Compliance & Legal

Medical practices spend an average of 785 hours per physician and $15.4 billion annually reporting quality measures to Medicare, Medicaid and private payers, according to a new report in Health Affairs. The study, led by researchers from Weill Cornell Medical College and funded by the Physicians Foundation, looked at the quality reporting efforts of primary care, cardiology, orthopedic and multi-specialty practices, polling 1000 of them (250 of each type), drawn at random from the membership rolls of the Medical Group Management Association. Their findings suggest that, while "much is to be gained from quality measurement, the current system is unnecessarily costly, and greater effort is needed to standardize measures and make them easier to report," researchers said. [Also: Slavitt, DeSalvo: Health IT has to work better for doctors] Practices reported spending 15.1 hours per week per physician wrangling quality measures -- 2.6 hours each week for physicians, with the rest of the work going to nurses or medical assistants. About 12 of those hours were spent logging data into medical records solely for quality reporting. Some 80 percent of practices said they spend more time managing quality measures than three years ago. Almost half said that's become a significant burden. But just 27 percent thought those measures necessarily correlated with quality care. Beyond the time invested, the dollars add up too. Weill Cornell researchers found that practices spent $40,069 per physician each year on quality reporting – totaling $15.4 billion annually. "The cost to physician practices of dealing with quality measures is high and rising," researchers said. "On top of the obscene waste of billions of dollars each year on quality measures, the most alarming thing about this study of MGMA member practices is that nearly three-fourths of the groups reported being measured on quality measures that are not clinically relevant," said Halee Fischer-Wright, MD, MGMA's president and CEO, in a statement. "The vast majority also stated current measures are useless for improving patient care," she added. "This study proves that the current top-down approach has failed. It serves no purpose to have over three thousand competing measures of quality across government and private initiatives." While care quality is essential and reporting standardization is critical, "if measures don't improve patient care, it’s an exercise in futility," said Fischer-Wright. "As the largest contributor to the problem, the federal government needs to get out of the business of dictating patient care through wasteful mandates and create simplified systems to support medical practices in improving quality across the country." As HIMSS16 in Las Vegas this past week, officials from the Centers for Medicare and Medicaid Services emphasized that quality measures would continue to be a key component in CMS' reimbursement programs. [Also: Meaningful use will still be part of MIPS reimbursement, CMS says] Kate Goodrich, MD, director of CMS' Center for Clinical Standards and Quality, said new payment rules under the Medicare Access and CHIP Reauthorization Act, or MACRA, would reimburse physicians based on a composite performance score factoring in quality measures (30 percent), resource use (30 percent), clinical practice improvement activities (15 percent) and meaningful use of information technology (25 percent). "Our intent is to have a single, unified program," she said, while acknowledging the need for flexibility and avoiding a one-size-fits-all approach: "We know physician practices are very different from one another." Earlier in the week, CMS Acting Administrator Andy Slavitt said the agency has been listening more intently than ever to physician feedback, working with those on the front lines to understand their pain points. He cited actual quotes from physicians, including one who said, "Most of what I'm doing during the day is entering data into the EHR." While offering few policy specifics, Slavitt seemed to indicate that's a message that's resonating with CMS. Doctors are "not describing problems we don't know how to solve," he said. "Job one is to bridge the gulf between our public policy work and what's actually happening with patient care. That has to become an integral part of how we do things." Twitter: @MikeMiliardHITN

LAS VEGAS - The Staten Island Performing Provider System is running into all of the challenges inherent in implementing a value-based model for Medicaid payment reform in New York State. The Delivery System Reform Incentive Payment Program has as its goal to reduce avoidable hospital use by 25 percent over the next five years, according to Staten Island’s Executive Director Joseph Conte, speaking at HIMSS16 in Las Vegas. Asked how the program was going, Conte said, “In 11 months that’s the expectation to achieve. We’re not there yet. Looking at information we have from two hospitals, it’s a positive trend.” [Also: See photos from Day 2 of HIMSS16] Staten Island Performing Provider System is a corporation formed by Richmond University Medical Center and Staten Island University Hospital. Over 60 healthcare agencies and community-based organizations have joined Staten Island in the effort to reduce costs while increasing the quality of health for a very diverse population including 130,000 Medicaid recipients and 50,000 uninsured residents.  The big challenge, Conte said, is that timely data is not available from the state.  “It’s at least a six to nine month retrospective,” he said. “Everyone’s in a different place as far as electronic health records.” As of October 2015, an IT assessment showed that of the 26 healthcare systems partnering with Staten Island, 92 percent had an EHR platform or were in the process of getting one and 14 of them had different EHR vendors, Conte said. The overarching mission is to align IT strategy and execution, said Raj Lakhanpal, MD, CEO of SpectraMedix, and member of HIMSS Clinical and Business Intelligence Committee. To this end, Staten Island will be collecting data from providers and data feeds, and integrating it to create longitudinal records. They will apply population risk assessment models to predict high-risk patients and to flag those who should be included in disease registries and to identify gaps in care. [Also: See photos from Day 3 of HIMSS16] Conte said, “Data needs to be turned into business intelligence. Everyone needs prompt, accurate performance feedback.” The partners will need to make some IT investments to connect to state, Staten Island and other health IT platforms, he said. They’re starting to realize the value of receiving real-time measures of population health, he said. “Data six and nine months old is of zero interest to them,” Conte said. “What’s of interest to a doctor, (he or she) never knows that their patient is in the emergency room, or has been hospitalized.” Twitter: @SusanJMorse This story is part of our ongoing coverage of the HIMSS16 conference. Follow our live blog for real-time updates, and visit Destination HIMSS16 for a full rundown of our reporting from the show. For a selection of some of the best social media posts of the show, visit our Trending at #HIMSS16 hub.

