Disparities among states show weaknesses and strengths of the Affordable Care Act

Four largest states have sharp disparities in access to healthcare

 

See LA Times article by Noam N. Levey - http://www.latimes.com/business/la-fi-obamacare-states-disparity-20150410-story.html

 

Californians and New Yorkers have better access to healthcare than Floridians and Texans, according to the study from the Commonwealth Fund, a New York foundation that studies health systems domestically and around the world.

 

The data may reveal the strengths and weaknesses of the Affordable Care Act, or at least the pathways the law affords the states.  The suggestion is that access to medical care and perhaps even ability to pay medical bills is affected by whether a state has expanded insurance coverage under the law.

 

·         Residents of Florida and Texas, which have resisted expanding insurance coverage through the health law, reported more problems getting needed care than residents of California and New York, which both guarantee coverage to their residents.

 

·         Floridians and Texans were also significantly more likely to struggle with medical bills and to report that they had medical debt.

 

·         More than 40% of residents of Florida and Texas reported that they did not go to the doctor when they were sick, didn't fill a prescription, didn't see a needed specialist or skipped a recommended test or treatment in the previous year.

 

·         The same proportion reported they had been unable to pay a medical bill, had been contacted by a collection agency over a medical bill, had had to change their way of life to pay bills or had medical debt.

 

"Health policy decisions made by state leaders matter," the study's authors conclude, warning: "Coverage gaps are leaving millions uninsured and without access to affordable coverage."

 

Some states have expanded Medicaid with federal aid made available by the law; other states — all led by either Republican governors or legislatures, or both — have turned down the assistance, citing concerns about Medicaid's effectiveness and cost.

 

States that fully implemented the law saw a 4.8 percentage-point improvement in the share of adults with insurance from 2013 to 2014, according to a recent Gallup poll. That was nearly twice the rate of states that have not fully implemented the law.

 

Just 31% of Californians and 30% of New Yorkers reported the same access problems as found in Florida and Texas. Even fewer said they had the same struggles with medical bills.

 

What is the situation in your state?  What are you seeing at registration or the back end of the revenue cycle?

 

Legislation to Remove SSN from Medicare Beneficiary ID cards

A NAHAM member active on our Policy Development and Government Relations Committee send the following -

President Obama has signed a bill<http://www.gpo.gov/fdsys/pkg/BILLS-114hr2enr/pdf/BILLS-114hr2enr.pdf> that provides $320 million in funding to remove Social Security numbers from Medicare beneficiary ID cards within the next four years in an effort to fight identity theft and fraud.

The law calling for removal of Social Security numbers from Medicare beneficiary cards comes after several years of recommendations for such a move by government watchdog agencies, including the Government Accountability Office.

 

GAO has repeatedly issued reports in recent years recommending eliminating Social Security numbers from Medicare cards to help protect individuals from falling victim to ID theft and fraud, ranging from healthcare-related fraud to thieves opening credit card accounts using those IDs.

Find the article SSNs to Disappear from Medicare Cards here:  http://www.healthcareinfosecurity.com/ssns-to-disappear-from-medicare-cards-a-8127?rf=2015-04-22-eh&mkt_tok=3RkMMJWWfF9wsRonv6rLZKXonjHpfsX57%2BUqXK6g38431UFwdcjKPmjr1YoBSdQ%2FcOedCQkZHblFnVwNS62vRKkNqKYK

 

Data Security versus HIT Interoperabilty

The HealthLeaders Media article, "EHR Data 'Blocking' Hobbles HIT, Says ONC", points out a tension between data security concerns and health information technology interoperability.

Find the article here: John Commins, for HealthLeaders Media , April 13, 2015 - http://www.healthleadersmedia.com/print/TEC-315231/EHR-Data-Blocking-Hobbles-HIT-Says-ONC

The byline reads: "Technology vendors, hospitals, and health systems restrict data access under the guise of security and confidentiality, but it can be challenging to identify and differentiate information-blocking from more benign impediments"

Highlighting the issue is a report by the Office of the National Coordinator for Health Information Technology.

Find the report here: http://healthit.gov/sites/default/files/reports/info_blocking_040915.pdf.

Part of the problem derives from concerns about competition.  The HealthLeaders Media reports that "The federal government's $28 billion investment in health information technology interoperability is undermined by vendors and providers who don't want to share data with perceived competitors."

The ONC report says that "information blocking" is a problem that will likely get worse.  Technology itself is an enabler, and the ONC finds -

"However, based on the evidence and knowledge available, it is apparent that some healthcare providers and health IT developers are knowingly interfering with the exchange or use of electronic health information in ways that limit its availability and use to improve health and health care."

