comes to the Fore
9. October: Regional Extension Centers Surpass their Goals
10. November: Growth in the Adoption of EHRs

The second must-read post is from January 25, "Health IT Taking Flight". Again, click here to read the full article. In the meantime, here's a summary of the five big trends expected in 2012:

1. Meaningful Use Takes Off. 
2. Health Information Exchange Turns a Corner.
3. Connecting the Dots on Health IT and Payment Reform. 
4. Consumers Use eHealth to Get More Involved.
5. Innovation Drives Improvement. 

We've said it, others have said it and it's worth repeating: health care reform is not "coming soon", it's here now and it's here to stay. Don't confuse health care reform with insurance reform (Obama Care). If for any reason you're still sitting on your laurels, it's time to leap into action. If they're low, forget about your current Medicare volume or Medicaid percentage and get involved with certified EHRs regardless. Remember that CMS was only the launchpad. Private payers are already on board the train too. All of healthcare is transforming. If you're in healthcare, you must morph in order to survive.

Alistair Jackson, M.Ed.

Meaningful Use: Not Just for EHRs.

In the January 2012 edition of Optometric Management, Dr. Walter West wrote an article entitled, "Meaningful Use: It's not Just for Electronic Health Records". His essential question is whether or not providers are fee-focused or patient-focused in their use of diagnostic equipment. It's the easiest thing in the world, after acquiring a new piece of expensive equipment, to find suddenly that a lot more patients are suspects for the disease your new instrument is designed to screen. Dr. West issues a challenge to review your clinical protocols and ensure that your use of diagnostic equipment truly improves the quality, safety and efficiency of patient care.


I wholeheartedly agree, yet want to take this notion a step further: health care reform is designed to eliminate unnecessary testing. Let's understand that significant cost overruns in health care are attributable to tests being done multiple times at multiple facilities. The reason may not just be poor judgement or an ulterior motive on the part of a doctor. The patient may want a second opinion and go to another hospital, for example. Hospital A cannot access the records at hospital B so cannot offer simply another review of the original tests; the tests are duplicated. Same result. Same diagnosis. Double the cost. It happens all the time, sometimes at a cost to Medicare of $20,000 or more per instance.


Now granted, eye care has not primarily caused this problem. However, it must be fixed across the board. At the heart of the issue are two things: a lack of portability of patient health information; a fee-for-service reimbursement system that cannot differentiate between excellent care, mediocre, poor or fraudulent care. The answer? EHRs and a pay-for-performance model. 


Long story short, as we move into Stages 2 and 3 of EHR certification, health care reform will root out sub-optimal practices, whatever the cause. Exams will be submitted every time for electronic audit, and reimbursement will be contingent upon achieving best results. Billions of dollars are being spent on the transformation of healthcare in order to lower costs, raise quality and improve patient outcomes. Each provider has a part to play in achieving those very same goals.


Alistair L. Jackson, M.Ed.

De-mystifying 5010 versus ICD-10.

Although the published CMS resources on the transitions to 5010 and ICD-10 are actually quite clear, we still run across fairly pervasive confusion between the two. They are related but are not one and the same.

5010 is a transaction set that governs claims submission. It replaces the current 4010 series. Payers are converting to this higher standard as a precursor to the introduction of ICD-10. The compliance date was January 1, 2012 but an "enforcement discretion period" effectively extends it to March 31, 2012.

The 5010 changes apply to all HIPAA "covered entities". Confusion arises here because clearinghouses can appear to change the rules. They may tell software vendors or providers that the deadlines don't really apply or aren't as hard and fast as they're made out to be. What this means is that they, the clearinghouse are the covered entity and the provider is not. (If a provider does not use a clearinghouse and submits claims directly to the payer, then the provider is the covered entity.) So, when a clearinghouse is used, compliance applies strictly to the clearinghouse. The clearinghouse may then choose to extend grace to the provider by continuing to accept claims in the older format. As long as the clearinghouse completes the conversion to the new format (5010) and submits to the payer in that format, the requirement has been met.

