New Round of HIPAA Audits For Business Associates and How to Survive Them

As the role of analytics and electronic health records systems grows in healthcare, the number of vendors interacting with patient data has grown exponentially. Because of the numerous access points to patient data, the federal government appears to be clamping down on the sometime porous flow of patient data handled by contractors, whose security failures have been linked to the exposure of nearly 33 million individuals' medical records since 2009.

Under HIPAA, these contractors are referred to as “business associates.” And now, these business associates will be included as primary audit targets in the second round of HIPAA audits by the Department of Health and Human Services’ Office for Civil Rights.

The audit of business associates is necessary to keep out firms who are insincere about becoming HIPAA compliant, and are thus reckless with patient data.

According to Adam Greene, a partner in the Washington, D.C., office of Davis Wright Tremaine, some larger healthcare organizations have employed hundreds and in some cases as many as a thousand business associates.

In one sense, by including the business associates, the civil rights office is simply catching up with privacy and security rules it issued three years ago. But the OCR announcement also means that enforcement of these more stringent rules could give healthcare organizations more leverage to get stronger agreements with their contractors.

Upgrades to the HIPAA privacy and security rules in the health IT provisions of the American Recovery and Reinvestment Act of 2009 puts BAs on an equal legal footing with HIPAA covered entities – hospitals, physician practices, health plans and claims clearinghouses. That means vendors that violate the rules are subject to civil monetary penalties of up to $1.5 million a year.

The first phase of audits will involve OCR staff and special hires conducting “desk audits,” not requiring agents to go into the field. Covered entities will be asked to provide basic information about their business associates. “It won't be a complete list,” Green said, but it will provide a starting point for identifying business associates to audit.

Just as business associates now share equal legal liability under HIPAA, they've long shared culpability for data breaches, according to federal records.

That said, how can business associates “survive” a HIPAA audit? According to Hayes Management Consulting, there are six key steps to getting through a HIPAA audit successfully.

First, prepare and practice. Before the OCR audit, conduct an internal round of HIPAA compliance audits and risk assessment. To impress OCR, show proof of conducting such assessments on a regular schedule.

Second, evaluate your privacy and security policies. Perform an in depth assessment of your current privacy and security policies and procedures, or active HIPAA compliance program. Similarly, designate a HIPAA Compliance Officer. HIPAA privacy compliance should focus on PHI access, administrative requirements, uses and disclosures. For security compliance, concentrate on administrative physical and technical safeguards.

Third, perform an internal review of electronic files. Encrypt all electronic files, especially patient sensitive data. Verify and validate which electronic files are being encrypted, and which are not. Do this before any external audits are done.

Fourth, assess organization compliance risks. OCR Phase 1 HIPAA Audits revealed two-thirds of organizations could not demonstrate they were performing complete and accurate HIPAA security risk assessments. To ensure that your organization can meet compliance standards, start by inventorying all of the organization’s systems that handle ePHI, and develop some remediation action plans.

Fifth, compile a list of all vendors and business associates. OCR will ask to see all business associates that have access to your organization’s PHI. Include anyone that works behind the scenes with your hospitals, health plans or providers. For example, such associates include contractors, consultants, software vendors, and data storage companies.  

Sixth and finally, evaluate, evaluate, evaluate. Inspect your HIPAA policies and procedures, most importantly employee access, new hire employee training, ePHI policies, eFILE sharing procedures, faxing, emailing, notice of privacy policies, data breach mitigation, disaster recovery, data backup and be sure to update policies and procedures regularly.  

The original article by Joseph Conn can be found at the following address: http://www.modernhealthcare.com/article/20160323/NEWS/160329942?utm_source=modernhealthcare&utm_medium=email&utm_content=20160323-NEWS-160329942&utm_campaign=am

Surprise Medical Bills Addressed in 2017 HHS Budget

For the uninsured, seeking medical treatment almost always results in a costly medical bill. But, over the past few years, it's become clear that even if you have health insurance in the U.S., you're still susceptible to receive pricey medical bills—many of which can be a complete surprise.

For the insured, an expensive bill is expected when one visits an out-of-network physician. Lately, bills have been popping up in the least expected places. For these patients, charges roll in even though they did research and, presumably, went to an in-network hospital or saw in-network physicians.

President Obama’s 2017 budget for HHS takes action to eliminate these surprise bills.

Embedded within the 2017 budget is a provision to “eliminate surprise out-of-network healthcare charges for privately insured patients.” The administration would try to solve the problem by requiring physicians who “regularly provide services in hospitals” to accept in-network rates, even if they aren't in the insurer's network. Hospitals would also have to “take reasonable steps” to ensure patients see in-network physicians.

