Doubt over financial viability could be the only thing holding them back.

Home monitoring devices could be the next big thing in health care, but the technology won’t catch on unless doctors get a more lucrative financial incentive for using the technology.

Some HIT products’ selling points focus on providing physicians better rewards, reports blogger Ken Terry. For instance, Watermark Medical offers a home device and a website where for sleep apnea testing. Through a device inserted into a patient’s nose, medical professionals can monitor data from the device’s sensors, and consequently report to a doctor about the patient’s diagnosis.

“The physician charges $250-$450 per test and keeps $100-$150 of that. While the doctor pays Watermark $4,000 for the diagnostic device, it creates a new revenue stream,” Terry writes in his blog. He estimates about 1,000 physicians are using Watermark’s device to do 4,000 tests per month.

GE is not far behind with its Healthymagination — a $6 billion, five-year initiative in which the company has invested about $700 million on R&D, and $250 million in an equity fund for HIT companies. Some of its innovations include portable handheld Vscan ultrasound that will cost 20 percent less than GE’s current bedside ultrasound units, a “low-dose” CT scanner that will cost 15 percent less than current products, and more remote monitoring devices developed in collaboration with GE’s partners.

Many doctors charge on a fee-for-service basis for office visits. Home care service does not appeal to them as much because they either get little or no compensation. For this reason, many doctors turn a blind eye to supporting innovations in home care — even if it’s a lot more economical to monitor patients remotely at home than to have them come for office visits. To get doctors on board, and maximize the potentials, entrepreneurs must offer new types of reimbursement, Terry suggests.

In August 2009, an ABI Research study found that the market for health care monitoring devices was on the verge of explosive growth. The organization predicted that over the next few years the market will show a remarkable 77 percent compound annual growth rate, resulting in global revenue of almost $950 million in 2014.

The Feds are watching… Handle modifier -59 with care. AUDIO: Modifier “-59″ and NCCI Edits.

Respondents fear unresolved reimbursement issues could be a barrier.

The use of telehealth technology will have a positive impact on the health care industry over the next 10 years, a poll by Intel suggests.

Eighty-nine percent of the health care decision makers polled put their bets on the technology, but also expressed some reservations, including the reluctance of patients and caregivers to try it, and the issue of reimbursement.

Telehealth services could be as simple as a physician using email to check on a patient’s condition, or as advanced as two health professionals discussing a case via video conferencing. Respondents believe that the technology will result to better patient care and lower costs. Other benefits mentioned include better doctor access to patient data and early detection of health issues.

Two-thirds of the health professionals surveyed are telehealth users, and 87 percent say they are satisfied with the technology. Non-users say they plan to give it a go with the next year.

“The survey demonstrates the increasing need to shift from the current reactive health care system to a more proactive model that champions the patient and gives clinicians the information they need,” Mariah Scott, director of sales and marketing for the Intel Digital Health Group, said in an Enterprise Networking article.

On the other hand, respondents think that unless the reimbursement process is fully resolved, the issue will continue to hinder the progress of telehealth technology in the industry. For instance, providers and patients may clash over the relative value of telehealth services.

There are also some concerns on the comfort level of patients and providers in using telehealth, although Intel has previously reported a more open perception to using the technology. The study recommends a need for better education to overcome perceived barriers.

The telehealth market is predicted to grow on a much wider scale from 2012 onwards, according to a report by research company InMedica. Mobile phones will play a big role as gateways — reaching as many as 350,000 people in 2014. Last year, health hubs were the most widely used telehealth gateways, constituting about 80 percent of the total gateways market.

The Feds are watching… Handle modifier -59 with care. AUDIO: Modifier “-59″ and NCCI Edits.

Upfront costs could give way to savings in many areas, but do your homework first, and focus on balance.

If your medical practice has been considering the switch to an electronic health records (EHR) system, you may have heard how one can improve the efficiency of your billing processes, but you might also be frightened by the significant upfront costs.

So how do you balance the benefits with the expense? Follow these experts’ advice on how EHRs might benefit the key areas of your practice.

