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The following is a guest post from Jane Sarasohn-Kahn’s Health Populi blog reflecting her thoughts on last week’s HIMSS12: The record attendance at HIMSS12, in terms of both attendees (numbering some 38,000) and exhibitors, illustrated just how hot health information technology has become in the 20 years since I first began attending this meeting — when it was only a few thousand hospital computer geeks and materials managers picking up pocket protectors and calculators from vendors. At this year’s conference, the major concerns were when Stage 2 meaningful use details would be revealed. HIMSS communications leadership in the press room thought it would be Tuesday, then Wednesday. Finally, it was Thursday the 23rd of February when Farzad Mostashari, National Coordinator for Health IT at the Department of Health and Human Services, said to a press conference of HIT reporters that the regs were, “At the Federal Register; they are having formatting issues….(the regs) are going to get promoted; I think people should just chill.” Chill? The questions surrounding what would be included, downplayed, or enhanced for Stage 2 was a main topic of conversation all week at HIMSS. Of course, business was transacted without these details as the heavy lifting (or implementing, as it were) continues on adopting electronic health records and using them in ways that will ensure providers win their fair share of incentives flowing from the HITECH Act included in the stimulus bill (ARRA). EHRs alone won’t bend the national health care cost curve or improve population health. To get to those grand goals will require connectivity and Big Data, and these were two major themes at HIMSS 2012. We used to talk about “interoperability” in the David Brailer days of the Office of the National Coordinator. In 2012, it’s about connectivity, based on the PR and market positioning of dozens of large HIT vendors who are trying to walk the talk of openness and iPod-like platforms for plugging in heterogeneous applications. Connectivity then enables data bits and bytes to move through the health ecosystem, beyond a single institution through the cloud — and it was cloudy all over the HIMSS convention floor, both among large Big Iron vendors as well as the smaller up-starts who are providing some of the more novel and nimble applications that can help physician practices move from “here” to “there” in getting to meaningful use and connectivity. Big Data and data analytics are also important news at HIMSS 2012 as we move from fee-for-services payment (outside of Kaiser, Group Health, Geisinger and VA) toward paying for performance, outcome and value. To do so requires real-time utilization management — the ability to identify people before they get too far downstream as high-cost high-risk patients. But patient care isn’t a one-way street: patient engagement can help get people more involved, responsible and active in their own care — and that’s when outcomes improve and costs (year on year) fall in aggregate. In meaningful use Stage 1, patient engagement is prominently featured. Thus, patient portals were all over the HIMSS convention floor. They came in a broad range of look-and-feel, but most that I kicked tires on weren’t as well designed as I would have liked. We are in the nascent era of patient portals, with miles to go to get to something remotely engaging. Only the most activated patients would cotton onto the portals I viewed. I respect the hard work that’s gone into the dozen+ I dove into…and offered constructive comments to every vendor with whom I met. I am no patient portal maven — after all, we’re in the First Phase of such tools — but I’ve been schooled at the foot of Edward Tufte, Juhan Sonin, Michael Graves, and Ikea ; )  As Sonin told attendees of his talk