Usually, patients face unexpected charges because of large payment disagreements between insurance companies and physicians. Physicians will refuse to participate in an insurer's network if they believe arguing insurers are low-balling them. But, insurers say doctors ask for unreasonably high rates. Hospitals and patients are often left in the middle. Under President Obama's 2017 budget, patients would be removed from the disputes, and physicians would have to cave to the insurers' rates.

However, American Medical Association President Dr. Steven Stack said last year that he didn't like any approach that would “coerce physicians through yet another way to not receive sufficient payment,” indicated that the budget proposal won’t be popular with physicians.

President Obama's budget for 2017 stands pretty much no chance of moving through Congress, but it does reveal the president's final priorities for his own and future administrations.

The original article by Bob Herman can be found at the following address: http://www.modernhealthcare.com/article/20160211/BLOG/160219975?utm_source=modernhealthcare&utm_medium=email&utm_content=20160211-BLOG-160219975&utm_campaign=am

CMS State Innovation Models Grants Awarded

The HHS announced Tuesday that a significant portion of the $665 million in available grants was awarded to health IT programs.The District of Columbia, 28 states, and three territories received grant money to fund local experiments in improving health care. The money is the second round of grants coming from CMS's State Innovation Models initiative. A breakdown of the awarded grants can be found at the initiative website. 

Politico reports that the selected health IT projects largely focus on improving data in electronic health records and systems. Part of the $100 million New York will receive will go toward better health IT, "including greatly enhanced capacities to exchange clinical data and an all-payer database." Overall, the state is looking to create a stronger, more integrated primary care workforce and delivery system. Colorado will receive up to $65 million over four years to integrate physical and behavioral health care in primary care and community mental health center. Part of the money will expand IT efforts including telehealth. The money will also assist in integrating public health, behavioral health and primary care sectors. Data analytics is a factor in the plans for Michigan and Iowa.

ICD-10 Transition Date Finalized for October 2015

The Centers for Medicare and Medicaid Services announced last week that the final deadline to comply with the ICD-10 implementation requirement is October 1, 2015. The tenth edition of the International Classification of Diseases is widely viewed as a significant change in the way claims that are submitted to Medicare and private insurance payers are classified. 

These changes enable providers to coordinate patients care over distance and time, improve the accuracy of patient records with more detailed patient history coding, and reduce fraudulent claims. CMS also believes that the ICD-10's granular classifications will improve the data and analytics related to public health research, surveillance, and reporting. The more specific classifications found in ICD-10 represent, in part, the evolution of diagnosis and the modern developments in medicine and medical technology used to treat patients. 

CMS released an online resource designed to help providers in small practices make a timely transition to ICD-10. The "Road to 10" is an online resource available here. The  Road to 10 breaks allows providers to select a profile based on their expertise that is specifically tailored to each speciality's common codes, clinical documentation procedures, and clinical scenarios. Additionally, the Road to 10 gives users the opportunity to create an ICD implementation action plan specifically suited to the needs of their small practices. 

Healthcare Enrollment May Be Stifled By Federal Website Maintenance

Consumers attempting to complete health insurance applications through online healthcare exchanges before the February 15th deadline may be frustrated this weekend. February 15 is the deadline to apply for coverage that will begin on March 1. 

The Department of Health and Human Services (HHS) announced Monday that heavy maintenance to the Social Security Administration's website (SS) will result in the inability of HealthCare.gov to verify Social Security numbers and other personal details required for coverage under the Affordable Care Act. 

The maintenance is expected to begin Saturday, February 15 at 3p.m. and end Tuesday, February 18 at 5a.m. Those consumers that are affected by the website maintenance should phone the federal call center on Tuesday to arrange for coverage March 1. The number to the federal call center is 1-800-318-2596.

Congressional Gridlock Stalls Hopes for National Patient Identifier and Meaningful Use Stage 2 Delay

Many in the health IT field believe that implementing a national patient identifier and a deadline extension for stage 2 meaningful use requirements would ensure a more cohesive operation of patient access and identification systems and increase patient safety.  Both of these problems require congressional action to solve, but with a Congress that fails to pass even the most basic pieces of legislation and appropriations it is unlikely there will be any legislation addressing these issues in the year to come.

National Patient Identifier

A national patient identifier would go far to improve patient safety by improving the accuracy with which patients are matched with their medical records.  Ideally, a national patient identifier would be a unique number for each patient with a two-digit checksum at the end of the number. In practice this would allow a patient’s data to move completely through multiple data systems without comingling with other patients’ records that may contain similar names, addresses and other identifying factors.

