In early January, 2014, the Office of Inspector General (“OIG”) for the Department of Health and Human Services (“HHS”) issued a report criticizing HHS’s Centers for Medicare and Medicaid Services (“CMS”) for failing to adopt stronger integrity practices governing electronic health records (“EHRs”). “CMS And Its Contractors Have Adopted Few Program Integrity Practices To Address Vulnerabilities In EHRs,” oig.hhs.gov/oei/reports/oei-01-11-00571.pdf. Here are some of the OIG’s challenges and concerns: “…clues within the progress notes, handwriting styles, and other attributes that help corroborate the authenticity of paper medical records are largely absent in EHRs. Further, tracing authorship and documentation in an EHR may not be as straightforward as tracing in a paper record. Health care providers can use EHR software features that may mask true authorship of the medical record and distort information in the record to inflate health care claims.” Continue reading OIG Criticizes CMS For Lack Of Adequate Fraud Detection Practices in Electronic Health Records
The meaningful use (MU) regulations provide incentive monies for hospitals and physicians that establish electronic health records systems (EHRs) and satisfy other criteria, such as providing new forms of ‘patient engagement’ like technologically-enabled patient-provider communications. The advantages of a wireless record-sharing are enormous – quicker diagnoses, better quality tracking, and seamless payment systems. But there are lots of steps and decisions required in setting up EHRs and developing broader data exchange systems like health information organizations/exchanges (HIOs or HIEs). Last week, the Department of Health and Human Services’ Office of the National Coordinator denied certification for two small EHRs and promised ongoing rigorous enforcement of EHRs. Continue reading Electronic Health Records and Health Information Exchanges/Organizations: The Changing Landscape
Last month, top health care investors and entrepreneurs came together with hospital, payor and government leaders at a conference sponsored by the University of Pennsylvania’s Wharton Healthcare Management Alumni Association to discuss the restructuring of the health care system. Jonathan Blum, CMS Deputy Administrator and Director of the Center of Medicare participated on a panel about about macro health care system changes and one of the key take aways was not surprisingly, that change in the health care system is all about the data. Continue reading Medicare and Health Care Reform: Why Isn’t Real Time Data a Priority?
Health care payors (plans, insurers) are emerging quickly as one of the dominant players in the mobile health (mHealth) marketplace. Apps to exchange information with patients regarding appointment reminders, to coordinated care among various providers for diabetes and other conditions, and to provide patients with personal health records (PHRs) are becoming all the rage. Payors command a unique place in the healthcare industry; not only do they receive and distribute the healthcare dollars but they maintain deep files of information on the consumers whose care they pay for. With their reserves of funds, payors are also uniquely positioned to invest in the use of mobile health in the delivery of health care. They can develop and distribute apps from basic-to-sophisticated, from those that merely provide good diet tips to beneficiaries, to those that collect and transmit critical health data to physicians and other providers. They can also incentivize beneficiaries to adopt mHealth solutions by, for instance, offering to reduce premiums in exchange for compliant behavior. Further, the employers who pay for health coverage may incentivize, or penalize, employees that do not utilize mHealth tools offered by payors.