On a basic level, an EHR is a computer-based system for storing, retrieving, and managing patient health records over a secure network. But it should also be able to handle data for medical referrals, medical treatments, medications, demographic information, and other nonclinical administrative information. A good EHR system transmits claims to the insurers in a 24-hour period, calculates the correct level of service (requiring physician confirmation), and matches the number of visits with an equal number of charges — all huge benefits for billers.

Of course it depends on the vendor, but many EHRs automatically create charges from the note that is entered into the EHR, which “eliminates the need for charge entry and in most cases also takes care of payment posting as well,” says Lucy McCabe, owner of LCM Consulting in Mineola, NY. When a patient arrives, her information enters a queue in the EHR, which the physician can access when he sees the patient. He can enter the patient’s signs and symptoms into the system.

“The information is then transferred over to the billing department, who attach the ICD-9 to the physician verified charges which are created by the EHR, and a claim is generated,” explains Barbara J.Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I,CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, NJ, and senior coder and auditor for The Coding Network.

The system eliminates paper charts and documentation, so everyone from the physician to the front desk to the biller has access to the latest real-time updates on your patients. This fact might be particularly attractive for third-party billers. You also “will want a complete daily record of any rejected transmissions – with clear reasons for the rejected claim,” McCabe says. This will allow you to correct any rejected claims and resubmit them as quickly as possible.

Physicians should be prepared – especially at the outset – to spend more time in front of the computer, learning the system, notes Cobuzzi. Physicians might want to spend time some time watching another physician actually using the system. In fact, everyone in the practice who will be using the system should spend as much time as possible watching other people use it and learning what they do and do not need.

“Choose a vendor that has long term experience in medical practice software before making a commitment to any system,” McCabe advises. Do your research, shop around, and talk to other practices.

Excerpted from Medical Office Billing & Collections Alert.

Your case management struggles may have a simpler fix than you realize. AUDIO: Back to Basics: Case Management Roles and Models Revisited.

Beacon funding program to kick off when 130 applicants are chosen.

Fifteen lucky communities will be awarded a total of about $220 million in grants for health IT infrastructure, national coordinator for health IT David Blumenthal, MD has announced.

The grants will come from the Beacon Community program, which provides funding to communities to build and strengthen their HIT infrastructure and exchange capabilities. The chosen communities will have to “pay it forward” by achieving measurable improvements in health care quality, safety, efficiency, and population health — and then sharing lessons learned.

“It’s more than we expected,” Blumenthal said, referring to the 130 community applicants. It is a sign that we’re ready to put health care IT to work on improving population health, he added.

The Beacon grants will come from the $2 billion in ARRA funds administered by the Office of the National Coordinator for Health Information Technology (ONC). A complete list of ONC’s grant funding plan targets is provided in a recent blog post by John D. Halamka, MD, MS, chief information officer of Beth Israel Deaconess Medical Center, and includes:

• Regional extension centers (RECs) $643 million;
• Health Information Exchange $564 million;
• Workforce Training Programs $118 million;
• Beacon Communities, which he put at $235 million;
• Strategic Health Advanced Research Projects (SHARP) $60 million;
• Nationwide Health Information Network/Standards and Certification $64.3 million (details are pending).

“There are other smaller contracts and projects, hence the total above is less than $2 billion,” he notes.

Blumenthal said that this year has been “a year of creation,” acknowledging the establishment of several programs (i.e., State Health Information Exchange Program; the SHARP Program [Strategic Health IT Advanced Research Projects]; and the Curriculum Development Centers Program). He also called the government efforts ambitious.

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Medical device tax could pose big costs for consumers.

Now that the $787 billion American Recovery and Reinvestment Act of 2009 (ARRA) includes approximately$20 billion for healthcare IT, the administration is starting to throw a lot of money around. Just where is that $20 billion coming from?

Some industry folks think it could come in the form of a new tax on medical devices. In a recent post on the Health Data Management Blog, Editor-in-Chief Greg Gillespie spotlights this new tax – a 2.3 percent excise tax on medical devices set to go into effect in 2013. He says this figure hasn’t received much exposure in the media because it doesn’t sound like much – unless you’re in the medical devices market. The tax could generate almost $2 billion every year, says Gillespie.