However, the likelihood of legislation requiring a national patient identifier is very slim after Congress voted to overturn a HIPAA provision that would have required a patient identifier in 1998. Congressional opposition focused on privacy concerns and the capability providers have to identify patients with several different identifying factors. Former national health IT coordinator Farzad Mostashari, M.D., explained that he believed the odds were very low for a national patient identifier and that it would require the industry proving they are unable to keep patients straight by cross-checking a patient’s identity with other identifying factors available to the provider.

Meaningful Use Incentive Program

The electronic health records meaningful use incentive program was created to advance the adoption of health information technology nationwide. Beginning in 2014 eligible hospitals and professionals will have to comply with stage 2 of the regulatory standards in order to receive corresponding incentive payments. 

Senator Alexander and Senator Thune, along with 15 other Senators, wrote a letter to HHS Secretary Kathleen Sebelius requesting more time for implementation of stage 2 standards. Their letter stated, “If the goal is to improve care by achieving broad and meaningful utilization of EHRs, providing sufficient time to ensure a safe, orderly transition through Stage 2 is critical to having stakeholder buy-in, a necessary component of long-term success.

However, former national health IT coordinator Farzad Mostashari, M.D., does not think that this extension will be granted.  Without speaking to the merit of the request, Mostashari recently told a group gathered at the CHIME Fall Forum that the extension would take up to a year to approve, and the extension requested is a year. The overlap would through U.S. health IT into “total chaos” due to the uncertainty during the rulemaking process to amend the schedule.

 Resources

Don Fluckinger’s article, “Shut down thoughts of a national patient identifier,stage 2 extension,” 

A podcast discussing the benefits of a national patient identifier can be found here. 

Alexander-Thune Letter from 17 Senators to Secretary Kathleen Sebelius requesting a meaningful use stage 2 delay can be found here. 

Enrollment of Young Adults in Healthcare Exchanges

The Obama Administration announced Monday that young adults comprise nearly a quarter of the health plan enrollees. The Administration hopes to reach the goal that 38-40% of enrolled individuals will be young adults by the end of the enrollment period on March 31. 

The enrollment of 18-35 year olds is seen as crucial to the success of the healthcare plans. Politico reports that without young adult enrollment healthcare premiums could rise considerably and the healthcare market could become unstable. 

Despite doubts from some insurance companies, director of the Office of Health Reform of HHS, Mike Hash, expressed confidence that the newest numbers would result in "an appropriate mix" of young, healthy registrants and those with more expensive healthcare needs. Another senior official explained that a Kaiser Family Foundation report showed that only a quarter of the enrollees needed to be young adults to avoid the so-called death spiral to unstable healthcare markets. 

Study Finds Copy-Paste Function in Electronic Health Records Leads to Medicare Fraud

A report released by the Department of Health and Human Services (HHS) Wednesday outlined more flaws in the government oversight of adopting electronic health records. This is the second report issued by the HHS that specifically criticizes the CMS oversight of the federal program created to convert paper patient records to an electronic format. 

The report specifically points to the lack of clear "program integrity practices" to provide guidelines on the proper use of copy-paste, or cloning function, in updating electronic health records and recording new office visits and treatments. Doctors and hospitals use the feature to reduce the time it takes to input patient data. Many say that without this function the health practitioners would drown in the patient input process, to the detriment of the treatment quality for their patients. 

However, the report finds that widespread indiscriminate use of the cloning function may lead to the input of more extensive treatment and tests than actually occurred. This, in turn, leads to doctors overcharging Medicare for care that was not actually provided. There is also concern that without proper oversight this type of fraud may grow exponentially in the coming years with the implementation of electronic health records nationwide. 

The report issued by the Office of the Inspector General for the Health and Human Services Depart is available here.

Media coverage of the report is available at:

• New York Times, "Report Finds More Flaws in Digitizing Patient Files." 

Health "Datapalooza" Announced

As part of the HHS Health Data Initiative, The Health Datapalooza will be held this year on June 5th and 6th in Washington, DC. This event is being put on by the Health Data Consortium, a group of organizations that joined together with the aims of promoting new data, making existing data more accessible by consumers and developers, and encouraging the development of products and services that improve health and health care. The Department of Health and Human Services (HHS) is a member of the Consortium.

More information on this event, including how to register to attend or submit an application to present, can be found at hdiforum.org.

The CMS Innovation Center is helping plan one session of this two-day event. An ACO “deep dive” will demonstrate how Accountable Care Organizations can make effective use of claims data through innovative software services and analytics. Surgeon and author Atul Gwande will be leading a discussion between the audience and a diverse set of stakeholders from data analysts to a number of the Pioneer ACOs.

From hdiforum.org:

HDI Forum III: The Health Datapalooza promises to bring together a diverse group of data experts, technology developers, entrepreneurs, policy makers, health care system leaders, CIOs, CTOs, and community advocates to support innovative applications of health and health care data.