on health IT and design, “software is a visual medium.” And so many portals’ pages looked like literal photocopies of medical forms — without videos, engaging graphics, or gamification. Still, this phase of patient engagement is about availability and access to data — this is a journey, not a destination, I tell myself. But innovative design clearly is prescribed for the patient portal, v2. In the “that’s what I’m talking about” vein, check out Tonic Health for its fresh approach to patient-centered design and engagement. What’s promising on the patient engagement front are the many applications available to people at-home via remote monitoring and on-the-go via mobile applications. This year at HIMSS, the Qualcomm Life and 2net hub included many patient-facing tools from HelloHealth, Asthmapolis, AirStrip, and iSonea, among 40 such offerings.  This section of the conference was a nice bridge from the Consumer Electronics Show to the B2B meeting that is HIMSS. I was very happy to see it as health engagement is critical to optimal patient outcomes. With accountable care payment regimes, these tools will be useful complements to inpatient and ambulatory care — keeping patients healthy on-the-go, and safe and well at home to stem readmissions to hospital. Remote devices and patient engagement are addressed in Eric Topol’s important book, The Creative Destruction of Medicine, which I read enroute to/from Vegas. Every attendee at HIMSS should have been given a copy at check-in. Health Populi’s Hot Points:  I find the lyrics from Elvis’s iconic song, Viva Las Vegas, to reflect my post-HIMSS 2012 reflections: Demonstrating meaningful use to earn Stage 1/2 incentives: Bright light city gonna set my soul Gonna set my soul on fire Got a whole lot of money that’s ready to burn, So get those stakes up higher The hard work ahead How I wish that there were more Than the twenty-four hours in the day ‘Cause even if there were forty more I wouldn’t sleep a minute away The risk and opportunity cost Oh, there’s black jack and poker and the roulette wheel A fortune won and lost on ev’ry deal All you need’s a strong heart and a nerve of steel How I wish that there were more Than the twenty-four hours in the day ‘Cause even if there were forty more I wouldn’t sleep a minute away Oh, there’s black jack and poker and the roulette wheel A fortune won and lost on ev’ry deal All you need’s a strong heart and a nerve of steel Viva Las Vegas, Viva Las Vegas. Health care in the U.S. is at a crossroads. HIMSS being sited in Vegas provided a sobering lens about where health IT in the US could go: if momentum drives adoption, meaningful use, and data analytics that can inform care decisions in real-time getting patients the right care at the right time, then we say, in Todd Park style, “Viva health IT!” If, on the other hand, the scenario turns out to be a growing chasm between the health care provider “have’s” and “have not’s” (especially community physicians), then the nation will have placed a bet, and lost. And that will not be so much about a few billion dollars; that will be the opportunity cost of moving America’s public health outcomes into a leading place on the league table of other OECD nations. Next year, HIMSS will be hosted in New Orleans — two years in a row in cities that tout good times, not so much Healthy Cities milieus. While no one likes to laissez les bons temps roulezmore than me, I wonder if that’s what we’ll feel like doing reflecting over the 2012-13 year of HIT implementation. Here’s hoping we’ll toast to progress… View Jane’s column titled, “From Volume to Value: Connectivity, Big Data and Sustainability Shape HIMSS12" at iHealthBeat that was published today here:http://www.ihealthbeat.org/perspectives/2012/from-volume-to-value-connectivity-big-data-and-sustainability-shape-himss12.aspx


