Author Archives: Vignesh Eswaramoorthy

MACRA and MIPS

On April 27th 2016, CMS released a significant new ‘proposed rule’. Once this becomes a rule, it will chart Medicare payment course for the foreseeable future. MACRA or Medicare Access and CHIP Reauthorization Act 2015, which continues to be supported by both parties, will alter the way Medicare pays to providers who give care to Medicare patients.

MACRA will replace Standard Growth Rate (SGR) which determines Medicare’s payment to healthcare providers. To replace Standard Growth Rate, MACRA will establish a new value based reimbursement systems called the Quality Payment Program (QPP). Under QPP there will be two payment models

1. Merit-based Incentive Payment System (MIPS)

2. Alternative Payment Model (APM)

CMS predicts that most of the providers will be subject to MIPS for the first year of MACRA that is till 2017, this will include providers who reports PQRS and Meaningful Use and also those who are not part of any. ACOs that do not bear enough risk for exemption, will also fall in this payment model.

MIPS is the combination of the three existing models namely Meaningful Use, Physician Quality reporting System (PQRS), and Value Based Modifier (VBM). MIPS will categories four measures to compare provider performance to a MIPS composite performance score (CPS) of 100 points. Those four measures are

1.Quality (50%)

2.Advanced Care Information (25%)

3.Clinical Practice Improvement Activities (15%)

4.Cost Category (10%)

Composite Performance Score earned for a given year determines MIPS payment adjustment in the next calendar year and scores earned by each physicians will be made public. So, it is important to understand and prepare for the four measures.

1. Quality

Clinicians can choose six measures to report to CMS, that best reflect their practice. One among these measures must be an outcome measure or a high quality measure, and one a cross cutting measure. Clinicians can also choose to report a specialty measure set.

2.Advanced Practice Improvement Activities

Clinicians will report key measures of interoperability and information exchange. Clinicians are rewarded for their performance that matter most to them.

3.Clinical Practice Improvement Activities

Clinicians can choose the activities best suited for their practice, the rule proposes over 90 activities to choose from. Clinicians participating in medical homes earn full credit in this category. Those participating in Advanced APMs will get at least half credit.

4.Cost Category

Cost category points are calculated by CMS on the basis of claims and availability of sufficient volume. Clinicians do not have to report anything for this category.

CMS, has suggested a delay in MACRA implementation out of consideration for small physician practitioners. But even with the delay, MACRA will become a reality soon and it can have the following impact on practices.

1.Practice Revenue

MACRA will have two impact on practice revenue, annual inflationary adjustment to the part B fee schedule, by which there will be a small increase for payment years CY2016 to CY2019, which will be the first payment under QPP and MIPS payment adjustment on the group/physician’s Composite Performance Score based on which there can be significant variations in reimbursement.

2.Lots of Data to Collect and Process

The MACRA act is incredibly complex and precise in its details. With all the data to be reported for validation, physicians will have to have an organized system to collect and verify the data. For some providers this might be welcome upgrade, but for the small practices this would mean additional investment on infrastructure and staff.

3.Improve Care Quality

MACRA will effectively shift accountability focus so that there will be an increased counselling and follow-up. By connecting the payment model to care quality, providers will be more invested in population health of community they serve.

4.Practice Reputation

There is call for transparency in healthcare payment and MACRA CMS is heeding to that call. MIPS will publish each eligible physicians annual Composite Performance Score (CPS) within a year, after the end of the relevant performance year. These published results will have an impact on provider’s reputation and indirectly their revenue. A good score, probably higher than a national average will work in favour of providers and a bad score will do the opposite.

Over the past few years CMS and the Federal government have been pushing healthcare sector away from fee-for-service to value-based-service. With MACRA implementation scheduled next year, CMS will achieve a great much, in this direction. MACRA law may pose to disturb small physician practitioner’s quiet afternoons for a while, however the hope is that when the dust settles everyone will stand to benefit.

