MGMA 2011 – Robert Tennant

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Ann Fishman, with EHRtv, and Dr. Howard Rollins, MD, medical consultant, speak with Robert Tennant, Senior Policy Advisor at MGMA.



Category: Featured, MGMA 2011, Uncategorized
Date: January 17, 2012
Views:3,998 views
Information:

Ann Fishman: I’m Ann Fishman at MGMA 2011 with EHRtv, Dr. Howard Rollins and Robert Tennant, Senior Policy adviser for MGMA. Thank you so much! You are my go-to person for all things legal and policy as it relates to health IT in the US.

Robert Tennant: Thank you Ann, a pleasure to speak to you today.

Ann Fishman: The last time we spoke we were discussing era 2009 and the requirements to encourage or mandate ubiquitous adoption in the US by clinicians of EHR technology, it is now 2011 how are we doing? Have we met the targets?

Robert Tennant: Well I think what we have seen Ann is practices facing a number of challenges in meeting the meaningful use criteria. I think it has acted certainly as a stimulus we have seen a lot of interest, a lot of attention, practices are very aggressively trying to become meaningful users of HIT but they are encountering some serious challenges. The criteria themselves have quite onerous, there is also some issue regarding, for example security risk assessment, which is required to meet meaningful use that has been a challenge mainly because there is right or wrong answer. There is not a definition out there that a practice can use, so we are starting to see practices ramping up their interest in it but also they are encountering challenging economy, so it has been a difficult time because meaningful money comes as a rebate, not as an incentive so they need to proof that they are meaningful users before they can tap into those meaningful use dollars.

Ann Fishman: Well what are we doing in terms of reimbursements, have they been made and if so what are the numbers?

Robert Tennant: The last figures that I have seen which are towards the end of September suggest that we are not quite getting to where we expected to be with the Medicare eligible professional incentives we are about 66 million dollars, about 3100 eligible professionals have qualified for money but what is interesting is the contrast. Now about 6100 EPs have qualified under the Medicaid EHR incentives which translates to about 133 million or about twice as much money under Medicaid, so the question is why so slow on the uptake with Medicare and why more on the Medicaid and I think at least partially it is due to the fact that under the Medicaid program, the EP only needs to prove that they have adopted certified and qualified EHR, they don’t’ need to attest to having met all of the meaningful use criteria. So the Medicare program is much more rigorous and therefore there have been less adoption and less payments made.

Ann Fishman: What will the effect of the ACA section 1074B on HIT?

Robert Tennant: The affordable Care Act also known as Obama Care included a very important section, section 1104 which is administrative simplification. This is really a wish list of many of the admin sim features we, MGMA, have been pushing for many, many years. It includes such things as operating rules for each of the HIPAA transactions, also health plan identifier, also looking at standards for electronic funds transfer which is the EFT movement of money from the health plan to the practice and also electronic claim attachments which is the supporting documentation to adjudicate a claim now under this new section they can be sent electronically therefore saving the practice and the health plan money. So what is interesting is this is going to, I think, drive up adoption of HIT in general because it will allow the practice to take advantage of these trim lining capabilities because and very importantly the health plans are now mandated to provide all of these standards. Not only are they mandated but there are significant new fines for non-compliance up to hundreds of millions of dollars for large health plans that refuse to adopt these new standards.

Ann Fishman: So is this good news or bad news?

Robert Tennant: It is excellent news, so it really is what I call a perfect storm. What we are trying to do is practices is get them so they can automate many of the functionalities within the practice as possible therefore driving down their cost with today’s economy, with the potential of Medicare payment cuts, the only way a practice is going to improve their bottom line is by decreasing the amount of money they spend on the administration of heath care so these types of standards I think will be an important catalyst for driving out waste and inefficiency in the health care system.

Dr. Howard Rollins: Robert obviously these are tough economic times and physician practices are no exception, I believe that we are in the infancy of moving technology into physician practices, are there any other incentives that physicians can have, what is their motivation for making this investment and bring technology into their practice?

