Welcome to Financial Edge

Thank you for subscribing to Financial Edge, HIMSS’ financial systems eNewsletter—your source for the latest issues and emerging trends focused on financial systems and related technologies within healthcare delivery.

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Story ideas and other comments can be emailed to Nancy Vitucci, Manager, Publications.

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HIMSS09: Financial Systems Symposium Examines How to "Show Me the Money!" in Today's Healthcare Market

At HIMSS09, participants in the Financial Systems Symposium explored how selection and reimbursement of patient care directly impacts providers—and their organizations’—bottom line. Sessions focused on topics such as the challenges and resources of electronic payments, the impact of consumerism on healthcare, the new administration’s healthcare agenda and ways to leverage IT to address patient responsibility and new services from the banking and clearinghouse sectors. Industry experts offered their views on how the bigger role financial institutions are playing in healthcare is impacting healthcare delivery.

Financial systems symposium attendee Tom Witmer sees a positive impact from this collaboration. “I believe this role will continue to be significant, positive and good for members and patients, as long as financial data analysis and services do not adversely effect access and quality of care,” said Witmer, the vice president of revenue cycle technology at Kaiser Permanente IT in Oakland, Calif. Witmer added that he attended the symposium to “understand current financial systems offerings and engage in this relatively new group at HIMSS.”
 
Charlene Day, a financial systems analyst at Elizabethtown (NY) Community Hospital, was looking to learn the approaches other facilities take to specific revenue cycle issues and their rates of success. Day works for a small critical access hospital. “The symposium addressed aggressively managing the revenue cycle and gave insight into how even simple changes could result in increased revenue,” she reported. “I was also gratified that many of the strategies brought up by the panel and during the Q & A were either in place or being considered at our hospital.” She adds that during the symposium, she learned large institutions struggle with the same issues as her facility. "We’re not as off step with our peers or the larger institutions in tweaking our revenue cycle as was previously thought," she said.

Witmer notes that his most valuable “takeaway” from attending the symposium was hearing about the degree and momentum to which the consumer financial services industry is aligning and delivering solutions to health plans, providers and patients. “Existing paper and other services are being aggressively cannibalized,” he said.

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Red Flags Rule Delayed until Aug. 1

The Federal Trade Commission (FTC) has announced it is delaying the enforcement date of the Red Flags rule until August 1. This regulation, published in the November 9, 2007 Federal Register, requires creditors and financial institutions, including those in healthcare, to develop written identity theft prevention programs. These programs must identify, detect and respond to patterns, practices or specific activities that could indicate identity theft. The original compliance date, Nov.1, 2008, was changed to May 1 when the healthcare community expressed concerns about compliance. Details about the regulation and this latest compliance extension are available on the FTC’s Web site.

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HIMSS Publishes Its Definitions of 'Meaningful Use'

Last month, HIMSS published its definitions of ‘meaningful use of certified EHR technologies,’ as outlined in the American Recovery and Reinvestment Act of 2009 (ARRA). HIMSS sent a cover letter, plus two definitions: 1) meaningful users of certified EHR technologies and 2) meaningful use for hospitals, to the National Coordinator of Health IT and the Acting CMS Commissioner, within the Department of Health and Human Services (HHS).

ARRA calls for multiple years of Medicare incentive payments to hospitals and physicians who meet the requirements of “meaningful use of certified EHR technology” (an electronic health record). To be eligible for the incentive payments, hospitals and physicians must use the technology in a meaningful manner; to exchange electronic health information to improve the quality of care; and, submit clinical quality measures – and other measures – as selected by the Secretary of HHS. Further, hospitals and physicians must meet the definition within a specified time frame, which as described in ARRA, must be made increasingly stringent over time by the Secretary.

Approved by the HIMSS Board of Directors, HIMSS’ definitions resulted from consensus-building effort with input from HIMSS members (73 percent of which work in end-user settings), and the public at-large. In summary, HIMSS recommends the following:

1. To ensure continuity, recognize CCHIT as the certifying body of EHRs.
2. To achieve incremental maturation of “meaningful use,” adopt metrics that can be reasonably captured and reported beginning in FY11/2011,* and then made increasingly stringent using intervals of not less than two years.  HIMSS’ definitions include specific metrics to enact, in phases, over a multi-year period.
3. To bridge existing gaps in interoperability of health information, coordinate with HITSP and IHE to create new harmonized standards and implementation guides.
4. Reconcile the gap between “certified EHR technologies,” “best of breed,” and “open source” technologies.