Mobile Health

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Rapid growth in the healthcare industry and increasing technology innovations are transforming the way healthcare is being delivered. Mobile Health technology is one such disruptive innovation

mhealth apps has become popular over the past few years and is still trending. By 2017, over one-third of the world’s population will have smartphones. As people become more health conscious, the use of such apps will also increase.

Health apps record a large amount of data, and this data in sync with EMR will help providers and care team to track patient’s day-to-day activities and evaluate progress. Collection of data process will become easy but the real challenge is to engage patients and execute a care plan.

By using patient portal, providers can engage their patient through Mobile Health technology. Mobile Health can increase the outcome, based on the patient’s engagement level. In order to keep active, professionals have to educate their patients via portals, health apps, and educational programs.

A survey indicates that people with one chronic condition are not consulting their primary care physician not more than once in three months. Though certain services like Telehealth and Mobile Health has been initiated to ease the care process, people are reluctant to embrace it for various reasons. The only way to do is encourage them to participate.

Using digital health tools we can bring better health outcome and help patients stay connected to healthcare professionals. There are many wellness applications but a customer standard tool for providers to extract data from multiple tools is a challenge. Using a common platform help will help in data accuracy and effective usage.

Many Americans use health monitoring devices. But the story changes when you evaluate the subsets; survey tells those newly insured people are more interested in using apps to monitor their health activity than people who already suffer from one or more chronic conditions which is not a positive sign, as people with chronic conditions are in high health risk probability.

Patients now expect providers to interact digitally, like in other services. Provider’s attempt to satisfy their expectation level but due to the absence of a reliable secure solution, it may fail to rise up to the demand.

Hospitals are now developing their own app. But only two percent of patients are using this app, mainly to access their health record, appointment scheduling, and prescription refills.
In that 2 percent, some patients face difficulty to access or enter data. When the patient attempts to enter data, after a short time they get tired and stop entering resulting in incomplete data, which in turn means incomplete patient data.

Developers always focus on customer’s needs. Increase in needs will increase the competition, which results in more application and all those are customer-driven products. Some apps help people to self-diagnose. Chronic patients who use fitness app have gradually decreased their visit to the physician. Knowing that some physicians also have stopped suggesting those apps to patients. But providers need to realize the benefits of Mobile Health and should encourage their patients to use those apps.

The customer plays an essential role in transforming the healthcare industry. Technology is useful only when customer understands the use of a product.

HealthCare Data Management

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Data Management in healthcare requires a meticulous approach, Accountable care organizations or the ACO’s usually have many hospitals associated with its network, which makes data management all the more difficult.

Hospitals have patient’s medical records either in electronic form or paper-based. ACO’s will have to
consolidate data from all hospitals and convert it into an actionable format, and make it available to be accessed across the network, to achieve better population health.

There’s a considerable challenge in a consolidation of Healthcare data. Data line in healthcare is typically lengthy and complex in the structure which is not easy to consume as it is possible in any other field. Each time data has to be retrieved and handled through secure communication, to ensure data protection.

In order to update or retrieve a patient information without any interchange, data arrangement should be perfect. Indexing is one method which helps in loading or recovering files in an orderly pattern and gives a clear and complete view of an individual patient record without any case of missing information. Data gathered and stored are reliable and acts as a primary source of information for an ACO. Integrated data approach combines patient-centered data from smartphones, wearable, and other connected devices and gives a comprehensive, near to real-time data.

Recent technology advancements help to perform advanced analytics that can yield a better diagnosis and enhance right treatment. This encourages people to engage in their own care, as unified data makes the process simpler. ACO admins can access these files to monitor the patients and measure the performance of the physicians through an actionable dashboard. Providers can schedule physician meeting with patients, whereas physician’s role is instrumental to communicate with patients and induce continuous engagement for better results.