Medical device manufacturers will try to find ways to pass the costs on to the consumers, the middlemen, and device suppliers, Gillespie says. Whichever way the cookie crumbles, it’s the end consumer whose arm is going to get twisted, say some experts. Excise taxes like these, according to Gillespie, have almost always seen indiscriminate use of funds to shift money from here to there.

And this time he says EHRs are being perceived as the backbone of a potential national health infrastructure that will use health information exchanges to plug everyone – patients, providers, insurers, government health agencies, etc. – into one mammoth-sized health entity that will definitely need sustainable revenue streams.

This could result in the EHR industry getting pinched for that money, Gillespie argues. Because there’s been an artificial expansion in the EHR market on account of the HITECH Act, and because the EHR market has some deep-pocketed players in it, the EHR market should pitch in its contribution in the form of a tax on their products, right?

Gillespie says that taxing EHRs is something feds have been attempting for some years and now they finally have a foot in the door. The FDA, for instance, has been trying for quite some time to add EHR regulation to its host of responsibilities. And in February 2008 the FDA made some noise by issuing a proposed rule for regulating medical device data systems (MDDS), defined as software that transfers, displays, reformats or stores data from a medical device without acting upon that device. The rule proposed to classify MDDS as a Class 1 medical device, the lowest risk category.

Industry players are trying to fight back, but the writing may be on the wall: It is just a matter of time before an EHR tax rears its head, and whether the entry will be through the front door, or a stealthier form of medical device tax remains to be seen, says Gillespie.

Adapted from Health Information Compliance Alert.

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Study finds health IT investments worth $3B savings.

The Department of Veterans Affairs (VA) may have shelled out billions of dollars to jump onto the health IT bandwagon, but a recent study claims the move has a big payback. As the private sector races to join the electronic health record zeitgeist, it might be worth studying how the VA has done it.

The VA system, called Vista (for Veterans Health Information Systems and Technology Architecture), yielded $3.09 billion in cumulative benefits net of investment costs by 2007, says a team from Center for IT Leadership at Partners Healthcare in Charlestown, MA, who authored the study.

The team looked at VA’s four electronic medical systems, and measured reduced workloads, freed workspace and savings from items such as unneeded medical tests and avoided hospital admissions.

However, initial investment costs were high. One system—the Computerized Patient Record System—cost $3.6 billion. Another, called the Laboratory Electronic Data Interoperability application cost $470 million. Other IT networks are used to manage medications with bar codes, picture archiving and communication systems.

When compared to the private sector, the VA was found to have spent more on IT, but it performs better in such areas as cancer screening and glucose measures for diabetics. For instance, the study looked at the success in meeting clinical guidelines through the use of electronic health records and computerized physician alerts in managing diabetes, which affects about 25 percent of VA patients. The result showed that VA patients with diabetes had better glucose testing compliance and control, more controlled cholesterol, and more timely retinal exams compared to the private sector.

The government agency has a unique, integrated structure that is more likely to produce results from IT projects and is hard to match in the private sector, notes the authors. But that shouldn’t keep health care organizations on the private side from trying.

“VA has seen its investment in health information technology pay off for veterans and taxpayers for many years, and this study provides positive evidence for this correlation,” says VA Secretary Eric Shinseki. “The benefits have exceeded costs, proving that the implementation of secure, efficient systems of electronic records is a good idea for all our citizens.

The abstract of the study is available from the Health Affairs website.

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Get practical advice to avoid violation of HIPAA and HITECH’s security rule: “Email that to me.” – Electronics, Health Information, and HIPAA.

“How soon” depends on effectiveness of federal stimulus, experts say.

The “meaningful use” debate continues to make waves as practices grapple with whether or not they qualify for sizable financial incentives.

The federal stimulus bill allots approximately $19 billion in Medicare and Medicaid incentives for physicians, hospitals and other healthcare organizations not only to adopt certified EHRs but also to use them in a meaningful way. Early adopters have been promised bonuses, but these bonuses will turn into penalties for players who do not act fast enough, as a recent post on American Medical News reminds us.