The Forum will feature keynote addresses, an Apps Expo, demonstrations of new, cutting-edge apps, and thought-provoking panel discussions. There will also be plenty of time for networking and one-on-one interaction.

Source: CMS News Release

HHS Sponsors Contest for Web App to Identify Local Health Trends

Federal officials are challenging developers to design Web-based applications that use Twitter to track health trends in real time. Health officials may be able to use knowledge of these trends as an early indicator of emerging health issues and a warning of public health emergencies in a community.

The U.S. Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) issued the challenge, a developers’ contest called Now Trending - #Health in My Community. The online challenge runs through June 1, 2012.
Social media trends can be powerful indicators of community health issues. However, current Web-based apps look backward, collating social media data to show how trends developed. The ASPR challenge would create a Web-based app to use social media data as an advance signal of a public health emergency.

“When we looked back at the H1N1 pandemic, we saw that, in some cases, social media trends provided the first clues to flu outbreaks,” said Dr. Nicole Lurie, assistant secretary for preparedness and response and a rear admiral in the U.S. Public Health Service. “Based on that 2009 pandemic experience, local health officials asked for our help in developing a Web-based tool that could make social media monitoring useful as part of the surveillance systems in place now to identify new diseases early.”

With early identification, health officials can respond quickly, including advising people how to protect their health and minimize the spread of the disease. Minimizing the spread of disease could help the community bounce back quickly from an outbreak or a public health emergency – or potentially prevent a public health emergency, such as a pandemic, from occurring.

To win the challenge, the application must be innovative, scalable, dynamic, and user-friendly. The app must use open-source Twitter data to deliver a list automatically of the top five trending illnesses over a 24-hour period in a specified geographic region. The application must be able to send the data to state and local health agencies. These agencies, in turn, can cross-reference the data with traditional biosurveillance systems, build a baseline of trends, determine emerging public health threats, and advise the public on how to protect their health.

The person or team developing the best application will receive $21,000 from ASPR as well as a $1,000 travel stipend to attend an event announcing the winner. In addition, the winner will be invited to present the winning tool at a Fusion Forum, a discussion series sponsored by ASPR’s Fusion Cell for state and local health officials to help identify pioneering ways to move from open source information into use as a public health response. The winning application will be made available to state, territorial, tribal and local health agencies across the nation for use in their communities.

To register to participate in the Now Trending - #Health in My Community Developer Challenge, visit http://challenge.gov/HHS/334-now-trending-health-in-my-community. Upon submission participants must warrant that they are the sole authors and owners of the final product.

ASPR’s Fusion Cell manages the large volumes of disparate internal and external data sources necessary for situational awareness, rapid decision support, and ultimately the discovery of new indicators and warnings of events of public health significance. This ensures that decisionmakers are better informed, better prepared, and better able to rapidly respond to protect people’s health during emergencies and save lives.

Visit www.phe.gov to learn more about ASPR, its Fusion Cell and other aspects public health and medical emergency preparedness, response, and recovery.

Source: HHS News Release

Policies Give States Flexibility to Establish Affordable Insurance Exchanges

Health and Human Services Secretary Kathleen Sebelius announced policies to assist states in building Affordable Insurance Exchanges. Starting in 2014, these one-stop marketplaces will allow consumers and small businesses to choose a private health insurance plan and offer the public the same kinds of insurance choices as members of Congress.

The policies released will help states in designing their Exchanges to best meet the needs of their consumers. They offer states substantial flexibility as they design a marketplace that works for their residents.

“These policies give states the flexibility they need to design an Exchange that works for them,” said HHS Secretary Kathleen Sebelius. “These new marketplaces will offer Americans one-stop shopping for health insurance, where insurers will compete for your business. More competition will drive down costs and Exchanges will give individuals and small businesses the same purchasing power big businesses have today.”

The policies provide states with the guidance and certainty they need as they continue to work to build these marketplaces for their residents for operation in 2014. The policies offer guidance about the options on how to structure Exchanges in two key areas:
- Setting standards for establishing Exchanges, setting up a Small Business Health Options Program (SHOP), performing the basic functions of an Exchange, and certifying health plans for participation in the Exchange;
- Establishing a streamlined, web-based system for consumers to apply for and enroll in qualified health plans and insurance affordability programs.

The final rule builds on the flexibility and resources provided by HHS already to build state-based Exchanges. A majority of states have taken significant steps in building Exchanges. Previously, HHS awarded 49 states and the District of Columbia $50 million to begin planning their Exchanges, and as announced recently, 33 states and the District of Columbia have received over $667 million in Establishment Grants to begin building their Exchanges.