One of the most common reasons why data management is challenging in healthcare is that of the lack of training to the participants. Payers might be doing data mining for years to monitor claims but providers are yet to leverage the advantages of data to the fullest.

Present system needs analytics assistance to drive the agenda of high-quality care at a low cost.
ACO’s may not be keen to hire a data analyst to do this process. All they require is an integrated, built-in analytical tool that can be easily installed, and be used like any other critical business application.

Another major problem is storage. To be able to arrive at a meaningful information from the data file, one must ensure collected data set covers a lot of ground data including provider, physician details along with the patient, and has to compatible to data warehouse it. Some organization prefers outsourcing where security is a major concern but they are left with no choice.

The volume of data increases day by day which is directly related to cost. The next option would be Cloud computing for many large organizations and mid-level company. And migration has already started because of its fast and secure data sharing benefits.

When it comes to payment issues analyzing cash flow is no longer difficult for hospitals with performance-based payment. Data analytics being able to analyze real-time data provides immediate information which helps in better decision making and to optimize the operations at regular intervals.

HealthViewX is in the business of Healthcare IT innovation, we help providers improve their performance, care quality, and patient experience through our cost-effective solutions.

Healthcare Reach For The Cloud

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In pursuit of practice effectiveness and cost efficiency, the healthcare industry is reaching for the cloud. Cloud computing is the concept of using off-site, third-party servers to store, analyze and share information seamlessly via the internet. By adopting this model, computing will not be a long-term investment but a consumable service, bringing down the setup and operation cost and channelize better handling of sensitive patient information.

Cloud computing has penetrated every industry and healthcare providers are now realizing its potential. Hospitals, both big and small recognize the need or have already invested in cloud computing. In this era of information explosion, healthcare professionals face a stupendous amount of data every day. As technology continues to drive the pace of progress, the industry becomes more information-driven, and the data gathered will only keep increasing. Traditional on site may not have the flexibility that healthcare industry is currently looking for.

To the transforming healthcare industry and its evolving needs cloud computing offer the following advantages

1. Data Security

With the proliferation of Electronic Health Records (EHR’s) and other such technology, the sensitivity of patient information has attracted the attention of hackers to hospitals. This poses an ever-present threat to hospital servers and is a common worry to hospital executives that they would accept. All major cloud computing service providers are experts in managing a large amount of data and employ more security features than any hospital can afford on its own. Cloud computing providers have dedicated staffs and resources who are always on the lookout for possible security concerns and devise to prevent any breach and ensure 24/7 security.

2. Scalability

Cloud computing is extremely scalable, its capacity can be increased or decreased whenever the need arises and it can be done quickly and with ease. In case of traditional on-site servers, scaling up or down is a tedious and time-consuming task, often involving long process and delays. In case of cloud, the need can be communicated to the cloud provider and functionality can be made available much faster. This flexibility helps hospitals to be cost-effective and at the same time meet any need that may arise.

3. Pay for services consumed

Cloud computing charges are calculated on services consumed, healthcare service provider do not have to invest a substantial amount of money to set servers on-premises and spent on a monthly basis for its maintenance. Cloud servers are the lot less expensive as there is no capital investment required. For cloud, the healthcare providers need to only pay a service fee on the basis of usage, this is uncluttered and makes it easy for hospitals to calculate and forecast expenses.

4. Telemedicine

Telemedicine is the use of information technology to remotely administer, diagnosis and treatment. Cloud computing can positively accelerate the deployment of Telemedicine and also reduce the cost of deployment. Telemedicine supports home care patients and also patients in rural areas when needed.

5. Peer Collaboration and Research

Cloud computing gives provider’s access to all information as and when needed. Primary care physicians can collaborate with experts in times of need, doctors can guide nurses or caregivers to administer procedure on patients in an emergency.
Providers can share data and gather information on diseases and efficiency of treatment like cancer and diabetes.
With its universal availability and secure access, the providers can share patient data to researchers without the fear of breach of data integrity. With more collective data to investigate, researchers will be able to study the nature of diseases and its causes which affect many in our society.