Where is your practice in terms of a timeline? Will you get the carrot or the stick?

Around two weeks before the proposed “meaningful use” rules were issued by CMS, Data Health Management conducted an online poll asking participants how soon they thought EHR will be adopted. A total of 83 responded in the poll and opinion was nearly equally divided amongst those who thought adoption of EHRs would be rapid and those who thought it would be gradual, reports Health Data Management. The poll shows that while a broad consensus exists about the future viability of EHRs, opinions differ about how and when that future will arrive.

One of the participants in the poll, Karl D. Schubert, managing partner and chief technology officer of Minnetonka, Minn.-based TechNova Consulting, feels that the expansion of EHRs is going to be gradual. In a post-poll interview, he compared the adoption curve to how banks rolled out ATMs – which was certainly not a lightning fast event. “The future for digital health is bright, but it is not going to happen overnight. It will not be easy,and we will have to invest money to save money and improve health care in the long run.”

Schubert said in the interview that technological challenges and roadblocks will need to be resolved before EHRs are widely adopted. “Today’s average interaction by a health services consumer still involves a 19th century paperwork trail, and that drives costs up, efficiencies down, and [can cause] improper diagnosis and treatment,”he said. “There are major challenges, though, that will need to be overcome such as universal data taxonomy, ease-of-use for the consumers and providers, personal information safeguards, and checks-and-balances to ensure that the data is good and remains good.”

Hidden Penalties Cause Concern

Another factor that divided respondents of the poll between the “Rapid” and “Gradual” factors was the impact of the spending stipulated under American Recovery and Reinvestment Act to encourage meaningful EHR adoption. Twelve percent of the respondents dismissed this stimulus effort as being merely cosmetic.

But Brett Harnett, research assistant professor and chief, division of IT at the University of Cincinnati Dept. of Surgery, disagrees with this 12 percent and says that the push which the ARRA provides will definitely catalyze EHR adoption. He compares the federal program with a mandate of sorts.

According to Harnett, even though the program does not specifically require EHR, it does eventually penalize practices without this technology by reducing their government reimbursements. “The government has taken a two-pronged approach to the adoption of EHRs,” he said in an interview following the poll. “First by mandating it and second by incentivizing it. Although there are issues to resolve such as interoperability and unique patient identification numbers, the incentive represents a financial ‘carrot’ that should be embraced by providers.”

For the full story, go to Health Information Compliance Alert.

AUDIO: Information security risk analysis musts for health care information managers. With Jim Sheldon-Dean.

Not an EP? Here are other ways EMR can save you cash if you know the ropes.

If you haven’t witnessed or lead a conversion from paper records to an electronic medical record (EMR) system, you’re at least aware that the process is a huge undertaking — that often results in even lower productivity and more confusion. So, is making the change really worth it? Experts agree that yes, going electronic is worth it. Here are a few reasons why:

1. You Open More Cash Inlets

Many research studies pull their data via electronic records. So, if you can’t tune in to participate, opportunities for cash perks will fly by. “Grant money and incentive programs are available, for example, and they want data in the electronic form,” points out Francine Wheelock, PT, MPA, manager of clinical systems for MaineGeneral Health. Just look at the nationwide push for value-based purchasing and outcome data, and expect to go electronic in if you want to be in the loop.

Stay alert: Last year, the federal government launched the Health Information Technology for Economic and Clinical Health (HITECH) Act, which plans to pay eligible healthcare professionals incentives for the “meaningful use” of certain EMRs.

Some providers, such as SLPs, OTs and PTs, are not classified as ‘EPs’ under the HITECH Act and therefore are not eligible for the incentive payment, confirms Kate Romanow, director of health care regulatory advocacy for the American Speech-Language Hearing Association. But they may be eligible in the future, so therapists “may want to consider implementing EHR now,” she says.

