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TOP NEWS—ICD-10 Implemented

CEO Update October 2015

CEO Update

Special points of inter-

est:

ICD-10 Implement-

ed

CMS Issues Stage 3

Final Rule for

Meaningful Use

Patient Safety

Chapter

Emergency Care in

rural areas

Price transparency

A recent conversation with Paula Digby, a

HealthTech partner from AQ-IQ, regarding ICD-10

and whether hospitals reported a smooth transition

resulted in her telling me that she was very busy!

With any major change, there are always glitches

that need to be worked out. CMS released the fol-

lowing infographic to clarify billing processes:

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CMS Issues Final Rule

The Centers for Medicare & Medicaid Services (CMS) released a final rule with com-

ment period modifying the reporting period for the Medicare and Medicaid Elec-

tronic Health Records (EHR) Incentive Programs in 2015 to a 90-day period to align

with the calendar year and providing additional flexibilities. The final rule also defines

the “meaningful use” of EHRs for Stage 3 of the Medicare and Medicaid EHR Incen-

tive Programs to start in 2018, with the option for providers to begin in 2017.

At the same time, the Office of the National Coordinator for Health Information Tech-

nology (ONC) released a final rule that sets new certification criteria, standards and

implementation specifications for EHR technology to support Stage 3. Some have

said that the Stage 3 rule is too much too soon. CMS will accept comments on the

Stage 3 requirements and how they will fit into new Medicare physician payment

methods introduced by the Medicare Access and CHIP Reauthorization Act of 2015.

Comments are due December 15.

Highlights of the proposed rule for hospitals and critical access hospitals (CAHs) in-

clude reporting on the same nine objectives of meaningful use:

Protect Patient Health Information

Clinical Decision Support (CDS)

Computerized Provider Order Entry (CPOE)

Electronic Prescribing (eRx)

Health Information Exchange

Patient Specific Education

Medication Reconciliation

Patient Electronic Access to Health Information

Public Health and Clinical Data Registry Reporting

CMS removed the core and menu approach and will require providers to meet all objec-

tives. 12 objectives were removed from Stage 2 for hospitals and CAHs that CMS believes

are redundant, duplicative or topped out. For eligible professionals (Eps), CMS removed

11 objectives. CMS finalizes its proposal to require all providers to meet Stage 2 require-

ments beginning in 2015, with certain exceptions for those meant to be at Stage 1 in 2015.

Specifically, these providers would be given “alternate exclusions and specifications for

certain objectives and measures” in 2015. CMS adds certain alternate exclusions and

specifications in 2016, but not the full set available for 2015 . Source: Excerpted AHA

News. Oct 7, 2015

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TJC — Patient Safety Chapter

Page 3

CEO Update

IIC

TJC states that healthcare organizations and providers of care have the

first obligation to “do no harm .” The patient safety chapter was designed

based on the following guiding principles:

1. Aligning existing Joint Commission standards with daily work in order to

engage patients and staff throughout the healthcare system at all

times on reducing harm.

2. Assisting healthcare organizations with advancing knowledge, skills,

and competence of staff and patients by recommending methods

that will improve quality and safety processes.

3. Encouraging and recommending proactive quality and patient safety

methods that will increase accountability, trust, and knowledge while

reducing the impact of fear and blame. Source: jointcommission.org

TJC seems to be espousing the principles of Lean in this chapter with the

following guidelines for quality management systems:

1. Ensure reliable processes

2. Decrease variation and defects or waste

3. Focus on achieving better outcomes

4. Use evidence to ensure that a service is satisfactory

Creating a patient safety culture is everyone’s responsibility from the board

to the CEO to caregivers at the bedside to those who assure the patient

has a clean room. No one person is accountable for patient safety be-

cause it takes a village to transform a culture. Senior leaders must set the

standard and coach others to “do no harm.” Like the airline industry,

healthcare organizations should be one of the safest places to be, yet

there continues to be gaps in creating a safe culture for patients. There

are volumes of data that report how patients have been harmed, so it is

time to shift the pendulum and report strategies that are effective in pre-

venting harm and use them to affect a culture of safety.

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From the Hill Emergency Care in Rural Areas

The Medicare Payment Advisory Commission (MedPAC) recently had

discussions regarding access to emergency care as a result of hospital

closures occurring in rural areas. Two options were presented by the

American Hospital Association who are representing rural hospitals

that included:

1. Hospitals would be permitted to be a 24/7 emergency

department, where they would be paid hospital outpatient

PPS rates per service and fixed grants to help pay for standby

capacity costs,

OR

2. Hospitals would be permitted to be a primary care clinic with 24/7 ambulance service,

and would be reimbursed similarly to federally qualified health centers (FQHC).

The concern is significant for individuals living in rural areas who may experience navigating considerable

distances cumbersome or impossible when seeking emergency care. As closures escalate, further action

should be taken to address this issue.

Price Transparency

It is reported that there has been an uptick of individuals choosing high deductible health plans (HDHP) or

health savings accounts (HSA) since 2011. The growth of HDHP/HSA has grown by about 15% annually

(Source: American Health Insurance Plans) since 2011. This model suggests that when individuals are using

their own dollars there is a shift in buying habits. For example, the cost for an outpatient procedure such as a

colonoscopy can vary significantly based on the location where the procedure is offered. As a result, con-

sumers are shopping around to determine where they will spend their dollars. Unfortunately, healthcare or-

ganizations do not always have pricing for services rendered to patients, and if they do, those prices are not

necessarily publicized. The adoption of and growth of HDHP/HSA places a burden on consumers and

healthcare organization; the consumer will be price-shopping, and healthcare organizations will need to

know what their services cost and be transparent about it.

Example: Modern Healthcare

reported (July 8, 2015) that

“State progress on healthcare

pricing transparency has

slowed around the country,

and some states have even

stepped backward in provid-

ing clearer information to con-

sumers about their healthcare

costs. “ The Catalyst for Pay-

ment Reform and the Health

Care Incentives Improvement

Institute have released their third annual report card on state price transparency laws, and once again, a

majority of states received a failing grade—45 to be exact. Two years ago, only 29 states received Fs. One

wouldn’t buy a car without knowing the price, nor does it seem logical to buy healthcare without knowing

the cost.