EPtalk by Dr. Jayne 1/17/19

All is not quiet on the Congressional front, with the House Committee on Ways and Means sending a letter to CMS Administrator Seema Verma asking for greater transparency in the development of alternative payment models. The Committee notes that “significant policy changes made unilaterally by the executive branch without sufficient transparency could yield unintended negative consequences for beneficiaries and the healthcare community.”

The letter goes on to note that the Center for Medicare and Medicaid Innovation (CMMI) is tasked with consulting experts in medicine and healthcare management, yet the model development process doesn’t always follow the traditional rulemaking cycle that includes public comments. The letter requests that CMS provide a list of “models under active consideration by the agency,” including timelines, comment periods, etc. and gives the agency two weeks to deliver a response. I won’t be holding my breath to see what CMS says.

The US Government Accountability Office has also been busy, releasing a report this week regarding challenges for matching patient records across provider platforms. The 21st Century Cures Act required the GAO to review current matching practices and ways in which federal bodies might improve things. The report highlights work by the Pew Charitable Trusts to improve matching, including standardization of demographic data such as addresses and how EHRs use that data and exploring how biometrics might assist in matching.

It’s clear that we aren’t going to see a universal patient identifier anytime soon, which makes it incumbent for members of the patient care community (including EHR vendors, hospitals, providers, and payers) to come together and create solutions. Having worked with multiple EHRs, I can attest to the fact that some of them don’t even follow US Postal Service formatting standards for addresses, which boggles the mind since they’re readily available and used in many industries. I’ve seen multiple online retailers use the address formatting technology, so I’d think that my medical records should be at least as important as the breadmaking supplies I ordered recently.

The game is afoot for organizations ready to submit 2018 Merit-based Incentive Payment System (MIPS) data. Those eligible clinicians who participated have until April 2 to get the job done at the QPP website. There is a new system in place with a compound acronym – the HCQIS (Health Care Quality Information Systems) Authorization Roles and Profile (HARP) system will be used.

I’d recommend logging in early to make sure your credentials from the previous Enterprise Identity Management (EIDM) system were transitioned correctly and to register with HARP if needed. On a lark, I checked my participation status using the QPP Participation Status Tool and was surprised to see it list a location where I have never seen patients. I’ll be taking the penalty, so will leave it up to my practice administrator to sort it out.

CMS also announced that the new Medicare card mailing process is complete, and that nearly 60 percent of claims are being submitted with the new Medicare Beneficiary Identifier (MBI) numbers instead of Social Security numbers. The final wave of mailings includes Medicare beneficiaries who live in Canada and Mexico. While the final transitions are being worked out, patients can use their old cards through December 31, 2019, although I hope those transactions quickly become few and far between.

Walgreens is uniting with Microsoft to create so-called “digital health corners” for its retail stores. Walgreens plans to begin using the Microsoft cloud and data centers, which means no business for rival Amazon. Walgreens CEO Stefano Pessina is quoted in the article as saying, “Healthcare is too complicated, too big, and if I can say, a little too messy” thus the need to “team up with many, many different, practically all, the players in this industry.” I guess they consider cosmetics service Birchbox to be an industry player since they’ve signed a deal with it as well. The “digital health corners” will be piloted in a dozen stores and are intended to promote management of chronic diseases along with sales of health-related devices. The deal also includes Walgreens signing on for Microsoft 365 services.

In other retail news, Walmart is breaking with CVS after a squabble over prescription pricing. Patients with CVS Caremark pharmacy plans will have to find other places to pick up their medications, although I suspect other providers can’t possibly compete with the loss of the people-watching opportunities at Walmart. In a confusing twist, Walmart-owned Sam’s Club pharmacies remain in-network, so you can still pick up your bulk items at the same time as your pills.

I’m helping some practices make the move to telehealth and have been poring through the literature looking for data on outcomes from virtual care vs. traditional in-person visits. A recent news release from Massachusetts General Hospital caught my eye, as their work was published in the American Journal of Managed Care. The authors found that video visits maintained the same perceived quality of care and communication as in-person visits, while being found more convenient. Mass General has been doing telehealth for more than a decade, with video visits being offered for the last five years for patients requiring follow-up care. Additional key findings included:

• 79 percent of patients found it easier to find a convenient time for a follow-up video visit compared to an in-person office visit
• 21 percent of patients thought the overall quality of virtual visits was better
• 68 percent of patients scored the video visit at 9 or 10 out of 10, and those ranking it low typically cited technical issues as the reason.

Several of my close friends have reached out about HIMSS preparation, especially wanting to know whether I’m in full party-planning mode yet. Although I’ve received a couple of advanced notices from people who want to be sure their event makes my must-attend list, I really haven’t seen much in the way of invitations yet.

One of my usual HIMSS BFFs is likely not going to attend HIMSS this year. The value just isn’t there and it’s time away from work and family that doesn’t seem very productive any more. I have to admit I’ve had second thoughts about attending due to the cost and the general hassle factor, especially since my practice is being very grumpy about allowing the time away in the middle of flu season and the opening of two new locations. I held my ground on the time off, however, since by not going I’d sorely miss the opportunity for those once-a-year catch-ups that I really enjoy.

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