Cloud computing eliminates the need to build and maintain complex and expensive servers leaving hospitals the time and capital to invest in the good work.
Cloud computing can help bring patients and doctors together to ensure care at the right place at the right time. Promoting collaboration and aiding research cloud computing can become an active resource in the search for the cure for a disease. It can bring better treatment to patients in the inaccessible region and improve the average quality of healthcare. Cloud computing may very well be the silver bullet the healthcare industry been looking for.

Prescription For Specialized Costs

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US government spends more on healthcare than any other industrialized or high-income countries. But the gains from this investment is not proportionally positive. On average, Americans live shorter lives and are more likely to report a cancer diagnosis, cardiovascular disease or other chronic illnesses. One main reason among many is the average American’s ever decreasing access to primary health services.

There is a looming shortage of primary care providers in the country. Experts predict that by the year 2025, the shortage of primary care providers could become a crisis. Even now it is estimated that one in five sick people visit ER for care, they could have accessed from a primary care center.

The percentage of primary care physicians in the US is at 30%, a gradual decline from 50% five decades ago. According to experts the reason for the downwards trend can be traced to the early 40s and 50s when the general public first adopted the idea of advancement in medicine as specialization. As a result, we now have more specialists than ever before but quality of care and access to care took a hit.

Various case studies have related following problems with specialization:

1.Cost of Expertise:

Specialization adds cost to the health system which will ultimately be passed on to patients. Specialists have a greater chance of over-diagnosing a symptom and patients may be prescribed unwanted and costly treatment regimes. Experts are more likely to overuse healthcare infrastructure than a primary care physician. Many scholars now agree that psychological problems like ADHD, depression and some chronic illnesses like chronic kidney disease and some form of cancer are overdiagnosed.

2. Wrong Diagnosis:

Specialists in a field may diagnose a problem through a limited scope, in an attempt to study an issue from such conformity of their respective expertise may lead specialists to conclude the wrong diagnosis. This drawback to properly diagnose a symptom can affect patients with multiple illnesses. When the government is drawing up plans to curb the cost of treating the chronically ill, this diversified islands of thoughts and actions may not be helpful in realizing it.

3. Biases:

Specialists practicing in a field may be biased in diagnosing symptoms or cases outside their area of expertise. Such biases may lead to medical errors such as overlooking the influence of a treatment on other patient conditions, underestimating the seriousness of other health concerns. These biases may be useful in some cases but in most cases usually just adds up cost and endanger the health of patients.

Improving access to estimated 60 million Americans to primary care is not easy but necessary to ensure quality care for all. Various studies reveal primary care and income disparity are the two major influencers in life expectancy and that access to primary care also leads to improved population health parameters. Some of the major benefits of improving access to primary healthcare are below

1. Early Detection

An early detection of disease can help chances of successfully treating these diseases. Early detection is detrimental for effective treatment of some chronic diseases and conditions.

2. Efficiency

In the absence of specialization, a primary care physician will be able to observe and treat symptoms and illnesses in a holistic way making the whole process more efficient. As the whole healthcare policy is tilting away from cost per service to quality of service, the role of primary care professionals will find new importance.

3. Cost-less:

In the prevalent system, a disease is diagnosed after it has occurred. By identifying diseases at an early stage and providing holistic care primary care can cut down the cost of healthcare. Such a system can reduce the number of chronic care cases and thus remove the burden on healthcare infrastructure and also be making it available for more of the population. This will onset a positive cycle, establishing a cost-efficient healthcare system on its own.

The positive influence of primary care access to population health cannot be denied and efforts must be made to refocus attention on primary holistic care. Hope comes in the form of Accountable Care Organization and other initiatives of both federal and state governments compelling healthcare professionals to work together and improve patient outcome. Strengthened primary care may not solve the puzzle that is the US healthcare system, but it sure can be one decisive piece.