ICD-10, by contrast, applies to diagnosis and procedure codes. They will replace the current ICD-9 codes but not CPT codes for outpatient billing. The compliance deadline for this step is October 1, 2013.

In both cases, the software vendor has work to do. Being ready for 5010 compliance is much simpler than ICD-10 compliance since the latter means reorganizing the EHRs around ICD-10 structures. ICD-10 is a better, more logical system (used worldwide), a much more comprehensive one than the current ICD-9s.

For the provider and provider staff, here's an important call to action. Yes, you need to be talking to your software vendor and hopefully hearing right and reassuring messages about the integration of ICD-10 codes into the EHR. But understand too, ICD-10 compliance is not all in your vendor's court. There's a significant learning curve for billing staff, akin to learning the metric system after growing up on imperial measures. Find the courses and workshops offered locally and at major conferences and tradeshows and get moving on that. This is another big piece in the transformation of health care that ultimately means the survival of your business.

For more detailed information on both 5010 and ICD-10, the CMS website has excellent resources - FAQs, checklists, widgets. Click here to go there ... and all the best!

Alistair Jackson, M.Ed.

More open doors for Optometrists: Medicaid.

When the HITECH wagons were first circled, we heard about the two incentive streams, Medicare and Medicaid. The AOA EHR Affiliate Program (aka "the state roadshow") also promoted both streams. There was a big problem however: Optometrists were not eligible for the Medicaid stream. Even though many were being faithfully reimbursed for their Medicaid claims, Optometrists were not recognized as Eligible Providers under any state Medicaid program.

In the fall of 2011, that began to change. Illinois was the first state to open its doors recognizing OD's as Eligible Providers. Thanks are due to the Illinois College of Optometry and Illinois Eyecare Institute for blazing that trail. Other states have followed suit, including Minneapolis and Alabama. We can expect a wave of acceptance across the country now. As of early January, 43 states had launched their Medicaid programs.

What does this mean for you as an Optometrist?

• It means you may have an option to go the Medicaid route. I say "may" because you need to check this out in your state, maybe even be ready to give it a push through your state optometric association.
• Eligibility for Medicaid programs requires that a minimum of 30% of your patients are Medicaid patients. 
• Understand that the Medicaid incentive programs are different than Medicare. They vary somewhat by state but, generally speaking, the timelines, the rules and the reimbursements are favourable. Click here to read some insights from the Wisconsin Medicaid program that may be applicable to your own state's program. 
• Yes, you can switch from Medicare to Medicaid. You can do it up front or mid stream. Click here to read a good article on switching incentive programs.

Whether you choose Medicare or Medicaid, it's important to move with respect to EHR adoption and the transformation of health care. If you don't qualify for either program, don't be fooled. With or without the incentive money, it still matters. Embracing EHRs is about the survival of your business in the health care reform world.

Alistair Jackson, M.Ed.

Information at the speed of trust.

It's not in the DNA of EMRlogic Live to be a mere signpost to what everyone else is saying about eye care or EHRs or Health Care Reform. But today I came across an article that jumped out at me as worth pointing to. After all, we're no longer vacationing on Eye Care Island. Let's think about these comments by National Coordinator for Health Information Technology Farzad Mostashari at the Jan. 10 meeting of the Health IT Policy Committee. Read the full article here.

Excerpts:

• In 2012, meaningful use will soar...
• Mostashari predicted interoperability and exchange would be the “second and more complex challenge,” following meaningful use. The emphasis will be on containing the costs and reducing the risks and liability of exchanging health data. Information “will flow at the speed of trust,” he said.
• In 2012, the business case for care coordination, which requires the exchange of healthcare information, will be driven by payment reform, not only through federal efforts, but also by the way states and private plans will pay providers.
• The health IT czar said exchange would go slowly at first, with providers sharing only with providers they know on a first-name basis. “It will then go from a trickle to a flow, to a flood, as trust builds over time,” he said.
• Consumer health IT will be a another emphasis for this year
• We will be moving forward on the next generation of quality measurement...
• We need the infrastructure for measuring quality, but also for improving quality.