Here is one source of the problem according to the ONC finding -

"Some EHR developers allegedly charge a substantial per-transaction fee each time a user sends, receives, or searches for (or "queries") a patient's electronic health information. EHR developers may also charge comparatively high prices to establish certain common types of interfaces—such as connections to local labs and hospitals. Many providers also complain about the costs of extracting data from their EHR systems for their own use or to move to a different EHR technology."

But the report finds providers can also share some of the blame, or a misunderstanding by providers of what federal and state law requires of them -

"Such constraints are not information blocking insofar as they are consistent with the requirements and policies established by federal and state law that protect patients' electronic health information," ONC said. "But it has been reported to ONC that privacy and security laws are cited in circumstances in which they do not in fact impose restrictions."

Example: A provider cites HIPPA privacy rules to deny the exchange of electronic protected health information for treatment purposes, even though HIPPA specifically permits such disclosures.

Of particular interest is the question raised: Who Owns the Data?

Health records belong to the patient.  So says Chris Van Gorder, president/CEO of San Diego-based Scripps Health.

And Consider the power of that ownership in this New York Times article: The Healing Power of Your Own Medical Records: http://www.nytimes.com/2015/04/01/technology/the-healing-power-of-your-own-medical-data.html?_r=0

As reported by HealthLeaders Media -

"The only legitimate concern providers have with patient data exchanges is confidentiality, Van Gorder says, because providers are liable for any release of confidential patient data to anyone other than the patient."

What do you think?  When is data blocking legitimate and not contrary to the interests of the patient?  When does data blocking exceed legitimate legal and business concerns and become an impediment to the patient?

Theft of paper and electronic health data exceeds computer hacking

6 in 10 Health Data Breaches Due to 'Criminal Activity' - Researchers discover that in the majority of incidents, the security and privacy of patient health data is compromised by the theft of paper or electronic medical records rather than computer system hacking.

This from the HealthLeaders Media article here:  Cheryl Clark, for HealthLeaders Media , April 15, 2015 - http://www.healthleadersmedia.com/print/TEC-315329/6-in-10-Health-Data-Breaches-Due-to-Criminal-Activity.

Find the full report in the Journal of the American Medical Association here - 

http://jama.jamanetwork.com/article.aspx?articleid=2247135

HealthLeaders Media reports -

"Theft, illegal hacking, and other breaches of protected health information have compromised 29 million medical records in 949 incidents between 2010 and 2013, spelling out a crying need for better data security", according to a report published in JAMA."

According to the study's author, "theft of paper or electronic records accounted for the majority" of the incidents. "Protecting the security and privacy of patient data needs to be a priority in many different venues, and with all types of patient data, including paper records."

Five states, California, Texas, Florida, New York, and Illinois, accounted for 34% of all reported breaches.

Of the 949 incidents encompassed within the study, 273 involved an external vendor, such as a healthcare system partner, an insurer, or a business that uses the data for analytics or quality reporting.

Associated with the JAMA study is an editorial coauthored by David Blumenthal, MD, of the Commonwealth Fund and former National Coordinator for the Office of the National Coordinator, that charges that policy makers are partly to blame.

Find the editorial, also by Deven McGraw here -

http://jama.jamanetwork.com/article.aspx?articleid=2247128

"They should create stronger penalties and incentives for organizations to be more careful with the data, [Blumenthal] says, acknowledging that it's a difficult task because they're "still trying to influence providers and organizations to understand that we live in a different age."

According to Blumenthal and McGraw, more than 80% of the data breaches reported by Liu result from a "mundane and correctible problem: the failure of covered entities to observe what might be called good data hygiene" such as:

·         Failure to encrypt their own data

·         Allowing storage of patients' personal health information on employees' personal devices

·         Not requiring sound practices to authenticate authorized users

Complicating the solution is the lack of clarity provided by federal rules on data protection,

Health Insurance Portability and Accountability (HIPAA) and the Health Information Technology for Economic and Clinical Health Acts (HITECH), and the desire of the health care providers and IT ventures not to be further regulated. 

Read the entire article.  It further highlights Blumenthal and McGraw and suggests that if the federal government doesn't step in, various states will.  It ends with a Blumenthal prediction - 

"But I suspect we'll have some scandals and events that outrage people before this happens. That's regrettable, but it's the way our democracy works. And in the meantime, you can pretty much anticipate that due to inattention and lack of care, and to a lesser extent hacking, there will be large data breaches of increasing size and concern."