About Jane Sarasohn-Kahn:

Jane Sarasohn-Kahn is a health economist and management consultant that serves clients at the intersection of health and technology. Her clients include all stakeholders in health, including providers, payors and plans; companies in biopharma, medical devices, financial services, technology and consumer goods; non-profits and NGOs. Jane’s lens on health is best-defined by the World Health Organization: health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Please visit her blog at:http://healthpopuli.com/ Twitter:http://twitter.com/#!/healthythinker

Health_Care_Reform_Image2-400x300 In a recent report published last month by the Urban Institute and Robert Johnson Foundation states that if the Patient Protection and Affordable Care Act (ACA) is enacted,  it would reduce the number of nonelderly uninsured Americans from 50 million to 26 million.  However, if the Individual Mandate clause of the PPACA is repealed, the number of uninsured Americans will rise between 40 and 42 million. The report also states that ACA would increase private insurance by 7 million people and if the mandate were eliminated from law as enacted, private coverage would decrease by 11 million. The infographic below by hCentive shows the number of uninsured elderly projected to rise without the individual mandate:  

The results from this report were produced utilizing the Urban Institute’s Health Insurance Policy Simulation Model (HIPSM) that simulates the decisions of business and individuals in response to policy changes such as Medicaid expansions, new health insurance options, subsidies for the purhcase of health insurance, etc. This model helps provide estimates  of changes in government and private spending, premium rates, and health insurance coverage as a result from specific reforms. Although the reform is cut by more than half , the government  would only spend 3 to 8% less on acute care for the nonelderly. The reduction in uninsured care paid by taxpayers and healthcare provdiers would also be smaller without the mandate. Full implementation of the ACA with a mandate increases private insurance by 7.4 million nonelderly enrollees, from 164.9 million without reform to 172.3. The following table provides a summary of how distribution of health insurance coverage would change under healthcare reform (CLICK ON TABLE FOR LARGER VIEW)The details of this report titled, Eliminating the Individual Mandate: Effects on Premiums, Coverage, and Uncompensated Care by Matthew Buettgens and Caitlin Caroll is available here

About the Urban Institute The Urban Institute is a nonprofit, nonpartisan policy research and educational organization that examines the social, economic and governance problems facing the nation. For more information, visit www.urban.org.

About the Robert Wood Johnson Foundation The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For nearly 40 years the Foundation has brought experience, commitment and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthy lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit www.rwjf.org.

 The AMA(American Medical Association) has up the stakes in the fight against ICD-10 recently writing a letter to Congress urging lawmakers to stop HIPAA’s required implementation of ICD-10 and to call on stakeholders to assess an appropriate replacement for ICD-9.  AMA is stating that the implementation of ICD-10 will create no additional burdens on the practice of medicine and have no direct benefit to individual patient care, as physicians struggle with other costly transitions associating with implementing electronic health records in their practices. AMA CEO and executive vice president, James L. Madera states, “the struggle to keep up with  the various health IT use and reporting requirements leaves little time for physicians to get engaged in the practice redesign and payment and delivery reforms envisioned in the Affordable Care Act.  Physicians will be forced to close their Medicare patient panel or limit the number of Medicare patients that they treat in order to minimize the aggregate financial and administrative blows to their practice due to the unfair penalty programs that are being and will be administered.” Yesterday on his blog, prominent physician blogger and CIO at Beth Israel Deaconess Medical Center, John D. Halamka MD also provided his thoughts that the billions of dollars to implement ICD-10 will not improve quality, safety, or efficiency. John states, “I’ve spoken to many people at HHS, CMS and the White House about the need to rethink the ICD10 timeline, deferring it until after Meaningful Use Stage 3 which enables us to focus on improving our clinical documentation and adopt SNOMED-CT to capture structured signs and symptoms.” Enclosed in the AMA letter to Congress was a table and timeline that illustrated the drastic volume of financial penalties associated with various federal programs that physicians will be facing simultaneously. 


AHIMA’s Viewpoint

AHIMA responded to AMA’s initial attack against the implementation of ICD-10 late last year expressing their disappointment with AMA stating adoption of a 21st system classification system will bring important benefits to patients, providers, and payers. AHIMA’s CEO Lynne Thomas Gordon stated, “We need to move our disease classification system towards international standards and also align it with the meaningful use incentive program as well as value based reimbursement.”  (Modern Healthcare 11/17) Gordon’s response does support the fact that the Affordable Care Act (ACA) includes financial savings associated with reduction in healthcare fraud and abuse, which is one of the key benefits of ICD-10. ICD-10 provides the more granularity of diagnosis and treatment information making it easier to detect potential healthcare fraud/abuse. The transition to ICD-10 will provide more robust codes that will help support electronic health record’s detailed requirements of information more accessible to support the move towards health information exchanges between healthcare organizations.

Conclusion

With only a dismal 9% of healthcare providers only halfway through ICD-10 according to a KLAS report last October, does the AMA make a valid point when it comes to all the competing priorities physicians and healthcare organizations are faced with at this time? So who is right in this debate? Should ICD-10 be delayed until Meaningful Use stage 3 or are we focused on the wrong thing and instead should focus on implementing an efficient reimbursement system instead? What do you think? To view the letter in its entirety, please click here