*ARRA requires the hospital-focused definition to be effective FY11 (October 1, 2010).  For meaningful users (physicians), the definition must be effective January 1, 2011.

Click here to access the definitions and read more.

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ARRA/HITECH Act—The Timing of Reimbursement vs. the Timing of Investment

By Ted Perkins

Considerable attention has been paid to the January 1, 2011 “Meaningful Use’ provisions of the ARRA/HITECH Act, and to the phasing of the funding over the subsequent years. With Medicare/ Medicaid mechanisms not producing reimbursements to physician practices until 2011 at the earliest, physicians must have software systems implemented for at least 1-2 months prior to the January 1 date. Physicians purchasing these systems can anticipate significant upfront capital investment in 2010. Typical capital items for systems purchases may include workstations, computer tablets, servers, connectivity such as broadband, wireless/wired networks, scanners, software licenses and backup systems, just to name a few components.  Additional spending is necessary for workflow redesign and staff training. Funding may prove a challenge for many physicians in mid-2010, given reimbursements will not be available until 2011 at the earliest.

What will be the major source of short-term capital for providers? Some states are proceeding with legislation to create revolving loan funds to advance monies for these purchases. It is questionable that these revolving loan funds will even be sufficient to support the demand. This may give rise to private financing companies entering the market with bridge loans. While some software vendors may entertain a deferred payment arrangement, others suppliers such as hardware vendors and broadband providers will likely expect payment upon delivery. In addition, the recent turbulence in the credit markets may impact private-sector offerings.

Physician practices should begin to ask questions now about accessing capital for these system expenditures and identifying a solution to cover the potential working capital gap. Physicians should explore and define their expectations in seeking capital funding—will it be from only the public-sector, the private-sector or a mix of funding options?  The time to begin preparing is today. 

Ted Perkins, MBA, is information officer for a multi-specialty ambulatory practice near New York City. He has participated in several HIMSS Financial Systems work groups and task forces over the last two years and will begin his two-year term on the HIMSS Financial Systems Steering Committee on July 1.

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Virtual Conference & Exhibition

Economic stimulus and the technologies to achieve the healthcare reform agenda set forth by President Obama are on the minds of all health IT professionals. HIMSS’ fifth Virtual Conference & Expo on June 9-10 will provide attendees with an 18-session educational program focused on the future of health IT. Free to qualified registrants,* next month’s HIMSS Virtual Conference & Expo features two educational tracks: Health Policy and the New Administration and Transforming Healthcare Through Practice.

Led by industry thought leaders and designed to provide guidance to those connecting clinical and financial systems, the following educational sessions explore trends and changes in financial systems:

• Maximizing Financial Incentives and Satisfying the New HIPAA Requirements Under the HITECH Act
• Outcomes and Lessons Learned from 5010 Testing Project Collaboration
• Getting Clinical Decision Support Right: Improving Quality to Satisfy ARRA and Payers
• Ensuring Compliance with FTC's Red Flags Rules on Identify Theft Prevention

At the HIMSS Virtual Conference & Expo, attendees can also gain product knowledge and connect with their peers. Attendees interact with speakers in live Q&A sessions after their presentations, as well as with peers and exhibitors in real time via threaded discussion boards in virtual lounges or using the internal instant messenger and e-mail systems. The virtual exhibit hall brings together attendees and leading industry vendors to easily explore leading product solutions through video demonstrations, downloadable product brochures and documents, as well as live chat. Plus, if registrants miss part of the live event, they can access all education sessions, keynote speeches and exhibits on demand for 30 days after conference, free of charge.

Register and learn more about HIMSS Virtual Conference & Expo online. *Registration is complimentary to qualified registrants: Non-qualified individuals may attend for a nominal fee ($99 HIMSS Members/$119 non-members).

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Viewpoint: Leveraging Health IT to Achieve Price and Quality Reporting

Although the healthcare industry’s interest in price and quality reporting is escalating, the ability to achieve price and quality reporting is very difficult—even with the leverage of technology and interoperability.