Advantages and Disadvantages of Precision Medicine

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Diseases are influenced by various factors that an individual is subjected to, some of which are general factors while others are specific individual factors. While the former is studied in great detail, the latter is not. Understanding individual factors can help us treat disease more effectively or even prevent diseases more altogether.

This method of tailoring treatment to an individual based on specific personalized factors is called Precision Medicine.

Thanks to the rapid advances in the field of genetic mapping, we now understand the influence genes hold on a person’s health and well-being, opening the possibilities for discovering a cure for chronic illnesses like cancer or diabetes. However, the most interesting aspect the concept presents is to cater treatment to patients not on the basis of general understanding of diseases or symptoms, but to the specific need of the patient and critical factors.

The idea of precision medicine is relatively new but holds great promise, and some of the potential advantages of precision medicine are as follows:

1. The efficiency of Care:

Precision medicine makes decisions based on individual specific factors that affect their health. Today, decision making regarding treatments is on the shoulders of the patients, as even doctors do not know how certain treatment will affect a particular individual. With precision, medical providers can cater customized treatment methodology for each of their patients, improving the probability of recovery.

2. Preventive Care:

When the genetic screening process collects enough samples, the results can be used to diagnose genetically caused diseases and even prevent such diseases by understanding the risk of an individual rather than simply reacting to an illness. The presence or absence of some genes can cause diseases, and by studying these variations we can protect ourselves from these diseases.

3. Limit Cost:

Targeted treatment on the basis of genetic mapping can reduce the cost of care with more informed treatment decisions and a greater chance of being effective. The cost will be potentially lower with the focus on preventive care rather than treatment of disease.

4. Population Health:

Studying genetic patterns in a population as a whole, and as sections can help in identifying causes for particular diseases and develop the treatment. Genetic study of sections of a population can predict a likelihood of diseases and early detection.

The advantages listed above make Precision Medicine seem like an attractive investment. These are fields already identified and destined to be addressed by other programs and ideas, but the effect precision medicine can have on healthcare is intense and far-reaching.

But, the skeptics who are not convinced with this plan point out that it has the following drawbacks.

1. Infrastructure Requirements:

Precision medicine has the potential to deeply impact healthcare, but for that, it requires massive infrastructure investments and time to implement. To implement precision medicine, fundamental changes must be made to infrastructure and mechanism of data collection, storage, and sharing. The federal fund earmarked for the development of precision medicine will not cover the requirement and the question of who will have to spend the rest of the fund (state or federal government, providers/patients or payers) is unclear.

2. Legal Problems:

For Precision Medicine to reach peak efficiency, a lot of genomic data must be collected from a large and diverse section of the population. If and when such a massive amount of data is collected, it is legally unclear who owns the data. The government does not own the data and the FDA has blocked individuals from accessing their own genetic information from companies. In addition to legal issues, the collection and storage of such large amounts of data bring privacy into question. As a result, the implementation of such a plan would definitely be met with significant pushback.

3. The relevance of the Information:

According to Former President Obama’s plan, data from 1 million volunteers will be collected for genomic research. The possibility of ‘missing out’ on certain sections of the population or inadequate samples of certain disorders or over-representation of other types of disorder is highly likely.

4. Healthcare Cost:

Ideally, precision medicine can eliminate repeated efforts, readmission and help take preventive measures against disease, stopping the hemorrhage of funds in healthcare. But to reach this stage, it requires massive investment in infrastructure for collecting, storing, and sharing this information.Investment must also be made to security infrastructure to protect the data and other add-on expenses could prove to be a burden.

Precision medicine uses new technologies and techniques to sort and identify the sources for various illnesses to treat, and prevent illness. It holds great hopes but is hampered by the many drawbacks.

The promises it holds are too great for these drawbacks to hold it back for long, and healthcare providers, government and IT professionals should work together to develop a solution to overcome these short-term disadvantages.