Los Angeles-based Complete P.T. Pool & Land Physical Therapy will pay $25,000 to settle HIPAA violations for allegedly posting patient testimonials, including full names and photos, on its website without obtaining authorization. The Department of Health and Human Services Office for Civil Rights announced the settlement terms on its website on Feb. 16. The settlement also requires Complete P.T. to adopt and implement a corrective action plan, and annual reporting of compliance efforts for one year. [Also: 8 out of 10 mobile health apps open to HIPAA violations] The complaint filed with the OCR on Aug. 8, 2012 said Complete P.T. was required by HIPAA to seek authorization for the testimonials. OCR’s investigation revealed that Complete P.T failed to reasonably safeguard protected health information, disclosed PHI without authorization,and failed to implement policies and procedures with respect to PHI that were designed to comply with HIPAA’s requirements. "The HIPAA Privacy Rule gives individuals important controls over whether and how their protected health information is used and disclosed for marketing purposes," said OCR Director Jocelyn Samuels in a statement posted on the OCR website. "With limited exceptions, the Rule requires an individual’s written authorization before a use or disclosure of his or her protected health information can be made for marketing." Twitter: @HealthITNews

As if healthcare executives don't have enough worries about implementing electronic health records, yet another issue is starting to ramp up. "What's been happening more frequently in the last few years is that certain plaintiffs' lawyers – a kind of group of them who communicate with each other – have started to see the medical record as an opportunity for litigation," said Mary Re Knack, a Seattle-based attorney for the firm Ogden Murphy Wallace. Knack will be presenting an exploration of these emerging litigation troubles in the session "Just Press Print: Challenges in Producing EHRs in Litigation" with colleague Elana R. Zana at HIMSS16, beginning in late February. Twitter: @HealthITNews Electronic health record design is paramount among those issues, Knack said, because EHR vendors quite naturally did not build the software with litigation in mind. "The data is all stored behind these templates, and depending on what you are trying to look at, whether it's a summary or lab reports or such, the data then populates the template on a screen. But when you print it, it doesn't print out as cleanly or as nicely,” Knack said. One of these obvious challenges in trying to review somebody's care is how do you see it? How do you even read what the care was? Who did what? And when? "You may have a case that's very straightforward medical malpractice, but because of the way the medical records get printed out, the same piece of data may appear in five places. Somebody who looks at it, whose goal is to show how it's confusing, can then start to challenge the care that was given based on the fact the medical record is confusing,” Knack explained. “They can take another step, and that is questioning whether the data in the medical record is accurate or if it has been changed." As a result, Knack said, a healthcare provider can find itself in litigation that is ostensibly about the care provided, when in actuality that organization has to " defend how the medical record works." [Like Healthcare IT News on Facebook] Practically speaking, she said, the potentially expensive situation needs to be addressed by enhanced communication between provider organizations, particularly C-suite staff, and their vendors, and also internally within provider systems. "In the healthcare community, the medical negligence work, because of the way it's insured, tends to kind of be off on the side,” she added. “This isn't true in every healthcare setting, of course, but it's off to the side many times so the people who are the decision makers with respect to bigger issues aren't necessarily aware of how these particulars are being used in litigation, because litigation is handled 'over there.'" Knack and Zana will be presenting "Just Press Print: Challenges in Producing EHRs in Litigation" from 2:30 - 3:30 p.m. March 1 at the Sands Expo Convention Center, Palazzo L. Twitter: @HealthITNews

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