 

Patient Identification Called "Paramount" to the formation of an Interoperable Learning Health System.

So say the College of Healthcare Information Management Executives (CHIME) and the Association of Medical Directors of Information Systems (AMDIS).

A joint statement sent by CHIME and the Association of Medical Directors of Information Systems to the ONC is asking that patient identifiers be included in the interoperability draft roadmap. Earlier this year The Office of the National Coordinator for Health IT released for public comment its shared nationwide roadmap for interoperability. Find the CHIME/AMDIS statement.   "Without a standard patient identifier, the creation of a longitudinal care record, composed of data and created through disparate systems, geographies and chronology is simply not feasible," the statement said. The American Hospital Association has asked the federal government to at least allocate funding to study consumer views about the patient identification system.     You can read more at FierceHealthIT.  In the same vein, the American Hospital Association (AHA) has called the need for a standard patient identifier urgent, notwithstanding the congressional law now on the books for over a decade that prevents the U.S. Department of Health and Human Services from creating a unique patient identifier. The main themes of the CHIME/AMDIS statement are summarized at the beginning of their submission:   1. Patient identification is paramount if we are to make any progress toward an interoperable Learning Health System (LHS).  Foundational to the vision espoused by the Roadmap is the ability of providers to accurately and consistently match patients with their data. A national approach to patient identification is prerequisite for interoperability and the lack of a standard patient identifier only serves to aggravate our industry’s technical challenges. Without a standard patient identifier, the creation of a longitudinal care record, composed of data created through disparate systems, geographies and chronology is simply not feasible. Future drafts of this roadmap must enable development of a standard patient identifier. 2. CHIME and AMDIS are supportive of the process established by this Roadmap to prioritize standards across several important domains. We also support the concept of a common clinical data set that adheres to clear, enforceable national standards. 3. We caution against being overly ambitious with the development of a nationwide governance mechanism and encourage focused prioritization through ingrained collaboration among private and public sector stakeholders. In our view, interoperability in the service of high quality, safe patient care should remain the principal focus of the near-term. 4. CHIME and AMDIS support the need for additional testing tools, including scenario-based testing and exception handling, and we agree that their development and use are critical actions for stakeholder assurance that HIT is interoperable. We also underscore the need to have a post-certification surveillance program steeped in assuring conformance to requirements established by certification. 5. CHIME and AMDIS also encourage policymakers to think more critically about how to recognize the vital role that patients and their family play as a point of integration of disparate health information. Patients can be powerful mediators of their own medical records and care plans towards the synchronization of services delivered across different settings of care. We believe it is an operational necessity for policymakers to enable patients to be conduits of information towards better, safer care delivery.   Good food for thought for all of us, including policy makers.  What do you think?

NAHAM's Patient Identity Integrity Toolkit

Did you miss the April 3 NAHAM webinar that rolled out the new NAHAM Patient Identity Integrity Toolkit? 

If so, go here for a replay:

https://attendee.gotowebinar.com/recording/7896428993548448002

This webinar, just under an hour, with Q&A, highlights the main features and elements of the toolkit.  These include question sets and checklists to help focus your Patient Access Staff, sample patient identity policies and procedures, such as newborn naming conventions, and numerous journal articles that highlight the importance of patient identity integrity strategies in our organizations. 

If you are a NAHAM member, you may also access the PII Toolkit, as well as NAHAM's Joint Commission Survey Toolkit and NAHAM's CMS Survey Toolkit.

Start here to explore the PII Toolkit: http://www.naham.org/?page=GovernmentRelations.

Special thanks to the NAHAM Public Policy Development and Government Relations Committee for developing the PII Toolkit!  And special thanks to Committee Chair Michael Sciarabba, MPH, CHAM, and Committee members Nancy Farrington, CHAM, FHAM, and Carmen Voelz, FHAM, CHAM, FHFMA for participating as webinar presenters!

For even more exposure to NAHAM's thought leadership on patient identity integrity, plan to attend the preconference Patient Identity Symposium at NAHAM's 41 Annual Education Conference & Exposition, at the J.W. Marriott, Indianapolis, Indiana, April 19 to 22.  The preconference Patient Identity Symposium runs from 2:45 to 5:00 on Sunday, April 19.  For more information go here: http://www.naham.org/?page=PreCon. 

The full conference schedule may be found here: http://www.naham.org/?page=Conference_Schedule and here: https://naham.site-ym.com/?ConferenceProgram.

To register, start here: https://naham.site-ym.com/?page=Conference15.