Robert Tennant: Great question I think there is what I call the carrot and the stick approach, in terms of the carrots there is no question that meaningful use money is going to help defray some of the cost for practices to adopt the technology. It is not going to cover all the cost but it is going to decrease the amount to money they are going to have to spend on this. But there are some other value points as well, one is compliance. Right now there is a new head of the office of civil rights which is the HIPAA privacy and security enforcement agency. We expect there to be audits and we expect there to be more enforcement of the current regulations. So I think when going to an EHR they can control their privacy and security environment much closer so I think there is a motivator there for the practice but also I think to be able to tap into the practice managements side and really automate that and integrate the practice management system with the EHR that is going to reap tremendous benefits we are starting to see some studies coming out of MGMA and other organizations which at least suggest that practices that adopt this technology are starting to see improved bottom lines. But also frankly the world is change, we starting to see more and more physicians using iPads and iPhones, technology is becoming more common place and I think they want to move that technology into their practice and not just leave it at home.

Dr. Howard Rollins: You are obviously a fan of technology in the field of medicine; do you personally believe that efficiency will improve to a great extent as this evolves?

Robert Tennant: Absolutely I think one of the challenges for health care is the movement of data, I know that when I go and see my primary care physician, if they refer me somewhere else, it is always a challenge to get my information from the primary care office to the specialty office. Now what we are trying to do is get to the point where that information flows efficiently but also securely and I think that is going to improve coordination of care and ultimately drive down cost and health care. Also when you have access to improved information, better information is going to mean less due plegative testing, it is going to mean better coordination of care by not only other care providers but also the patient and their care givers their relatives so when you are looking after an elderly parent being able to tap into the numerous providers and gain access to that information, stored centrally through a personal health record or a web portal, that is going to be outstanding in terms of really coordinating care within the family union.

Dr. Howard Rollins: From a technical stand point are you confident that we will be able to ensure security and privacy as we move forward?

Robert Tennant: Yes and no, there is no way to protect everything for example there have been some breaches that have happened recently Mass General up in Boston they had left records on a train. You can never remove the human element and that is just a reality we have to live with, I think we are prepared to give up a little bit of a freedom in the sense of we need a situation where the practice, the hospital, the lab, the health plan is maintaining a security of the information but still allowing that information to flow. I think there is numerous policies and procedures, I think we are going to see the government be more active in this area. I think that that once the framework is there, once people are more attuned to security and privacy, we will see fewer breaches and we will be able to maintain security a little bit better.

Dr. Howard Rollins: Thank you.

Ann Fishman: Robert, what will the impact of the ICD10 be on the medical community?

Robert Tennant: ICD10 the International Classification of Diseases 10th revision is mandated for October 2013 that is going to be probably the most massive change in health care since Lyndon Johnson signed the Medicare Act back in the 60s. This will impact not only the clinical side but also the administrative side of the practice. ICD10 codes go from about 9000 ICD9 codes to about 68-69000 under 10, I think what that is going to change is how we capture data, how we report data and how we pay claims and that is going to be a challenge mainly because we don’t know what the impact is going to be. The government did not do a pilot and so we don’t if for example payment policies are going to change. But what we do know is there was a place holder included in the proposed rule for stage 1 meaningful use which was to transition the reporting to ICD10 codes for stage 2. Now I don’t know how that is going to happen but I know it is a concern because we are already faced with an incredible challenge of meeting the HIPAA version 5010 standards where the compliance state is January 1st of next year. ICD10 is a hundred or a thousand times more complex and there of course no government money to defray any of the costs for practices to move to this new codes set. So I am very concerned about the impact of practices we are working with the government trying to educate them, letting them know that there is going to be an incredible cost, incredible disruption and there has to be appropriate action taken by the government to ensure that the system doesn’t grind to a halt because of these new codes.

Ann Fishman: Do the HER vendors bear any burden in managing this transition?