We posed the following questions to a few vendor stakeholders:

What’s driving the movement toward greater emphasis on price and quality reporting in healthcare? What benefits can the healthcare industry realize from price and quality reporting? How can health information technologies be leveraged to gain greater efficiencies in achieving price and quality reporting?  How do you see The American Recovery and Reinvestment Act of 2009 moving quality reporting forward in the industry?

Here are a few perspectives on the subject:

The American Reinvestment and Recovery Act of 2009 funds at the rate of $19 billion over five years the purchase of EMRs in physicians’ offices. This deployment of EMRs provides an opportunity to collect and report on both clinical and financial data points that currently are very difficult to obtain. To better manage the delivery of healthcare, these new sources of data must be mined to obtain information about the quality, safety and efficiency of the care delivered. It is expected that government and other payers will want physicians to mine this data and report their results. Although this reality may be initially threatening to physicians, it is imperative that it occurs. Once adopted, physicians will find this data useful to them as they strive to better manage their practice and raise the level of quality and efficiency of care delivered to their patients.
—Barry P. Chaiken, MD, FHIMSS, Chief Medical Officer, DocsNetwork, Ltd.

I believe the consumer will drive improvements in quality and price transparency in healthcare. As they become more involved in their care, they’ll come to realize that better information on cost and quality will allow them to make informed choices about their care. Over time, consumers will not tolerate a healthcare system without quality and cost transparency as they are getting this information in other segments of their life. For instance, when today’s consumer wants to book a hotel room anywhere around the world, data on cost and quality is readily available. This transparency will then encourage payers to reward high quality/low cost care. Providers operating in a competitive environment will be forced to improve the quality and cost of care provided if they are to compete effectively. The American Recovery and Reinvestment Act of 2009 will result in increased adoption of technologies critical to creating an environment of transparency.
—Colin Konschak, MBA, FHIMSS, FACHE, Managing Partner, DIVURGENT and Past President, HIMSS Virginia Chapter

ARRA Will Accelerate Consumer Quality Reporting
Today, it’s challenging for consumers to differentiate the quality of care hospitals provide because leading consumer quality reporting services use different data sources, metrics and methodologies. But the American Recovery and Reinvestment Act (ARRA) will make the task easier. That’s because the law requires providers to submit clinical quality and other measures selected by the HHS Secretary to qualify for the $19 billion that has been allocated to adopters of electronic health records. Consequently, ARRA represents a significant step toward standardizing quality reporting.

By accelerating adoption of EHRs, ARRA also will make it easier for providers to benchmark their clinical performance and drive best practices across the enterprise. Providers will be able to incorporate quality measures right into the EHR, resulting in safer, better and more cost-effective care. EHR adopters will outperform non-adopters, and they will let consumers know they are quality providers and how much that quality costs.
—Virginia Marcus, Senior Product Manager, Decision Support, Quadramed Corporation

The healthcare industry needs standards to determine consistent pricing and quality of service. Collecting information about services provides a clearer view of how actual care compares to established courses of treatment. Data to collect includes: who was treated, who provided it, details of the treatment, and the cost and outcome of treatment.

Banks should assist with information collection because payment information will eventually touch the banking system and banks are already trusted agents in that their ability to protect sensitive financial data is well known.

Implementing a new bank-centric payment and information collection process can replace disparate insurer networks with one, real-time, network that handles all claims and disbursements. This process requires every provider and payer join a holistic system – one that is unlikely without government sponsorship.

Having banks disburse government stimulus funds and on-going payments on behalf of uninsured and Medicare recipients not only streamlines the payment process, but also meets the government’s goal of increasing the amount of deposits bank have in reserves. If the government is going to get involved in both industries, it makes sense to tackle two major issues with one solution.
—Douglas Braun, President and CEO, Internet Payment Exchange, Inc.

As healthcare stakeholders strive to demonstrate meaningful use of health IT and capture their share of the ARRA funding, many are exploring how they will measure this metric. The government-driven concept, often associated with EMRs and improved patient outcomes, is motivating providers to examine methods to accurately capture and report care delivered. Ironically, this metric has been in place for many years, as healthcare providers documented patient encounters for claims submissions to payers. By leveraging the claims data that is already captured, verified, and exchanged with payers and other healthcare stakeholders through proven technology, providers are several steps closer to electronically linking that data to patient outcomes, forming a measurement of quality reporting.

