Showing posts with label ICD-10. Show all posts
Showing posts with label ICD-10. Show all posts

Monday, November 24, 2014

Net Neutrality Impacts Healthcare IT



Modern Healthcare's  Darius Tahir explains why healthcare providers should be paying attention to net neutrality in the following article:


The techie term “net neutrality” likely isn't in the daily lexicon used by most senior healthcare executives. But it should be, and soon, argue those in healthcare technology who have been following the topic.

The wireless telecommunications industry's trade group, CTIA, for example, has been circulating a letter to healthcare organizations, asking their support to oppose regulation that would ensure continued net neutrality. But others argue healthcare benefits from net neutrality and should be lobbying for its continuance via a new Federal Communications Commission mandate.

Net neutrality means everyone sending data is treated the same by carriers like Verizon and others; no one can pay or be charged more for faster transmission speeds and none can be barred from sending data. The tool that net neutrality advocates want to use—Title II of the FCC’s authorization act—would essentially make internet traffic into a public utility.

The FCC is expected to rule either by year-end or early next year.

The debate on net neutrality has intensified as the amount of data being transmitted in videos and other usages has increased, leading some to argue that too much traffic is crossing a too-small network, slowing down performance.

Telehealth and electronic record data exchange are the two primary areas of healthcare that would suffer were internet service providers allowed to charge higher prices for faster transmission speeds, say those who back net neutrality.

“I don't think people realize how much net neutrality can affect health services,” said Mark Gaynor, an associate professor of health management and policy at St. Louis University and a long-time advocate for net neutrality.

President Barack Obama earlier this month put the spotlight on the issue when he called on the FCC to “implement the strongest possible rules to protect net neutrality.”

But he muddied the debate when it comes to healthcare by saying the rule, “can have clear, monitored exceptions for reasonable network management and for specialized services such as dedicated, mission-critical networks serving a hospital.”

But many critics of a net neutrality rule believe that allowing internet service providers to charge for a “fast lane” or “paid prioritization” would be helpful for innovation. Such pricing would allow data from paying content providers to move more quickly to consumers. Currently, they argue, many networks slow at peak times when everyone wants to view Netflix videos or use other heavy bandwidth applications, like online gaming.

Charging those users more allows for more efficient usage of limited bandwidth, and provides an incentive to internet service providers to build more network infrastructure, which would accommodate more usage down the road. That position is partially supported by a July 2014 draft paper produced by two FCC officials, which use a model to show that overall market efficiency is improved if broadband providers are allowed to charge for fast lanes.

Billionaire internet entrepreneur Mark Cuban argued, in a post on his personal blog, that this debate has particular relevance to healthcare.

Hypothetically, he said, an emergency surgeon might want to access an internet application for a surgery—and finds that she can't get enough bandwidth for the service to work because “TV and movie services … swamp bandwidth.”

A net neutrality rule, he suggested, encourages that situation for two reasons: because it prevents the investment that would make a bigger network for everyone; and because it prevents high-priority data from jumping to the front of the line.

Cuban also doesn't believe Obama's exception for hospitals—which might put it at the front of the queue—would do much good, writing, “First in line in a traffic jam is still slow and buffering.”

Also opposing neutrality, Verizon has argued in a letter (PDF) to the FCC, that classifying internet traffic under Title II is not legally permissible, and an attempt to do so would invite legal challenges.

The push-and-pull over net neutrality has left the FCC's decision uncertain. The Washington Post reported on Nov. 11 that FCC chair Tom Wheeler had rejected Obama's call to reclassify internet traffic to Title II and he was looking to “split the baby” between internet service provider and net neutrality advocate concerns.

Most opponents of formal net neutrality believe that classifying internet traffic under Title II would result in onerous new requirements for internet providers, as the section was designed for older types of networked communication.

Jot Carpenter, the vice president of government affairs for CTIA, said in an interview that the rules would slow new innovations for wireless providers. The exception proposed by Obama, he said, would introduce confusion for the providers.

In those instances, he said, they would have to approach the FCC and see whether their intended idea—whether a formal partnership with a content provider or an economic arrangement—fell under the hospital exception. Carpenter derided that as the “Mother, may I?” approach to governance, which he argued is bad for innovation.

It's also unclear what might fall under the exception, Kerry McDermott, the vice president of public policy and communications for the Center for Medical Interoperability and a former FCC official said. Which hospital data would apply? Would other healthcare data apply?

Because of that perspective, Carpenter and CTIA have been circulating a letter to healthcare groups arguing that proposed reclassification would increase regulatory uncertainty for mobile health, which they argue is too young to withstand the shock.

While Carpenter declined to name which stakeholder groups had been contacted, a draft copy of the letter obtained by Modern Healthcare includes comments from the Healthcare Information and Management Systems Society. It's not possible to attribute specific comments on the letter to the organization. As of press time, HIMSS had not responded to inquiries regarding the letter. And Carpenter wouldn't discuss when the letter would be officially released, or with which signatories.

