The Slippery Slope: The Regulatory Landscape and HIMSS Response for Ambulatory Care Providers

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The Slippery Slope The Regulatory Landscape and
HIMSS Response for Ambulatory Care Providers

• Sue Sutton, RN, PhD
• President and CEO

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The Full Spectrum of Care Settings
Hospital Outpatient Departments
Large Group Practices
Critical Care Units
Inpatient Med/Surg Units
Small Physician Offices
Mark Leavitt, HIMSS Presentation to BOD, 4/2/04
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Contrasts Ambulatory Care vs. Acute Care
Critical Care Units
Inpatient Med/Surg Units
Hospital Outpatient Departments
Large Group Practices
Small Physician Offices
Acute Care
Ambulatory Care
Sources Health Affairs W4-79, 2003 NAMCS
Report, CDC, 2002
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Comparing Health Expenditures
Hospital Outpatient Departments
Large Group Practices
Critical Care Units
Inpatient Med/Surg Units
Small Physician Offices
Acute Care
Ambulatory Care
Source Health Spending Projections, Health
Affairs W4-79, 2003
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The IT Vendor Market
FinancialFocus
ClinicalFocus
Hospital Outpatient Departments
Large Group Practices
Critical Care Units
Inpatient Med/Surg Units
Small Physician Offices
Acute Care
Ambulatory Care
Mark Leavitt, HIMSS Presentation to BOD, 4/2/04
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HIMSS Responds.

• 2004
• BOD allocates resources focused specifically on
  Ambulatory Care
• Creates the Ambulatory Care Steering Committee
• Hires Mark Leavitt as Director of Ambulatory Care
• 2005
• Ambulatory Interoperability Showcase at National
  Meeting in Dallas
• Creates a Knowledge Resource Taskforce for
  Ambulatory
• Launches Ambulatory Section of HIMSS Website
• PACT Conferences
• Ambulatory Care Audio conferences
• 2006
• Ambulatory IT Showcase
• More.

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The Government is Interested in Ambulatory Care
too.
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What was the catalyst?

• IOM Report 2001 Crossing the Chasm
• Indicated that 45-90,000 patients were dying
  annually due to errors and omissions in hospital
  care
• Recommended the implementation of HIT to resolve
  problems of
• Patient identification
• Errors in transcription
• Medication errors
• Suggested the implementation of EMRs would
• resolve many of the quality issues in HIT

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What happened next?

• Not much!
• Slow adaptation of EMRs
• Why?

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What is happening in US Healthcare

• Adoption of EHR moving rapidly in large
  organizations
• Slow adoption in rural/small provider locations
• Market is setting out to a few big vendors
• Healthcare costs are sky rocketing
• RHIOs everywhere!

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RHIOs Everywhere

• Regional Health Information Networks (RHIO) are
  forming in every region of the country
• Over 150 documented to date
• Attempting to create regional sharing of EHR
  between providers/organizations
• Key Barriers
• Interoperability
• Standardization
• Method of Identifying Patients

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State of US Ambulatory Care

• 2005 survey of sicker adults in Australia,
  Canada, Germany, New Zealand, United Kingdom and
  US
• Sizable shares of patients in all 6 countries
  report that mistakes occur outside the hospital
• US stands out for inefficient care and errors and
  is an outlier on access/cost barriers

Health Affairs, Nov. 3, 2005, Taking the Pulse of
Health Care Systems Experiences of Patients
with Health Problems in Six Countries.
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Key Drivers for Legislation

• Improve patient safety and patient outcomes
• Promote information and communication technology
• Create a system and culture of quality
• Enhance individual patient knowledge,
  responsibility and power to choose

Newt Gingrich, HIMSS Summit, NYC June 6, 2005
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Saving Lives and Saving Money

• Newt Gingrichs Center for Healthcare
  Transformation
• Three parallel layers of health transformation
• Individual Change
• Institutional/Provider Change
• Science Changes Everything
• We must begin to say YES,IF, not NO, BECAUSE

Newt Gingrich, HIMSS Summit, NYC June 6, 2005
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Its been a busy year for legislators.

• Jan. 2005 President pushes the healthcare agenda
  focus on an improving the health of Americans
  while keeping the economy competitive
• June 6, 2005 Secretary of Health and Human
  Services announced the formation of an American
  Health Information Community (AHIC)
• AHIC to serve as a national standards and policy
  body to recommend to the federal government how
  to achieve interoperable EMRs that assure privacy
  and security.
• We are TURNING THE BIG WHEELS

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AHIC

• Announced the pending release of four RFPs to
  address foundation issues
• Standards Harmonization - single contract to
  develop, test and evaluate prototype standards
• Certification single award contract to evaluate
  the feasibility of an EMR certification and
  inspection process
• Prototypes for an Internet-based NHIN
  Architecture six awards for prototypes of
  interoperable nonproprietary NHIN architectures.
• Privacy and Security Solutions for Health Data
  Exchange Determine challenges and solutions for
  achieving smoother transmission of healthcare
  data.