The announcement builds on over two years’ worth of work with states, small businesses, consumers, and health insurance plans. The administration examined models of Exchanges; convened numerous meetings and regional listening sessions across the country with stakeholders; and consulted closely with state leaders, consumer advocates, employers and insurers. To finalize the rules announced today, HHS accepted public comment over 75 days to learn from states, consumers, and other stakeholders on how the rules could be improved, and HHS modified the proposals based on feedback from the American people.

For more information, visit:
http://www.healthcare.gov/news/factsheets/2011/07/exchanges07112011a.html

For more information on Exchanges, including fact sheets, visit http://www.healthcare.gov/exchanges.

Source: HHS News Release

HHS settles HIPAA case with BCBST for $1.5 million

Blue Cross Blue Shield of Tennessee (BCBST) has agreed to pay the U.S. Department of Health and Human Services (HHS) $1,500,000 to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules, Leon Rodriguez, Director of the HHS Office for Civil Rights (OCR), announced today. BCBST has also agreed to a corrective action plan to address gaps in its HIPAA compliance program. The enforcement action is the first resulting from a breach report required by the Health Information Technology for Economic and Clinical Health (HITECH) Act Breach Notification Rule.

The investigation followed a notice submitted by BCBST to HHS reporting that 57 unencrypted computer hard drives were stolen from a leased facility in Tennessee. The drives contained the protected health information (PHI) of over 1 million individuals, including member names, social security numbers, diagnosis codes, dates of birth, and health plan identification numbers. OCR’s investigation indicated BCBST failed to implement appropriate administrative safeguards to adequately protect information remaining at the leased facility by not performing the required security evaluation in response to operational changes. In addition, the investigation showed a failure to implement appropriate physical safeguards by not having adequate facility access controls; both of these safeguards are required by the HIPAA Security Rule.

“This settlement sends an important message that OCR expects health plans and health care providers to have in place a carefully designed, delivered, and monitored HIPAA compliance program,” said OCR Director Leon Rodriguez. “The HITECH Breach Notification Rule is an important enforcement tool and OCR will continue to vigorously protect patients’ right to private and secure health information.”

In addition to the $1,500,000 settlement, the agreement requires BCBST to review, revise, and maintain its Privacy and Security policies and procedures, to conduct regular and robust trainings for all BCBST employees covering employee responsibilities under HIPAA, and to perform monitor reviews to ensure BCBST compliance with the corrective action plan.

HHS Office for Civil Rights enforces the HIPAA Privacy and Security Rules. The HIPAA Privacy Rule gives individuals rights over their protected health information and sets rules and limits on who can look at and receive that health information. The HIPAA Security Rule protects health information in electronic form by requiring entities covered by HIPAA to use physical, technical, and administrative safeguards to ensure that electronic protected health information remains private and secure.

The HITECH Breach Notification Rule requires covered entities to report an impermissible use or disclosure of protected health information, or a “breach,” of 500 individuals or more to HHS and the media. Smaller breaches affecting less than 500 individuals must be reported to the secretary on an annual basis.

Individuals who believe that a covered entity has violated their (or someone else’s) health information privacy rights or committed another violation of the HIPAA Privacy or Security

Rule may file a complaint with OCR at: http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html.

The HHS Resolution Agreement can be found at http://www.hhs.gov/ocr/civilrights/activities/agreements/index.html

Additional information about OCR’s enforcement activities can be found at http://www.hhs.gov/ocr/privacy/hipaa/enforcement/examples/index.html.

Source: HHS News Release

Policies Give States More Flexibility to Establish Affordable Insurance Exchanges

Health and Human Services Secretary Kathleen Sebelius announced policies to assist States in building Affordable Insurance Exchanges. Starting in 2014, these one-stop marketplaces will allow consumers and small businesses to choose a private health insurance plan and offer the public the same kinds of insurance choices as members of Congress.

The policies released will help States in designing their Exchanges to best meet the needs of their consumers. They offer States substantial flexibility as they design a marketplace that works for their residents.

“These policies give States the flexibility they need to design an Exchange that works for them,” said HHS Secretary Kathleen Sebelius. “These new marketplaces will offer Americans one-stop shopping for health insurance, where insurers will compete for your business. More competition will drive down costs and Exchanges will give individuals and small businesses the same purchasing power big businesses have today.”

The policies provide States with the guidance and certainty they need as they continue to work to build these marketplaces for their residents for operation in 2014. The policies offer guidance about the options on how to structure Exchanges in two key areas:
-Setting standards for establishing Exchanges, setting up a Small Business Health Options Program (SHOP), performing the basic functions of an Exchange, and certifying health plans for participation in the Exchange;
-Establishing a streamlined, web-based system for consumers to apply for and enroll in qualified health plans and insurance affordability programs.