We already know that 2011 was a big year for EHRs adoption and Meaningful Use attestations. A recent report showed 614 optometrists and 385 ophthalmologists have received Medicare stimulus grants. 2012 promises to be bigger yet, much bigger.


The lesson from Mostashari is not however that MU will grow; it's that health care reform is continuing down its predictable path. This year we'll see: 

• interoperability through health information exchanges (HIEs); 
• care coordination through accountable care organizations(ACOs) and the medical home; 
• consumer health IT - the electronic patient record (EPR); 
• the advance of clinical quality measures (CQMs) for improving patient outcomes.

Without question, the train has left the station. I hope you're on board.


Alistair Jackson, M.Ed.

Beyond workflow: a primer on thoughtflow, Part 1.

The concept of workflow is common speak by now when considering practice management and electronic health records software. There's not a company out there that would admit to ignoring workflow, the seamless passage of data from the front desk to the back office as the staff and doctor team work together. We all know too, truth be told, that things fall through the cracks, costing the practice money every time. Eliminating silo thinking and practice is a challenge that none of us has yet mastered, even though some close the gaps more successfully than others. Adoption of EHRs has introduced a whole new set of desired efficiencies: instrument linking; the integration of imaging and drawing functions; and a host of new online possibilities, to mention a few.

One of the most interesting dynamics we have encountered in our work with eye care providers, especially as we have sought to surpass traditional EMR capabilities (e.g. recording results), is that doctors think very differently during a patient encounter than when they are discussing patient care, say with colleagues in a continuing education or focus group setting. In other words, there's an important gap between how doctors think they think and how they actually do think and make decisions in the patient care setting.

In the coming weeks, we will be delving into some important ideas and concepts originated by Dr. Sam Bierstock, a nationally recognized authority on healthcare clinical information systems in both the ambulatory and hospital environments, specializing in physician adoption of clinical technologies. According to Dr. Bierstock, “Thoughtflow is used to distinguish between how clinicians work versus how clinicians think and then work."

Imagine the importance of thoughtflow as we move to EHRs with embedded clinical decision support.

More soon. Stay tuned!

Alistair Jackson, M.Ed.

Q1 2012, A Landmark Period in U.S. Healthcare.

I'm going on record. "History will mark the first quarter of 2012 as one of the most significant periods ever in U.S. health care." 

January 2012 marks a formal beginning to one of the most fundamental effects of the health care reform movement, one of the most significant changes we have seen in our professional careers. 

Medicare has approved the final rules for establishing Accountable Care Organizations (ACOs) and will be accepting applications until January 23, 2012 for those organizations that plan to begin operation on April 1, 2012.  There will be another application deadline in March for organizations beginning July 1, 2012. 

So why is this significant for us as eye care providers?  Because it directly affects our access to patients.  ACOs are structured around coordination of patient care and a whole new reimbursement system that replaces the standard medicare fee-for-service payment model.  ACOs are able to participate in the cost savings they generate as long as they are simultaneously able to demonstrate they are improving the quality of care delivered. The demonstration period for ACOs is now past and any health care organization anywhere in the country that meets the criteria can apply for participation. 

Once ACOs are up and running in your area, they will affect your access to patients.  If you understand the process, properly prepare and actively demonstrate your value to your local ACOs, they can be very good for your business.  If you don’t prepare, no one is going to send you an invitation, and the ACO could limit your access to both your current patients and potential future patients.

You owe it to yourself to become knowledgeable about ACOs, what they are, how they will function, and what they mean to the future of your practice. For the benefit of your business, you need to be involved in a local ACO. 

Jim Grue, O.D.