ROCK AND A HARD PLACE FOR RURAL HOSPITALS: The meaningful use program could be the straw that breaks the back of small and rural hospitals, David Pittman reports in a story that drew on data compiled for POLITICO by HIMSS Analytics.
Of the 250 U.S. hospitals that closed over the last six years, 74 were in rural areas, where two-thirds of all hospitals now operate in the red. They’re being buffeted by factors ranging from sinking Medicare reimbursements, to GOP governors’ refusal to expand Medicaid, to the shrinking of rural communities. But many are also caught in the downdraft of the meaningful use program.
With the penalty phase here, or coming soon, and EHR upgrade and maintenance costs continuing, health IT is a nagging issue for many. EHR costs weren’t “the direct cause of the closing,” said Lynn Heller, whose 44-bed Bowie Memorial Hospital in Bowie, Texas, was one of 14 in the state to close the past three years. But those costs were “a piece of the pie,” he said.
MEANINGFUL USE SLEIGHT OF HAND: The behavioral health lobby wants House lawmakers to use a budget trick to expand the program to mental health providers. A letter Thursday to Energy and Commerce leaders Fred Upton and Frank Pallone asks that the Integrating Behavioral Health Through Technology Act, which sets up a five-year, five-state pilot to extend meaningful use to therapists and their institutions, be included in legislation set for markup later this month. The letter urges the use of “such sums” authorization language meaning to omit the funding amount from the legislation, leaving appropropriators to allocate any sum within budget caps. That would obviate a score from the Congressional Budget Office, easing the measure’s inclusion in a final bill.
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HURD RIDING HERD ON VA: The Texas Republican IT expert seems to be pushing the VA to ditch its EHR and buy a commercial system. He told the ONC annual meeting Thursday that a “buy not build” strategy could solve the interoperability problems of the Defense and Veterans Affairs departments. “There are dozens of private sector products already available that could solve this interoperability problem,” Hurd said. “We cannot have Washington limiting innovation simply because they lack imagination.” Hurd is chair of the House Oversight and Government Reform IT subcommittee, which has been eyeing health IT issues all year.
Our colleague David Pittman turned up a May 27 letter from Hurd and Robin Kelly, the ranking minority member on the committee, that asks for a major GAO study of VistA. The VA’s software development projects since 2001, they write, “have not produced the kind of modern systems and capabilities that Congress mandated.”
Observers wonder where the GAO probe will lead. A lot of money has been spent on VistA, like any system, says Roger Baker, the VA’s CIO from 2009-2103, but “it is by far the best EHR working in the federal environment right now. Don’t underestimate the difference in cost between supporting federal requirements and supporting commercial requirements. DoD will be proving that lesson with DHMSM for the next several years.”
Also from the ONC conference: The VA will host events this summer to give developers of patient-facing apps a chance to work with its EHR code, said Andrea Ippolito of the VA Center for Innovation. “Virtual” hack-a-thons will take place in June and July, in-person events in August and September.
The Senate Veterans Affairs Appropriations subcommittee postponed for a second time a hearing on the future of VistA that had been set for next Wednesday.
DESALVO UPBEAT AS EVER, BUT ADMITS PROBLEMS: The administration’s $30 billion investment in electronic records is paying off, ONC chief Karen DeSalvo told POLITICO’s “Pulse Check” podcast. Some health systems have used EHRs to improve care and quality; what’s required is a culture that embraced the move to electronic records, she said, citing organizations like Nemours and the Ochsner Medical Center. “They’ve been able to work through some of the challenges around documentation, and lower some of the noise to get to the signal” and improve care for patients. She acknowledges that HHS’s goals for digitizing health records were too ambitious for a lot of providers. “We as the regulator, were probably ahead of the technology in meaningful use Stage 2,” DeSalvo said. More from Dan Diamond’s story here, or get hip and listen to the Pulse Check Podcast.
AHA OFFERS A DIFFERENT INTEROPERABILITY METRIC: ONC should measure not only electronic health information exchange and use, but the availability of standards, structures and infrastructure to support those goals, AHA said in comments submitted to the agency today. ONC wants advice on how to measure health information exchange through certified EHRs by the end of 2018, as required by MACRA. AHA also recommends that ONC find ways to determine whether shared information is being used in care.
ONC MAKES VIDEOS FOR YOUR AUNT MOLLY: The agency on Thursday released videos about the rights patients have to access their health information, and a Patient Engagement Playbook to help clinicians and office staff engage patients through health IT. “Many people are not fully aware of their right to access their own medical records” under HIPAA, said ONC privacy chief Lucia Savage in a news release. “The videos we released today highlight the basics for individuals.”
The American Medical Informatics Association, meanwhile, used the ONC’s meeting Thursday to call for “total patient access” to EHR data. “It is unconscionable that in 2016 most patients are unable to obtain their entire medical record unless they print it out,” said the group’s president, Doug Fridsma. He called on the government to require certified health IT to enable patients to get a “full extract” of their health data. A prohibition on the release of unstructured data “has outlived its usefulness,” he said.
EHRs CAN NUDGE DOCTORS INTO SCREENING FOR CANCER: Pop-up alerts which doctors often deride as annoying, repetitive, or unnecessary also can be used for good, a study in Healthcare points out. Alerts can get providers to order more preventive care; practices implementing the alerts found modest gains in the numbers of completed colonoscopies and mammograms.
But doctors can’t rely on tech alone the authors note that the alerts produced stronger gains in ordered tests than in completed ones. That, they speculate, is due to a lack of patient follow-through. Docs will need to do some outreach and salesmanship to induce patients to stick to the plan.
LOUSIANA MOVES ON TELEMEDICINE BILL: The Bayou state is now only the governor’s signature away from removing its requirement that telemedicine doctors be in-state or keep an arrangement with practices who are in state, making it one of the least friendly states to the technology. A bill that cleared the Senate Thursday also defines telemedicine as “interactive audio” adding that video isn’t necessary. The state House and Senate this year passed different versions of similar bills, and the two needed to be reconciled. Teladoc has employed lobbyists in the state since last year.
WEST VIRGINIA NIXES PITTSBURGH TELEMEDICINE OFFERING: The West Virginia Health Care Authority has denied the application of a University of Pittsburgh Medical Center affiliate, University of Pittsburgh Physicians, to provide telemedicine services throughout West Virginia, The National Law Review reports. The denial was based on the Pittsburgh group’s failure to demonstrate need for the service or to meet “continuum of care” criteria. The authority was critical of the Pittsburgh’ group’s state-wide approach, and questioned its experience as a telemedicine provider. The application would have billed patients directly, but the decision does not rule out telemedicine service that is, say, billed by local providers but provided by physicians operating remotely.
OPIOID OD PREDICTER: A study conducted by scientists at the Geisinger Health System predicts that patients taking high doses of prescription opioids combined with psychotropic medicines are most at risk of dying or overdosing on the drugs. The study, which examined the EHRs of more than 2,000 patients hospitalized for overdose from April 2005 to March 2015, found that being married and having private health insurance had a protective effect, while history of previous addiction, mental illness or other chronic diseases were associated with higher risk. Among study participants, 9.4 percent died within a year of hospitalization.
Date: 3 June, 2016