The final rule builds on the flexibility and resources provided by HHS already to build State-based Exchanges. A majority of States have taken significant steps in building Exchanges. Previously, HHS awarded 49 States and the District of Columbia $50 million to begin planning their Exchanges, and as announced recently, 33 States and the District of Columbia have received over $667 million in Establishment Grants to begin building their Exchanges.

The announcement builds on over two years’ worth of work with States, small businesses, consumers, and health insurance plans. The administration examined models of Exchanges; convened numerous meetings and regional listening sessions across the country with stakeholders; and consulted closely with State leaders, consumer advocates, employers and insurers. To finalize the rules , HHS accepted public comment over 75 days to learn from States, consumers, and other stakeholders on how the rules could be improved, and HHS modified the proposals based on feedback from the American people.

For more information on the announcement, visit:
http://www.healthcare.gov/news/factsheets/2011/07/exchanges07112011a.html
For more information on Exchanges, including fact sheets, visit http://www.healthcare.gov/exchanges.

Source: HHS News Release

AHRQ Releases Patient Safety Organization Tools

The Agency for Healthcare Research and Quality (AHRQ) launched a resource program for Patient Safety Organizations (PSOs) that wish to assist hospitals in reducing unnecessary readmissions. This program is in response to the Affordable Care Act (ACA), which designates PSOs as an entity that can help hospitals with high readmission rates improve their performance, and calls for the Department of Health and Human Services (HHS) to support PSOs in this work.

To obtain additional information about this program, including the provisions in the ACA legislation and available readmissions resources, please go to: http://www.pso.ahrq.gov/readmin/readmin.htm

Source: AHRQ News Release

Study: Consumers Choose High-Value Health Care Providers When Given Good Cost, Quality Info

When asked to choose a health care provider based only on cost, consumers choose the more expensive option, according to a new study funded by HHS' Agency for Healthcare Research and Quality (AHRQ) that appears in the March issue of Health Affairs.

The study found that consumers equate cost with quality and worry that lower cost means lower quality care. But higher costs may indicate unnecessary services or inefficiencies, so cost information alone does not help consumers get the best value for their health care dollar, according to the study.

The study, entitled "An Experiment Shows That a Well-Designed Report on Costs and Quality Can Help Consumers Choose High-Value Health Care," found that when consumers were shown the right mix of cost and quality information, they were better able to choose high-value health care providers—defined as those who deliver high-quality care at a lower cost.

Health care consumers want to visit high-quality doctors and hospitals, and many public report cards are available to help them compare providers. However, few report cards include information on cost, and there has been little scientific evidence to guide the presentation of that information to help consumers choose high value providers.

A team of researchers, led by Judith H. Hibbard, Dr. P.H., at the University of Oregon in Eugene, studied 1,400 employees in a randomized experiment to find out how they responded to different presentations of quality and cost information. When providers were clearly identified as high quality, cost had less influence on consumers' decisions and consumers were more likely to choose a provider with lower cost but better quality than a high-cost provider.

"This study has important implications for the more than 150 public reports on physician and hospital care," said AHRQ Director Carolyn M. Clancy, M.D. "It's not simply a question of providing information on cost, but providing it in a way that is integrated with quality scores."

The study explored a number of ways to present cost and quality information effectively, using combinations of symbols such as dollar signs and stars, specific information such as dollar amounts and percentages, and labels such as "appropriate use" or "better." Consumers were more likely to choose high-value providers when presented with strong, unambiguous quality and cost information. In addition, a check mark indicating a "high-value" provider, along with the cost and quality information, also helped consumers use the information to make high-value choices. Given strong quality signals, consumers were also more confident in their choices.

The study's findings have implications for the design of public report cards that offer consumers information on the quality and cost of health care providers. Although report producers have been adopting strategies to help consumers process and use comparative information on quality and cost, many reporting websites still use overly technical information or present other barriers to easy comprehension, according to the study.

For additional AHRQ information about public reporting, please visit http://www.ahrq.gov/path/publicreporting.htm.

Source: AHRQ News Release

NeHC Releases 2012 Stakeholder Survey Results

National eHealth Collaborative (NeHC) released the results of the 2012 NeHC Stakeholder Survey, featuring responses related to health information exchange, consumer engagement and other NeHC programs. NeHC previewed the results at HIMSS12 during its stakeholder meet-up and other strategic meetings.

Coming on the heels of the release of the proposed rule for meaningful use Stage 2, survey results provide insights into perceptions of stakeholders related to barriers to health information exchange (HIE) and the importance of consumer engagement to transforming healthcare, which relate to some of the core measures that physicians and hospitals must meet in order to be eligible for Stage 2 meaningful use incentives. Stakeholders believe that the most important benefits of HIE include care coordination, ensuring that patients and providers have the right information available when needed to support patient care, and improving quality and efficiency. In addition, stakeholders believe that consumer engagement will be very important or important to transforming healthcare and achieving better outcomes.