Robert Tennant: Yes and no, legally no they are not covered entities under HIPAA therefore they are under no legal obligation from the government to adopt these new codes. The provider are, the providers are their clients, so I think that the vendor that takes 5010, ICD10, the administrative simplification provisions to heart they build that functionality into their clinical and administrative systems, they are going to be the vendors that succeed in this very difficult environment. The ones that don’t are the ones that are going to fall by the way side. ICD10 is incredibly invasive for technology vendors, they have to be on top of it, there is no sign that the government is going to move the compliance date or scrap ICD10 altogether. So we have to move on the assumption that the industry is moving forward with ICD10 vendors have to be ready. If the vendors aren’t ready the practice won’t be ready and we are all going to be in trouble.

Ann Fishman: You said that vendors are not covered entities under HIPAA but do they constitute business associates when they act to just basically be a depository of records on a cloud?

Robert Tennant: Absolutely and of course under HI-TECH there are some new business associate provisions which basically make them covered entities so if they are accepting PHI Protected Health Information from the practice, doing something with a manipulating story in it, changing the codes, anything like that then they are going to be “covered entities” and therefore will be bound by all the HIPAA privacy and security regulations. So that is going to be a challenge for the vendor but I believe it’s one that the good vendors are going to meet.

Dr. Howard Rollins: Most of the vendors seem to be migrating the cloud so it doesn’t mean to be a barrier these new obligations and penalties under HI-TECH?

Robert Tennant: No, I think, again with every challenge comes some opportunities and so I think vendors are looking for innovative approaches to how they can meet these HIPAA compliance requirements I think it is going to be very important to see how the government reacts to this new technology and to the new enforcement opportunities through OCR. So they have got a new head there and we are going see how aggressive they take enforcement, we are seeing breach notification, the breach notification final rules expected over the next few months, that again will be very, very important for vendors because if there is a breach and data is lost or stolen or hacked into the vendors themselves would be on the line not just on the practice.

Ann Fishman: Give us a little comparison between the US health care HIT and the Canadian environment?

Robert Tennant: For example Canada went to ICD10 but typical of other countries that have adopted HIT most of them did it through a more centralized approach, most of these countries in Canada and Australia had significant financial investment on the part of the government. So for example here in the United states, aside from meaningful use, practices are expected to foot the bill for all technology upgrades, including ICD10, 5010 that is a non-funded mandate, they don’t have those in more centralized health care environments like Canada, UK, Australia, places like that. I think they have been able to take a more centralized approach to things like certification and pushing technology into practices but that is not to say that there aren’t any challenges. I know they have heard trouble in the UK trying to move primary care physicians to a sort of centralized EHR platform. So nothing comes without challenges and costs and certainly IT is no exception.

Ann Fishman: I think challenge is the operative word today, doctor?

Dr. Howard Rollins: Robert we are speaking a lot about how bringing HI-TECH into a physician’s office and into health care affects health care in the country. As a physician I am compelled to ask you what is your opinion about how all these complexity will affect the individual patient?

Robert Tennant: Well I think it impacts the individual providers as well, I think the complexity the added regulatory environment has caused some physicians franticly to leave the profession. You have also seen consolidation where small practices simply can’t keep up with technology changes with regulations so they get bought up by the larger groups or hospitals, in terms of the patient there is enormous opportunity. If you have a chronic illness, if you are looking after a chronically ill patient, you have elderly parents, the opportunity that technology affords you is tremendous, the access to the internet so you know exactly what is going on with your health care, to be able to do simple things like register for you appointment, to update your demographic information for the practice or hospital online is a wonderful benefit. But again you have got to be cognizant that ultimately health care is delivered by the physician and technology can assist but ultimately it is that patient-provider relationship that is absolutely critical and I think providers have to be cognizant that when they are adopting technology it has to be with the idea of that partnership at the forefront. It can’t dominate, it has to compliment.

Ann Fishman: Well, Dr. Rollins and I could talk to Dr. Robert all day because he knows everything that there is to know on this subject but we will sign off for now and thank you so much, hope that we get to talk to you soon.

Robert Tennant: Always a pleasure to speak with you.

Dr. Howard Rollins: Thank you very much

Robert Tennant: Thank you doctor.

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