But Gaynor and others are anxious about the negative effects of allowing providers to charge higher prices to content providers.

“I don't want to see small companies that are trying to innovate be locked out by bigger companies that have more money and can pay for faster service,” Gaynor said.

Carpenter rejects that argument. “I don't know that there's any evidence to suggest that these startups would be prevented from reaching their customers or gaining critical mass in the marketplace or gaining notice. Paid placement isn't always an evil,” he said, citing Google's early history as an example.

And facing a toll might also hurt efforts to encourage interoperability, Gaynor continued. The healthcare system is hoping to encourage more data sharing, often through Health Information Exchanges. A charge for faster service provides a disincentive to sharing overall, and in particular hurts HIEs – which are non-profit and often struggle to find the proper business model under current conditions.

Innovation might be hurt in another way, Gaynor and his co-authors argued in a July 2013 paper in the Journal of the American Medical Informatics Association. Some internet service providers own or are closely associated with healthcare services; Verizon, for example, has a virtual visits telehealth service, as well as an Apple HealthKit competitor called Converged Health Management. If internet service providers are allowed to discriminate between content providers, they might favor their own, Gaynor writes.

That argument also attacks the FCC officials’ paper, which assumes that broadband internet service providers are not vertically integrated with a content provider.

Steve Kraus, a partner at venture capitalist firm Bessemer Venture Partners, agrees with Gaynor’s argument. “The whole premise of telemedicine would fall down,” he said, if startups suffer lagged performance.

He argued that the net neutrality debate is particularly relevant to healthcare: first, patients and providers often need speed in making care; and second, because the data being moved in healthcare – like medical records, genomics, and video – is often so large.

Kraus's colleagues agree, and are worried about the large telecommunications firms potentially giving themselves an unfair advantage, noting that both Verizon and AT&T have been investing heavily in healthcare.

Virtual visits firm American Well also feels strongly about net neutrality. In an interview, the firm's senior vice president of consumer markets, Mike Putnam, said that he believes paid prioritization would decrease healthcare access and cause the firm to pass on costs to the consumer.

Seth Ginsburg, the president of non-profit Global Healthy Living Foundation, has been advocating for net neutrality in Capitol Hill—and actually retained a lobbyist to do so, the only purely healthcare entity registered in the Senate's lobbying database to list net neutrality as an interest.

Ginsburg’s organization, which helps patients with conditions like rheumatoid arthritis, believes that paying tolls for faster service would harm its relationship with patients. The organization is a nonprofit, and can’t afford to pay a toll; and yet it also communicates time-sensitive information, concerning drug safety for example, to its patients. Allowing a fast lane would put the organization in a bind.

Ginsburg is contemplating complementing his firm's lobbying efforts by adding the voices of his patients, who he said are in all 50 states. He has seen a lack of healthcare interest in the political half of the debate. He suspects it's due to the other large healthcare IT issues on the docket, like meaningful use and the ICD-10 code switch.

Wednesday, August 6, 2014

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. 


Wednesday, May 7, 2014

Can't Miss Event May 13th at NAHAM 40th Annual Conference: NAHAM University Session

NAHAM University

 Hot Topics Discussion & Networking Opportunity


The National Association of Health Access Management 40th Annual Educational Conference & Exposition will be held May 13-16th in Hollywood, Florida. The conference theme this year is "From Admitting to Patient Access: 40 Years of Leadership." Conference attendees will enjoy outstanding educational sessions and invaluable networking opportunities. 

One of the most interactive and informative sessions is held before the conference officially begins on Tuesday, May 13th at noon. Peter Kraus, Business Analyst at Emory Healthcare, will moderate a NAHAM University session that is a popular venue for attendees to meet and discuss hot topics in the industry. 

The event is open to patient access manager participants from both academic and non-academic healthcare facilities. The topics for the 2-hour interactive session are determined by conference registrants. Kraus expects this year's discussion to cover the ICD-10 transition, Meaningful Use implementation, electronic health records, and issues that arise in the admission process. Participants found past discussions very helpful as colleagues offered road-tested solutions to the issues facing participants' individual hospitals.

What Hot Topics are you interested in? What issues is your hospital facing in 2014? 

Let NAHAM hear your topic suggestions for the the NAHAM University 
session in the comments section!



EVENT DETAILS
NAHAM University
Tuesday, May 13
12:00 p.m. – 2:30 p.m.
Separate registration fee applies. Lunch is included and will be provided starting at 11:30 a.m. 



Thursday, April 10, 2014

ICD-10 Deadline Delay Slows Medical Billing Conversion

Medical billing codes are used by doctors, hospitals, and health insurance companies to track each patient procedure and ensure that the doctors are paid. The ICD-9 code has been in place since the 1970s. The ICD-9 was scheduled to be replaced with ICD-10 by October 2014. 

The conversion would add tens of thousands of unique codes to the medical billing structure, an increase to roughly 72,000 codes in ICD-10 from about 4,000 codes in ICD-9. Advocates for ICD-10 argue that the new coding system is necessary to modernize the billing code to capture the variety of medical treatments available now that did not exist in the 19070s.  Additionally, they argue that a more detailed code will allow for more precise medical research and data collection. 