“It is both interesting and enlightening to understand what stakeholders are thinking related to core strategic priorities for NeHC including education, HIE, and consumer engagement,” said NeHC CEO Kate Berry. “This type of information can help inform our programs to ensure we emphasize the areas of greatest need to encourage progress toward widespread deployment of HIT and HIE to improve patient care.”

Highlights from the survey are included below:
“What are the most important benefits of health information exchange?” (Respondents were asked to select three)
73% - Better care coordination
65% - Providers and patients have the right information available when needed
39% - Improved efficiency
37% - Improved quality

“What are the biggest challenges to achieving widespread health information exchange?” (Respondents were asked to select three)
61% - Funding and sustainability
53% - Interoperability standards
46% - Provider adoption
46% - Disparate electronic medical record systems
34% - Privacy and security

“How important is patient/consumer engagement to transforming healthcare?”
95% - Very important or Important
5% - Somewhat important

“What Health IT topics are of greatest interest to you?”(Respondents were asked to select all that apply)
60% - Interoperability standards
57% - Meaningful use
51% - Examples of HIE
49% - Health IT policy updates
49% - Healthcare reform
44% - Privacy and security

For a full reporting of the top survey results click here.

NeHC conducted the survey from February 13-17. The questionnaire was distributed to over 7,000 stakeholders with a response rate of 3 percent.

NeHC intends to use survey results and additional stakeholder feedback to inform its continued work with HIE, consumer engagement through the Consumer Consortium on eHealth, and with planning future NeHC University education programs.

Source: NeHC News Release

AHRQ Quality Indicators Toolkit for Hospitals

The Agency for Healthcare Research and Quality (AHRQ) has developed an array of health care decision making and research tools that can be used by program managers, researchers, and others at the Federal, State and local levels. The Quality Indicators (QIs) are measures of health care quality that make use of readily available hospital inpatient administrative data. The current AHRQ QI modules expand HCUP QIs. The QIs can be used to highlight potential quality concerns, identify areas that need further study and investigation, and track changes over time.

In response to high demand for a recent Webinar about the AHRQ Quality IndicatorsTM Toolkit for Hospitals, AHRQ is repeating this popular event. Participants will hear live presentations about the toolkit from its developers and learn from a quality expert at a hospital that tested it.

The toolkit is a free resource to guide hospitals through the process of using the AHRQ Inpatient Quality Indicators (IQIs) and Patient Safety Indicators (PSIs) to improve care.

Webinar information:
Date: Tuesday, March 13
Time: 3:00-4:30 pm Eastern Standard Time
Register at: http://meet63385651.adobeconnect.com/hospitaltoolkitregistration2/event/event_info.html
(Note: If you registered for the first Webinar but could not participate, you can register for the repeat Webinar by simply entering your email address and password.)

The Webinar will cover:
-The purpose of the toolkit.
-How it was developed.
-How it is organized for easy use.
-How a hospital has used it to assess performance on the indicators, identify priorities, and implement changes to improve quality and safety.

Download the AHRQ Quality IndicatorsTM Toolkit for Hospitals at: http://www.ahrq.gov/qual/qitoolkit

More information on the AHRQ Quality Indicators is available at: http://www.qualityindicators.ahrq.gov/

WEDI’s Survey on ICD-10 Industry Progress Now Open

The Workgroup for Electronic Data Interchange (WEDI) is conducting its latest Industry Progress Survey on ICD-10. Information from this survey will be used to inform WEDI, CMS, and other organizations on the progress of ICD-10 implementation. This brief survey will also assist in planning necessary programs and actions to assist the industry in transitioning to ICD-10.

To gather the most complete picture of progress within the industry, this survey is open to all organizations affected by ICD-10 such as vendors, health plans, providers, and payers. The survey is open to both WEDI members and non-members.

Responses to this survey will be gathered online. WEDI asks that participants only submit one survey per organization. The survey will close on Wednesday, February 29, 2012. Please direct any questions to Ann Marie Railing at WEDI at 703-391-2718 or amrailing@wedi.org.

Please visit the ICD-10 website for the latest news and resources.

HHS previously announced a delay in ICD-10 implementation.

Source: HHS News Release

HHS Announces New Assistance to States for Innovation Projects

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced more assistance to states as it implements three new provisions of the Affordable Care Act. The announcement gives states help by:
-Providing a new round of Affordable Insurance Exchange Establishment Grants, totaling $229 million to 10 states, to help states build new health insurance marketplaces;
- Promoting transparency and meaningful public input into the Medicaid demonstration process, and streamlining the federal-state consideration process as states test new models of care.

