Many people have asked me to review the Quality Payment Program final rule, released on October 14, 2016. Several summaries have already been written but your best bet is to rely on the CMS Quality Payment Program website at https://qpp.cms.gov. Yes, the rule is still complex - over 2400 pages, of which more than 50% is the mandated response to comments made on the proposed rule. The good news is that CMS has been very responsive to feedback, creating a transition plan for adoption, reducing the number of criteria and extending the timeline which enables iterative learning before large scale implementation. Under the Quality Payment Program, clinicians have two approaches to choose from for reimbursement: the Merit-based Incentive program (MIPS) and Advanced Alternative Payment Models (APMs)...
John D. Halamka
See the following -
The ONC 10 Year Vision
On June 5th 2014, ONC released “Connecting Health and Care for the Nation: a 10-Year Vision to Achieve an Interoperable Health IT Infrastructure." The plan is divided in 3 year goals, 6 year goals, and 10 year goals. Five specific tactics support the strategies. Below is a summary of the report and a few comments from my Massachusetts experience that support the reasonableness of the ONC goals.
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The ONC Reorganization
Many people have asked me to explain the recent reorganization at ONC, reducing 17 different offices to 10...Simply, the era of stimulus has ended and ONC no longer has the operating budget to do as many projects as fast as during the era of ARRA... Read More »
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The Quality Payment Program Final Rule
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The Rise of Telemedicine
As reimbursement evolves from fee for service to alternative payment models, incentives will shift from treating sickness to keeping the population healthy. New investments will be made in technologies that reach into the home and enhance care team communication. 2016 saw an acceleration of telemedicine/telehealth. 2017 will see exponential growth. Telemedicine is hard to define. It could be real time video teleconferencing between clinicians (a consult), between a patient and clincian (a visit), or group to group (tumor board discussion). It could be the transmission of a static photograph, such as the poisonous mushroom/plant teleconsultation I do 900 times per year. It could be secure texting to coordinate patient care...
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The State of Health IT in Europe
...In the UK, I heard a great deal about misalignment between IT departments and clinicians. IT departments are reluctant to embrace social, mobile, analytics, and cloud, instead insisting on centralized command and control of Windows desktop devices, often running Citrix/Virtual Desktop. Clinicians want mobile devices, universal access to applications anytime from anywhere on any device, and big data visualizations... Read More »
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We've been swindled
...And the fraud is likely to be compounded. The next step in the process is a forthcoming Department of Defense procurement of an EHR system to serve the military and its dependents, whether being treated at military healthcare facilities or other facilities in the communities in and around our bases and other military installations. As I understand, there is no language in this multi-billion dollar procurement that would require the vendor chosen to achieve interoperability with those EHRs in community facilities where the government will send its patients--or where they might end up for emergent care...
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What Does the Trump Presidency Imply for Healthcare and Healthcare IT?
Many organizations have asked me to comment on the impact of the Trump Presidency on Healthcare and Healthcare IT. I served the Bush administration for 4 years and the Obama administration for 6 years. I know that change in Washington happens incrementally. There is always an evolution, not a revolution, regardless of speechmaking hyperbole. What am I doing in Massachusetts? I’m staying the course, continuing my focus on social networking for healthcare, mobile, care management analytics, cloud, and security while leaving the strategic plan/budget as is...
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What is Patient and Family Engagement?
I recently participated in a nationwide (not the United States) healthcare IT planning effort and one recommendation was universal availability of patient portals. Several reviewers commented that patient portal is a loaded term - it implies that clinicians control the data and patients are given a view into it. One person said, “that’s so 10 years ago.” BIDMC has been working with patient/family shared medical records, Open Notes and various consumer-facing apps since 1999. Over that time we've discovered that patients typically do not want raw data, they want something actionable - the tools necessary to assist their navigation through the healthcare process...
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When the Healthcare System Works
As I’ve written about several times in the past, this “care traffic control”, directing the patient to right intensity of care, then closing the loop for followup care is the future of medicine. It’s high quality, lower cost, and improves outcomes. The IT systems required to do it are more about workflow and process than the simple capture of records. As we envision the next generation of electronic tools, support for team based care with handoff management and closed loop communication among the stakeholders will be the most important new features. Read More »
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Wikipedia and Facebook for Clinical Documentation
Over the past several years I’ve written about the inadequate state of clinical documentation, which is largely unchanged since the days of Osler, (except for a bit more structure introduced by Larry Weed in the 1970s) and was created for billing/legal purposes not for care coordination...In recent lectures, I’ve called on the country to adopt Wikipedia and Facebook for clinical documentation...
You know Meaningful Use is Real When...
My 83 year old father-in-law returned from a recent outpatient visit to his primary care provider with two customized handouts - a transition of care summary detailing problems/meds/allergies and an opt-in consent for the exchange of that care summary over the state Healthcare Information Exchange, the MassHIWay... Read More »
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