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So, where are we today?
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October 20th

• David Brailer, MD of HHS says
• There is a new debate about who will control
  health information. I want it to be the patient.

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October 4 - HIMSS Government Relations Roundtable

• Rep. Jon Porter (R-NV), is planning to introduce
  as legislation which would turn the Federal
  Employees Health Benefits Program (FEHBP) into
  the nations largest EHR demonstration project
• introduce a bill that would mandate the creation
  of an EHR for every person covered by FEHBP,
  which amounts to about 4 million current and
  retired federal employees.
• Each person covered would get a wallet-size EHR
  identification card within five years of the
  laws enactment.
• The bill would phase in the EHR requirement,
  beginning with records of claims paid by the
  participating insurance companies.
• It is expected that the bill, to be called the
  Federal Family Health IT Act, also would provide
  for reductions in liability insurance premiums
  for physicians who use health IT systems.

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October 31st - HHS Details Regulatory
Agenda

• A final rule, expected in March 2006, giving safe
  harbor for certain electronic prescribing
  initiatives under the federal anti-kickback
  statute. This will enable hospitals and others to
  give physicians non-monetary remuneration--such
  as hardware, software and training--to assist in
  adopting electronic prescribing.
• A final rule, expected in October 2008, to create
  exceptions in the physician self-referral
  prohibition. This will enable hospitals and
  others to assist physicians with adopting
  electronic prescribing and other electronic
  medical records components. Federal officials
  recently said some rules to lift regulatory
  barriers would be delayed until certification
  programs were in place for various electronic
  records components.

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October 31st - HHS Details Regulatory Agenda

• A final rule, anticipated in February 2008, to
  require
• Medicare Part D plans and Medicare Advantage
  Plans to
• support electronic prescribing and adopt
  initial related
• standards.
• A proposed rule, slated for June 2006, to
  establish a
• standard unique national health plan identifier
  under the
• HIPAA administrative simplification provisions.
  
• A final HIPAA administrative simplification
• enforcement rule, anticipated in February 2006.
  

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October 31st - HHS Details Regulatory Agenda

• A proposed rule, expected in May 2006, to make
  annual modifications to the standard electronic
  transactions and code sets mandated by HIPAA.
• A final rule, slated for September 2008, to
  establish national electronic standards for
  claims attachments.
• A final rule, expected in December 2006, to
  implement requirements for electronic submission
  of Medicare claims and conditions upon which a
  waiver could be granted.
• A proposed rule, slated for September 2006, to
  permit release of Medicare beneficiary-specific
  information--upon patient consent--from quality
  improvement organizations to clinicians who are
  in a "treatment relationship" with the
  beneficiary.

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AHIC Contracts Awarded Nov. 11, 2005

• 18.6 M in contracts awarded to four consortia to
  build prototypes for a nationwide health
  information network
• Govt. through DOD, Veterans Affairs and agencies
  such as the Centers for Medicare and Medicaid
  Services will develop an ARCHITECTURE based on
  the prototypes

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The Winners - Four Consortiums

• Accenture working with vendors and partners in
  the Kentucky, Tenn. and West Virginia health
  market areas
• CSC working with vendors and partners in Indiana
  and California
• IBM working with vendors and partners in New York
  and North Carolina
• Northrup Grumman working with vendors and
  partners in Santa Cruz, Cincinnati, and Cleveland

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Their Charge

• Design and implement a standards-based network
  prototype
• Test patient identification and information
  locator services user authentication, access
  control and other security protections
• Test the feasibility of large-scale deployment
• Inform the deliberations of AHIC

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HIMSS is responding

• CMS Role on Developing the Personal Health Record
  (PHR)
• Physicians Referrals to Health Care Entities
  with Which They Have Financial Relationships
  Exception for Certain Electronic Prescribing and
  Electronic Health Records Arrangements
• A response is required almost weekly..

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What can HIMSS Members Do?

• Understand how these initiatives affect you and
  your work environment
• Work with your local chapter to craft responses
  to the proposed legislation
• Watch the HIMSS news
• Attend PACT conferences
• Stay tuned!

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Contact Information

• Sue Sutton, RN, PhD
• President and CEO
• 512-330-9584
• ssutton_at_towerstrategies.com