“We’re taking important actions that will give states more resources and more flexibility, and ensure transparency thanks to the Affordable Care Act,” said Secretary Sebelius. “All Americans will have access to quality, affordable health care once the Affordable Care Act is fully implemented, and today’s steps are important measures that ensure that States have the help they need to administer their Medicaid programs and oversee their insurance markets while assuring meaningful input for consumers and beneficiaries.”

Thanks to the Affordable Care Act, starting in 2014 Americans will have improved health coverage. Americans who do not have health care through their employer will be able to buy insurance from qualified health plans directly in an Affordable Insurance Exchange and may receive tax credits to help make coverage more affordable. In addition, all individuals under 65 years of age with incomes below 133 percent of the federal poverty level ($14,500 for an individual and $29,700 for a family of four in 2011) will be eligible for Medicaid. Today’s announcements will help States make this transition by giving more assistance to States as they make improvements to their Medicaid programs and insurance markets.

“As a former state health official, I know how important it is to have the right resources to ensure the health and well-being of our residents,” said Marilyn Tavenner, acting administrator of the Centers for Medicare & Medicaid Services (CMS). “These announcements are good news for states and good news for millions of Americans who will enjoy better health care as the Affordable Care Act is fully implemented.”

HHS is providing more resources to States to help them build their open health insurance marketplaces known as Exchanges. HHS announced the award of $229 million in Affordable Insurance Exchange grants to 10 states to help them create Exchanges, giving these states more flexibility and resources to implement the Affordable Care Act. The health care reform law gives states the freedom to design Affordable Insurance Exchanges – one-stop marketplaces where consumers will be able to choose a private qualified health plan that fits their health needs and will have the same kinds of insurance choices as members of Congress. The awards bring to 34 (including the District of Columbia) the number of states that are making significant progress in creating Affordable Insurance Exchanges. States receiving funding today include: Arkansas, Colorado, Kentucky, Massachusetts, Minnesota, Nevada, New Jersey, New York, Pennsylvania, and Tennessee.

More information on the Affordable Insurance Exchanges can be found here: http://www.healthcare.gov/news/factsheets/2011/05/exchanges05232011a.html

More Transparency
The Affordable Care Act requires transparency and meaningful public input in the development, review, and approval (or renewal) of Medicaid and CHIP demonstrations. These demonstrations allow States to undertake experimental, pilot, or demonstration projects, to run all or parts of their Medicaid programs in ways that would not otherwise be consistent with federal rules, and can have significant implications for beneficiaries, providers, and states. The final rule ensures transparency at each stage of the demonstration development and review process without impeding the timely submission and review of demonstration applications, ensuring public input while supporting ongoing innovation. Transparency and public input help to ensure that as these changes are being proposed at the state level and reviewed at the federal level, stakeholders have an opportunity to inform the decision-making process.

For more information, please visit: http://www.cms.gov/apps/media/fact_sheets.asp

More Flexibility
HHS along with the Department of Treasury finalized a rule providing more flexibility to States to find the health care solutions that work best for them. The Affordable Care Act gives states the option to receive a State Innovation Waiver so they may pursue their own innovative strategies to ensure their residents have access to high quality, affordable health insurance. Under the law, State Innovation Waivers are available in 2017, and today’s final rules provide detail how States can work with HHS to ensure their residents have the protections provided in the Affordable Care Act and access to innovative State approaches.

In addition, states will have more flexibility to apply for the Exchange Establishment Grants under an amended Funding Opportunity Announcement with additional application opportunities due out later this spring.

More information on the State Innovation Waivers can be found here: http://www.healthcare.gov/news/factsheets/2012/02/state-innovation02222012a.html

Final rules were placed on display at the Federal Register, and may be found at:
https://www.federalregister.gov/public-inspection

Source: HHS News Release

Mobile Devices Security Roundtable Scheduled

Registration is now open for a free Health & Humans Services roundtable on Mobile Security Devices taking place on Friday, March 16, 2012, 8:30 a.m. – 12:30 p.m. EDT at the Hubert H. Humphrey Building, U.S. Department of Health and Human Services – Great Hall,
200 Independence Avenue, S.W., Washington, DC.

The program may also be viewed via webcast.

The Roundtable will include three panels comprised of federal agency representatives, practicing providers, and representatives of research, provider and industry organizations. The event will be an interactive discussion with moderators encouraging interaction between the panelists and the audience. Questions will be accepted in person, through email, and via Twitter.

The Roundtable event is free and open to the public, through in-person or webcast participation, but you need to register online.

For more information or to register, please click here.

Source: HHS News Release