Plus, you can enhance coordination of care with healthcare providers who are eligible for HITECH incentives and are adopting EHRs, points out Sarah Nicholls, assistant director for payment policy and advocacy for the American Physical Therapy Association. So, “think about your business interactions today with those that are eligible.”

2. Quality of Care Gets a Boost

Electronic systems often offer access to a database of national outcomes data from users of the same software — a jewel for measuring and improving your care.

Another perk: Many of the systems will connect you to research on best practices for treating certain diagnoses, Wheelock notes. “Thus, an EMR can really help drive evidence-based practice.”

Electronic systems can also help standardize your care. “For example, if your practice sees the same diagnoses very frequently, you could build shells for care plans so that you have some standardization of care to start with, Wheelock adds.

3. Your Clients Expect EMRs

If you work for a rehab agency or are an independent contractor, whoever’s buying your rehab services wants to see a modern operation. “Switching to an EMR is important because when a customer wants you as the vendor to do so, you need to continue to meet the customer’s expectation,” says Kate Brewer, PT, MBA, GCS, VP of Greenfield Rehabilitation Agency in Greenfield, Wis.

Another thought: A more modern feel in your clinic may also help attract new patients who are shopping  around for a therapist and are alert to small details like being current with the times.

4. Mistakes Get Caught in Their Tracks

Forget to include a start date on your plan of care? Ready to code a claim and miss a CCI edit? Electronic billing and documentation systems can catch these types of errors before they cost you money.

How: “Whether it’s for a billing purpose, a compliance purpose, or a best practice, you can program a documentation system to force users to answer certain questions before proceeding,” Wheelock explains.

“We have made good progress [with our EMR], and it’s definitely improved our clean claims, improved our compliance, and helped train the therapists in how to do good documentation,” cheers Garry Woessner, MA-CCC, MBA, CAS, regional director of Benedictine Health System in Minneapolis.

You can save yourself the hassle of certain HIPAA violations too. “I used to be in home care, and until we went to an EHR, charts would get lost,” Wheelock recalls. “In addition, there was no way to know, unless you physically went in and looked at every chart, if someone was tardy with their billing.”

5. Easy Access Makes Life Easier

Implementing an EMR system is hard work, but the convenience of pulling up a patient record in a matter of seconds — and having it portable too — is worth its weight in gold.

Example: Consider home care therapists who are driving around to different sites and need to get patient history from a central server. Linking to a server remotely is now possible, and some EMR systems will even let you do so through a phone line, Wheelock says. The ability to connect to a central database is also a huge convenience for therapy organizations with multiple sites.

In fact, easy access to a patient record is important for any facility. Take, for example, a SNF setting working with a therapist shortage. “One therapist may be moving around to different facilities  to see patients, thus not always available on site to discuss the patients with nursing,” Wheelock proposes. But with an EMR in place, “the nurse, who’s still back in the facility, can pull up the therapy information very easily and quickly if she needs to.”

© Rehab Report

Audio training event: ‘Email that to me’ — Electronics, Health Information & HIPAA.

Study: Physicians are no big fans of electronic prescriptions.

Tailored incentives may drive physicians to adopt electronic prescriptions more, according to a study conducted which measured the use of stand-alone e-prescribing (SEP) in a health-plan-sponsored environment.

The findings appear in a report published by the American Journal of Managed Care (AJMC) on March 9. The study was designed to know how much the primary care physicians (PCPs) would use SEP, and to determine which physician and patient characteristics were associated with higher rates of each.

The report said that on the average, adopters use SEP for only about one-quarter of their prescriptions. Still, a certain number of adopters used the system a lot, prompting AJMC to conclude that further research should be done to identify which factors contributed to this behavior.

Using records from Horizon BCBSNJ, New Jersey’s largest health insurer, the study compared the characteristics of the 297 PCPs who adopted SEP through the health-plan sponsored initiative against the characteristics of 1892 eligible PCPs who did not.

The result showed that among the 297 SEP-adopting PCPs, 34 PCPs (11.4 percent) never used the system after it was installed, and another 22 PCPs (7.4 percent) quit using it after at least some initial use. Among the remaining 241 PCPs, only 20.4 percent were heavy users of the SEP system.

