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Saturday, February 14, 2015

Meaningful Use 2014 incentive payments: ONC, get out the Lipstick

Click the image to enlarge. Report detail here (pdf). Pretty ugly. 2014 attestation payments were only 30.2% of the prior year's ($3,007,177,555 / $9,948,115,223).

Increasingly, we're going to be in "reimbursement penalty" mode.
CMS: Meaningful Use penalties to reach $200M
By Heather Caspi | February 13, 2015

Dive Brief:
  • Current CMS data indicate that eligible professionals are facing an estimated $200 million in Medicare reimbursement penalties in 2015 for failure to fulfill Medicare meaningful use obligations. The numbers were announced this week during a HIT Policy Committee meeting.
  • The committee report indicates that the highest breakdown of EPs (34% or 87,000) will see payment adjustments ranging from $1 to $250.
  • The further breakdown shows 21% (55,000 EPs) can expect adjustments from $250 to $1,000; 14% (36,000) can expect adjustments from $1,000 to $2,000; and 31% (78,000) can expect adjustments upwards of $2,000...
Meaningful Use is Still Broken
Washington, DC - AMA: Meaningful Use is Still Broken ~ Steven J. Stack, MD President-Elect, American Medical Association:

"The American Medical Association (AMA) is alarmed by yesterday's announcement that more than three quarters of eligible professionals have still been unable to attest to Meaningful Use.

"The program's one-size-fits-all approach, that has not been proven to improve quality, has made it difficult for physicians to take part. The penalties physicians are facing as a result of the Meaningful Use program undermine the program's goals and take valuable resources away from physician practices that could be spent investing in better and additional technologies and moving to alternative models of care that could improve quality and lower costs.

"They additionally make it harder for physicians to meet Meaningful Use in the future. In order to successfully attest, physicians must spend tens of thousands of dollars for tech support, software upgrades, interfaces and data exchange, often on a recurring basis.

"The AMA continues to work with the Administration to improve the Meaningful Use program and looks forward to seeing how CMS' anticipated new rules address these issues this spring."

Is it Time for a “Simple” Electronic Health Record System?
by Jerome Carter on February 16, 2015
Recently, I participated in a series of emails about creating teaching materials for a course on clinical software design. This may come as a surprise, but there are no books on the topic of clinical software design. Of course, there are plenty of books about clinical software systems, especially EHR systems, but none that describe in detail how to design and build clinical care systems.
One reason for the lack of books is that most clinical software is designed and built by commercial entities. The resulting systems are proprietary and the processes used to build them, trade secrets. In light of the recent statements from the AMA (1) and ACP (2) regarding EHR usability and support for clinical documentation, obviously more needs to be done. A general picture of desirable clinical care system features emerges from those reports and other sources. The ideal systems are modular, recognize that one size does not fit all, have explicit support for workflows, allow for a degree of end-user configuration, support collaboration and communication, and can easily share data. As I have said many times, requirements are wishes until rendered in code. So how do we turn wishes and user complaints into next-generation products? Guess what? No one knows for sure…

Vendors are not withholding features or deliberately building systems that underwhelm users. There is no conspiracy. They are building exactly what has been requested—electronic replacements for paper charts (see Is the Electronic Health Record Defunct?). Meaningful use, while a distraction for sure, does not explain why pre-HITECH EHR systems lacked workflow support or collaboration tools or could not readily share information. Those functions were simply not considered compelling at the time...
Great stuff as always.

Speaking of great stuff, the always-pithy Margalit:
Health care is a massive market…

America is spending $3 trillion on health care every year. Does that number include toothpaste? Surely toothpaste is very important to your health. How about baby powder, diapers, condoms, soap, lip balm, nail clippers, detergents, mops, vacuum cleaners, washing machines, smoke detectors, air filters and air bags? How about everything Nike sells, diet books, your gym membership, bicycles, skateboards, everything Sports Authority carries in its stores, and all Weight Watchers products? And then there is quinoa and edamame, spelt, flax, organic kale chips and those scrumptious gluten-free kelp smoothies. You can also count the entire budget of the EPA, the FAA, the CDC, the FDA and the USDA, and while at it let’s not forget the war on drugs, the war on poverty and the war on terror, and of course education and vacation, sunscreen, traffic lights, firefighters, police and those weirdly bluish ice-melting crystals for your driveway. It sure looks like we are spending all our money on caring for our health.
In America, we spend $3 trillion every year on medical care, not health care. Medical care is what you get mostly from doctors and nurses, mostly in hospitals or clinics, and mostly when you are sick or hurt. Medical care is most often associated with pain, suffering and fear, and is something most people, most of the time, don’t use, don’t need and don’t want. The new thinking says that if we could spend less money on medical care, we could spend more on Bluetooth enabled holographic toothpaste, and that this is a good thing. After all, most of our $3 trillion is spent on a small fraction of sick and elderly citizens, most of whom will never get better anyway. Wouldn’t it be more fun to spend our money on nice things for the majority who is basically healthy, so they can be even healthier, and perhaps forever healthy?...

More to come...

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