I recently received a question via a referral from a friend and want to share it with my readers.
The scenario and question are:
My husband is an ER doc, board certified in Family Practice. Under the ACA primary care physicians are eligible to receive the increased Medicaid reimbursement once they fill out the attestation indicating they meet the eligibility requirements. However, in reading the CMS final rule, it seems to indicate that Emergency Room services (as well as OB) are not considered primary care.
He works for two ER contacting groups who are all over him to log on and do the attestation so they can receive the increased reimbursement. A couple of things:
1. We are both positive that even though he meets the criteria (primary care certified & 60% of designated codes outlined by CMS) having him complete the attestation is really skirting the intent. He has never practiced outside of the ER and does not have a practice. CMS is not increasing the reimbursement for ACEP certified ER docs so this is really a technicality that the regulators didn't anticipate.
2. CMS indicates that a mechanism must be in place by the MCO to distribute the increased compensation back to the physician. An ER group isn't really an MCO. My husband gets paid an hourly wage and they have no intent of increasing his pay based on the attestation.
Basically the push back is sign it or else. We were thinking perhaps he would sign it if the group agreed in writing to release him of all liability and indemnify him, and reimburse CMS if they decide to do a claw back down the road. My fear is this all gets muddy and I can see CMS doing something crappy that nobody has thought of yet because nobody foresaw this little nuance.
I referred this individual to their local Regional Extension Center and encouraged her husband to obtain something in writing on whether he qualifies for attestitation. If you have any other suggestions, please include them here as a comment.
More engaged consumers and patients are those who are more knowledgeable. Given the increasing role of digital processes in healthcare, that means a new component of patient education is needed for health literacy.
Interoperability is when two or more systems can exchange information and then use the information that has been exchanged. The infographic below explains how it works!
Teleophthalmology is one of my favorite telemedicine applications because it often brings access to screenings to those who might otherwise not receive them. And it helps improve the experience of care and limit costs for patients. Since November is National Diabetes Awareness Month, I thought I'd share some advice for those with the disease from the National Eye Institute.
Diabetic reinopathy is the most common form of the disease; affecting about 28.5% of Americans with diabetes age 40 and older. That’s more than 7 million people, and the number is expected to reach more than 11 million by the year 2030.
If you have diabetes, your doctors most likely have told you to keep your blood sugar under control through diet, exercise, and proper medication. But did you know that you also need a dilated eye exam at least once a year? A dilated eye exam is when an eye care professional dilates, or widens, the pupil to check the retina in the back of the eye for signs of damage. All people with diabetes, type 1 and 2, are at risk for vision loss, but certain groups are at higher risk: African Americans, American Indians/Alaska Natives, and Hispanics/Latinos.
The longer a person has diabetes, the greater the risk of diabetic eye disease, which includes the following: • Cataract (Clouding of the lens of the eye) • Diabetic Retinopathy (Damage to the retina) • Glaucoma (Damage to the optic nerve)
In November, when National Diabetes Month is observed in the United States, the National Eye Health Education Program (NEHEP) of the National Eye Institute (NEI) recommends that all people who have diabetes reduce the risk of vision loss from the disease by having a comprehensive dilated eye exam at least once a year.
“Half of all people with diabetes don’t get annual dilated eye exams. People need to know that about 95 percent of severe vision loss from diabetic retinopathy can be prevented through early detection, timely treatment, and appropriate follow-up,” said Dr. Suber Huang, chair of the Diabetic Eye Disease Subcommittee for NEHEP.
“Diabetic eye disease often has no early warning signs but can be detected early and treated before vision loss occurs,” said Paul A. Sieving, M.D., Ph.D., director of NEI. “Don’t wait until you notice an eye problem to have a dilated eye exam, because vision that is lost often cannot be restored.” In fact, diabetic retinopathy, the most common form of diabetic eye disease, is the leading cause of blindness in American adults ages 20–74. According to NEI, 7.7 million people ages 40 and older have diabetic retinopathy, and this number will likely increase to approximately 11 million people by 2030.
If you have diabetes, get a comprehensive dilated eye exam at least once a year. NEHEP also recommends you keep your health on track by— • Taking your medications. • Reaching and maintaining a healthy weight. • Adding physical activity to your day. • Controlling your blood sugar, blood pressure, and cholesterol. • Kicking the smoking habit.
These steps will help you keep your diabetes under control and help protect against diabetic eye disease.
For more information on diabetic eye disease, financial assistance for eye care, and how you can maintain healthy vision, visit www.nei.nih.gov/diabetes or call NEI at 301–496–5248.
This morning I looked up my community hospitals (same system) on a listing of penalities and bonuses from CMS. These are for Value Based Purchasing, which includes quality and patient satisfaction and Readmissions within 30 days. While my community hospital (Santa Barbara Cottage Hospital) has improved over last year they were still penalized for Value Based Purchasing. Their smaller Goleta Valley Cottage Hospital was also penalized, but at a smaller rate.
