EPtalk by Dr. Jayne 4/6/17

For people breathing easy after completing their 2016 Medicare-related attestations, it’s time to start gearing up for next year. Organizations need to register or update their information via the CMS Web Interface  prior to June 30 if they plan to participate as a group. Organizations that plan to use the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS survey also need to register. There are many other details on who does or does not need to register, so consulting the website and making sure you know whether an ACO or registry will be reporting on your behalf is recommended. For those not breathing easy because they’re still completing 2016 Medicaid-related attestations, good luck! Some states have extended their attestation windows into May.

CMS has also been busy promoting the value of Chronic Care Management, launching a new Connected Care program to raise awareness through the Office of Minority Health and the Federal Office of Rural Health Policy. Connected Care will focus on racial and ethnic minorities along with rural populations who statistically have higher rates of chronic diseases. The new website includes toolkits with detailed information about CCM, resources for implementation, and patient education resources. CCM requires a patient copay, and that has posed a barrier to adoption in my area. Patients already think physicians should be providing these services for free and don’t always understand the value of why CMS is making a push to specifically address the need for services. Although the copay is small, patients living from Social Security check to check and who may be choosing between medication and food are often reluctant to consent to enrollment. Sadly, those can be the patients who most need the services.

CMS has also been busy with its Social Security Number removal initiative. I’m working with my first consulting client on a project to look at how it uses the SSN within the organization and to assess vendor plans to remove the SSN from software systems. There is a new provider webpage, in addition to the main page, for the initiative. Although this program impacts Medicare beneficiaries and the use of the SSN as the de-facto Medicare ID, organizations use the SSN in a variety of different ways. Not everyone is excited about the removal program, as the SSN has also become a proxy for an individual identifier to a large degree. Kind of makes you think about our lack of a national healthcare identifier, doesn’t it?

ONC has updated the SAFER Guides, which are designed to help organizations assess EHR safety and best practices. Topics include organizational responsibilities, contingency (downtime) planning, interfaces, patient identification, clinician communication, and test results reporting/follow-up. I really wanted to review the latter topic, but received an error. There are plenty of practices that need this information. I can’t believe the number of groups I run across that either don’t track their laboratory and diagnostic orders from ordering through completion and patient notification, or track but don’t notify. The era of “no news is good news” should be long gone by now. Patients should never be expected to assume results are normal unless they hear otherwise.

Medicomp Systems announces its Medicomp University event, to be held starting April 24 in Reston, VA. Attendees will gain in-depth knowledge of the Quippe products and how to integrate them into EHRs. I’ve enjoyed watching the Quippe offerings evolve since I first saw it at HIMSS11. If you haven’t seen them, they’re definitely worth a look.

I’m way behind on email again, but it’s been fun to go back and weed through all the premature commentary about the repeal of the ACA. What had us hanging on tenterhooks now seems like a long time ago. For those of you who have never seen them, this is what tenterhooks look like. I’m also catching up on some educational webinars. My new pet peeve is people who use PowerPoint for presentations, but fail to put it in presentation mode, forcing the audience to review shrunken versions of the slides while being distracted by the thumbnail navigation.

I came across this article about what hospitals waste and it’s startling to think about. When patients are discharged, many supplies are thrown out due to concerns about infection control or potential contamination after they’ve been left accessible to patients or visitors. Policies vary dramatically from facility to facility across the country. I’ve worked at places that toss everything and at those where supplies are restocked, and seen all kinds of variations. There’s also the issue of hospitals getting new equipment and needing to get rid of old devices. I once assisted with an effort to send a “gently used” MRI machine to South America – now that was a project.

Scholarly research has been done looking at the problem, with findings that when hospital staff are appropriately incented, waste can be reduced. Many surgeons in one study were unaware of their operating room costs; when they were asked to reduce costs, they met goals where the control group’s costs actually increased. Getting people to be conscious of the true costs of the care provided is central to the concept of value-based care, especially when those costs are obscured, such as costs that are included in a hospital room charge.

During my recent hospitalization, most supplies were kept in a secured cabinet inaccessible to patients and family members, which not only controls costs but reduces contamination and the risk that something would have to be tossed for fear that someone had opened it or otherwise ruined it. Other items that are placed out for every patient (shower products, toothpaste, etc.) are discarded after each patient whether they were used or not, since it’s too difficult to determine if they’ve been opened or used. I specifically asked the staff about this prior to discharge – I hadn’t used anything, since I brought my travel kit with me. But they were going to toss everything, so I grabbed it for a community drive that gathers non-food items to be distributed to food pantries for their clients. You’d think hospital leadership would have considered that when crafting their policies and reached out to a local organization. Maybe they did, maybe they didn’t, but I’m trying to connect the two for some potential community benefit.

What does your hospital do with discarded or excess supplies? Email me.

Email Dr. Jayne.