Despite the benefits of moving to an ICD-10 medical billing system, the transition over the last five years has been difficult. In order for the transition to be smooth and successful all parties need to switch to the ICD-10 codes at the same time. Many smaller practices were not able to dedicate the training time and resources to complete the transition by October of this year. 

However, larger facilities, hospitals, and insurance companies with more resources were able to dedicate time and money to implementation measures and preparation. In fact, many have spent millions to train staff on the new ICD-10 billing codes. These facilities were relying on the statements by Health and Human Services representatives made as late as February 2014 that explained the October compliance date was firm. Questions remain about the implementation of ICD-10 at these facilities and whether these employees will need to be re-trained as the adjusted ICD-10 deadline nears.


Thursday, March 27, 2014

Bill to Delay ICD-10 and Sustainable Growth Rate Patch Passes House

Advocates on behalf of hospitals and practitioners were optimistic about the likelihood of a permanent 'fix' to the Sustainable Growth Rate for Medicare's physician reimbursement system. Members in both the House and the Senate introduced bills this session that would repeal the Sustainable Growth Rate in Medicare's physician payment formula. 

In a surprise development today the House passed the Protecting Access to Medicare Act of 2014, H.R. 4302, by voice vote. This bill does not provide a permanent fix, only a one year patch to the Sustainable Growth Rate. The legislation, sponsored by Rep. Pitts of Pennsylvania, did not extend a fix for the SGR to physician-owned hospitals. Insiders agree that the cost of longer term bipartisan bills with permanent fixes to SGR were tabled because the parties were not able to agree on how to pay for the costs--about $140 billion over a 10 year period.  

Many on the hill expect the Senate to move this bill to a vote tonight. Speaker Harry Reid is said to be working on a deal to bring the bill to the floor. However, Senator Wyden is said to be pushing back on passing a bill with only a short term fix. Stakeholders following SGR legislation believe that if a temporary fix is passed the Congress will feel less pressure, and efforts to pass a permanent fix this year will fade into the background. 

The Protecting Access to Medicare Act of 2014 also contains a provision to delay the ICD-10 meaningful use requirements until October 2015. CMS Administrator Marilyn Tavenner has repeatedly stated that the agency was not going to extend the ICD-10 meaningful use requirements. Many eligible practitioners and hospitals are concerned about being able to meet the deadline and have publicly appealed to the agency and Congress to extend the compliance deadline. 




Thursday, February 27, 2014

No Extension for ICD-10 Implementation

Marilyn Tavenner, Administrator for the Centers of Medicare & Medicaid Services, announced today that there will be no extension of the October 1, compliance deadline for the nationwide conversion to the ICD-10 diagnostic and procedural codes. Speaking at the Healthcare Information and Management Systems Society convention in Orlando, Florida, Tavenner also explained that CMS was not changing compliance requirements for Stage 2 despite extensive pressure on the agency. 

Stage 2 of the electronic health record incentive payment program requires providers to electronically exchange healthcare records with each other to improve the interoperability of CMS' value-based payment programs. Eligible hospitals must commence 90 consecutive days of meeting the meaningful-use criteria on schedule. The starting date for most hospitals was October 1, 2013. However eligible professionals and physicians which operate on a fiscal year must begin compliance on April 1 or July 1, 2014. 

CMS will consider extensions on a case-by-case basis for providers and health IT vendors to obtain a "hardship exemption" that will extend the deadline for that facility. Tavenner does not expect the exemptions to delay full Stage 2 implementation by 2015. 

Thursday, February 20, 2014

Timing is Crucial for Effective ICD-10 Education

The ICD-10 billing code system will expand the number of billing codes in the ICD-9 from 18,004 to 155,000 codes. This change will take place by October 1, 2014. The expanded codes create a need for the biller to have a more in-depth understanding of the medical conditions and diseases to accurately bill the patient. If billers are untrained or improperly trained it will create havoc for practices. Practices across the country are wrestling with the questions of 'when' and 'how' to train employees.

Several training methods are available. The depth of the training ranges from self-paced online modules to certification courses that require dozens of hours of in-person instruction. With the huge increase in individual codes and variety of training programs many administrators are left scratching their heads at the decision of how to train their staff. There seems to be a consensus that an online training module provides the flexibility and informational value that best suits the educational needs of many practices. 

Experts recommend that the training material used is centered around billing codes most commonly used in the practice. For example, the employees of a cardiologist practice should focus their training on the medical billing codes for heart-related disease and conditions. 

The experts also suggested that practices begin training now by assessing how well the staff works with ICD-9. The practice should address any bad practices and frequent problems before moving to the more complex ICD-10 system. 

Many experts suggest waiting to train employees until about three months before the transition to ICD-10 to avoid workers forgetting how to use the new coding system since they will be still be interacting with the older system daily.