I encourage everyone to see how their community hospital is doing on both quality/patient satisfaction and readmissions. Thank you to Kaiser for creating the listing!
I came across a great example of using social media for disaster preparedness activities. It is a YouTube video of Vandenberg's 30th Medical Group training on In-place Patient Decontamination. Beyond just sharing the video of the with the world, this is also an opportunity to enhance the after action (debriefing) conversations and the actual exercise report. It goes beyond just describing what happened, to actually being able to show what worked well or needs improvement.
It think having a social video also provides an opportunity to share the story with employees who might not have been involved in the actual exercise. I think back on my Maintenance guys at Ventura County Medical Center and Santa Paula Hospital who could set up a decontamination tent really fast. It might have been nice for others across the organization to see them in action, as well, but making the video available on a hospital blog, the Intranet, or even on a YouTube channel.
Making the video publically available is also an excellent way to share some of the behind-the-scenes work that hospitals do for the benefit of their communities.
Below is an article I wrote for Patient Safety and Quality Healthcare that really captures how I think about social technologies and the related media channels (brands). Yes, Marketing/ Communications comes first to mind, but the possibilities for social media are really so much more. Leave a comment and let me know what you think about these ideas.
Social technologies offer powerful tools that can be applied in healthcare settings to improve the quality of care and patient safety, especially as the U.S. healthcare delivery system transforms to accommodate changes brought about by the Affordable Care Act and aging baby boomers.
The anticipated shortage of healthcare providers along with significant increases in individuals accessing care means we must significantly transform how we approach and deliver healthcare services. Airlines, banking, and retail have had to re-envision their customer experiences and radically change business processes to accommodate evolving attitudes, expectations, and behaviors. In each of these industries, technology and online tools have played a major role in the transformation.
The shift away from a focus on treating episodes of illness to improving the health of populations highlights the need for automation of processes and more self-service options. Population health involves three fundamental components, each of which can be accommodated by social technologies (Care Continuum Alliance).
The first component is central care delivery and leadership role of primary care. It makes sense to offer consumers and patients an integrated approach to the presentation of the health information and access to trusted resources for self-management of their conditions. Too often providers offer their patients access to their electronic health information through a patient portal without any guidance or tools that can help them take action.
The second component is the critical importance of patient activation, involvement, and personal responsibility. Social technologies that have patient-centric design features are engaging, present information in a way that patients can understand, and facilitate closed-loop communications.
The final component is patient focus and capacity expansion of care coordination through wellness, disease and chronic care management. Social technologies are user directed and scalable. They can accommodate intimate groups or large pools of individuals in public or private conversations. They bring individuals together, even those who are graphically dispersed or have transportation challenges. Users self-select those in their network and can join as few or many communities as they like. The tools also facilitate the tracking of communications between a few or many.
Consider some of the goals and activities (below) that are required to effectively manage the health of a population and the potential efficiencies offered by use of social technologies, especially for those with multiple chronic conditions or complex needs.
Tracking patients on population basis
Confirming completion of preventative screenings
Monitoring adherence to care guidelines and treatment plans
Coordinating care across different settings
Intervening with individuals, as needed
For those who have difficulty envisioning the use of social and online tools in care processes, it is important to consider the entire care continuum and the fact that 98% of the time our patients are not standing in front of us. Visits to a provider make up a relatively small portion of a patient’s life. That means that population health can’t happen if we only focus on those processes when the patient is in our facility. It requires that we maintain contact and find ways to engage patients and their family caregivers before, during, and between encounters with the healthcare system.
Examples of organizations that are well positioned for population health activities by their demonstrated use of innovative social technologies include:
Boston Medical Center's use of an avatar to conduct pre-conception assessment of teens at risk for poor reproductive health and family planning outcomes
United Health Centers of San Joaquin’s use of a social networking platform to help safety-net providers and patients manage chronic disease.
Partners HealthCare’s use of texting for reminders and prevention messaging with multiple populations to realize improvements in adherence to care plans, decreases in “no show” rates and sustained behavior change.
Boston Children’s use of social media to augment traditional surveillance methods of hypoglycemia in diabetes to expand knowledge of complications and impact behaviors.
Children’s Hospital Dallas’s secure online social networking community for patient and family peer support.
Nemours/Alfred I DuPont Hospital for Children’s using a secure social enterprise network to collect real-time feedback from family advisors.
Aetna’s use of a social networking platform to support beneficiaries recovering from addiction and to help prioritize case manager outreach activities.
Healthcare leaders are expected to seek out and apply best practices, as well as adopt those information systems that support patient safety and quality. As we look toward a transformed healthcare delivery system, we can expect to see the most effective leaders leveraging what social technologies have to offer.