“Our adoption analysis found that PCPs who adopted SEP were more likely to be in practices with 2 to 10 physicians and were less likely to be pediatricians or have patients living in majority African American neighborhoods,” the report stated.

The report classified the overall use of SEP as low, but some physicians — in big and small practices — were able to adopt the system successfully. Unexpected barriers to e-prescribing use exist and should be addressed, maintain study authors.

These barriers were identified as:

(1) poor pharmacy connectivity;

(2) missing eligibility data;

(3) unreliable drug identifiers; and

(4) prohibited e-transmission of prescriptions for controlled substances.

Consequently, it offered suggestions on where future SEP research should focus, which include:

(1) identifying the specific factors that enable SEP use;

(2) considering the costs and benefits of SEP; and

(3) understanding whether SEP systems can enable interoperability of prescription information.

The “rush to deploy EHRs could lead to administrative complications, formatting problems, errors and interoperability glitches,” according to a recent BusinessWeek series that examines some of the technical issues accompanying the rollout of EHR in providers’ offices across the country.

As of last year, only 10% of U.S. health care facilities were using EHRs, according to the article, but the feds want half of them on board by 2014. If you’re aiming to be in that first half, read on to learn about some of the hurdles you’ll need to overcome …

♦ Deal productively with the uncertainly surrounding how to show you’re using EHRs in a “meaningful” way. CMS has issued its first proposed rule on the definition of meaningful use, which will determine whether a facility or provider qualifies for full incentive payments. The first rule, due out this spring, will focus on capturing health data in a coded format; tracking patient conditions and coordinating care; and implementing clinical decision support tools to facilitate disease and medication management.

Experts worry that hospitals and other facilities will feel compelled to meet the deadline for EHR adoption in 2011, so they don’t miss out on the first round of money, and struggle to meet the definition of meaningful use too quickly. Without robust IT departments and resources, a hasty rollout of EHR technology could be “disjointed,” says the article, and that may make for even more difficulties later.

♦ Keep up with multiplying compliance demands in addition to EHR requirements. Providers worry that their IT systems will be crunched by the confluence of several new requirements – only one of which is the EHR rule.

♦ Remember that new ICD-10 code sets are in effect and carry a compliance date of October 1, 2013, according to CMS’s final rule on the new sets.

Other new standards apply to medical claims and remittances under HIPAA; there are the red flag rules from the FTC; and new electronic medical record (EMR) systems are required in each facility — a requirement separate and apart from the aggregate EHR on a patient that exists across organizations.

♦ Be aware of IT staffing at your organization. IT staff can be low in some places, points out the article, which is worrisome because they won’t have the manpower or expertise to implement these complicated systems.

“EHR implementations are far more complicated for hospitals than for doctor’s offices, because they aren’t all-inclusive bundled systems,” according to the article.  “Hospitals use piecemeal technology that’s rolled out department by department and requires integration. And since many hospitals won’t just rip and replace their existing IT infrastructures, they’ll be forced to integrate new physician and nurse documentation systems, computerized order-entry systems and relational databases with their existing systems.”

♦ Start with CPOE. A recent survey by Computer Sciences Corp. indicates that while 70% of hospitals have systems that can support computerized physician order entries, only 8% have such systems throughout their facilities.

Implementing a CPOE system is a good place to start on the road to EHR adoption, according to the BusinessWeek series. Such systems can be set up in emergency departments first, for instance, before being rolled out to the rest of the hospital.

♦ Self-Assess and Network! “If you aren’t at least evaluating some EHR products and talking to your peers about this, you’re going to have a difficult time getting all of your reimbursement payments,” according to Sue Reber of the non-profit Certification Commission for Health Information Technology (CCHIT), which certifies EHR systems. “And you may even get yourself into the penalty phase.”

Other experts recommend that you run an audit of the IT systems you already have in place, asking whether they can be certified as they are, and whether there are any technology gaps that need to be remedied.

Do you MU? Do you know how that impacts your HIPAA compliance? Learn more here.