Although quality reporting adds an additional administrative requirement for providers, technology delivers an efficient method to measure the care delivered, resulting in increased reimbursement for clinicians while providing needed data analysis to enhance patient outcomes.
—Geoff Smyth, President of e4e’s Healthcare Services Division

For healthcare organizations seeking to leverage information technology to improve quality performance, the most important thing is to get started. Improving quality is a long-term commitment that requires building a new organizational culture, new skill sets and new information solutions—all of which need to evolve and mature over time. 

The first challenge organizations will face in quality measurement is improving the quality of the data. The data outputs are only as good as the data inputs. The end-users who enter the data have little incentive to improve the quality of data input until they are accountable for the output. 

To gain clinician buy-in, keep the focus on improving quality of care, not on reporting. The greatest value of IT is not measurement and reporting per se, rather the tools, processes and information (e.g., health management planning and decision support) that help clinicians improve quality.
—Douglas Gentile, MD, MBA, Chief Medical Officer, Allscripts

We would like to hear from our hospital and practicing physician community on your perspectives around price and quality reporting. Please submit your comments for inclusion in the June Financial Edge to Nancy Vitucci, HIMSS Manager, Publications.

The inclusion of an organization name, product or service in Viewpoint should not be construed as a HIMSS endorsement of such organization, product or service, nor is the failure to include an organization name, product or service to be construed as disapproval. The views expressed in Viewpoint are those of the author and do not necessarily reflect the views of HIMSS.

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Advocacy Update

Amidst an economic downturn, the first few months of the 111th Congress included legislative plans to revitalize the U.S. economy and develop a strong information infrastructure to support healthcare throughout the U.S. HIMSS recently released “The First Quarter Report on Health Information Technology (IT) and the 111th Congress,” which details some of the key milestones from January – April, 2009 that pertain to health IT policy in the 111th Congress. In addition, the report highlights corresponding HIMSS public policy and advocacy activities. Key milestones included in the report pertain to:

• Reauthorization of the State Children’s Health Insurance Program
• Passage of the ARRA
• Passage of the Omnibus Appropriations Act of 2009
• Healthcare Reform Deliberations
• Passage of the Fiscal Year 2010 Budget Resolution, and
• Introduction of Health IT Legislation

Unlike no other time in U.S. history, Congress made significant steps in establishing leadership for national health IT initiatives and providing funding to bolster the electronic exchange of health information. HIMSS members are encouraged to access the report to learn more about health IT policy in the 111th Congress and HIMSS’ education and advocacy activities.

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HIMSS10 Call for Proposals Open Through May 29; Topic Categories Include Financial Information Systems

There’s still time left to submit a proposal for the 2010 Annual HIMSS Conference and Exhibition, Feb. 28 – March 4 in Atlanta. The HIMSS10 Call for Proposals closes on Friday, May 29, at 5pm CST. The proposal form and details on intended audiences, topic categories—including Financial Information Systems, and evaluation criteria are available online. Individuals with questions regarding submitting a Financial Information Systems proposal, including how to best frame your proposal, can contact Adam Bazer, manager of education, HIMSS, at abazer@himss.org or 312-915-9257.

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Five New Publications Now Available from HIMSS

The HIMSS Store, available at www.himss.org/store, is the source for the latest tools and strategies for transforming healthcare through IT. The store features an extensive library of publications, reports and CDs, including several brand new publications: a new edition of HIMSS' bar coding and auto-ID guide, a step-by-step guide to improving medication use and outcomes through clinical decision support, an implementation guide to personal health records, a comprehensive guide to performance improvement in healthcare and a practical guidebook for strategic planning. In addition to the new titles, the HIMSS Store features titles on management, strategy and finance; clinical informatics and EHRs; nursing informatics; ambulatory care; patient safety; privacy and security; and preparing for the Certified Professional in Healthcare Information and Management Systems (CPHIMS) exam. 

To place an order or to learn more about HIMSS publications, visit www.himss.org/store.

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