Impact Insights

Week in Review 11/4/14

The final version of the 2015 Medicare Physician Fee Schedule includes payment for telehealth and chronic care management services.  CMS added a scope of service element to the final version of the Medicare Physician Fee Schedule for Calendar Year 2015 that would require providers who bill for Chronic Care Management services (a new reimbursement item) to use certified EHRs and patient-centered electronic care plans for demographics, problem list, meds, allergies, a structured clinical summary record, and use of that technology to manage care transitions.  The schedule also provides payment for several types of telehealth visits including annual wellness and psychotherapy.

Impact Advisors’ Thoughts:  Medicare’s movement toward payment for both chronic care management services and telehealth signals further movement toward payment for services that improve “value.”  Commercial payors are likely to follow suit in the near term.  Expect to see continued increase in use of telehealth services.  It is also likely that more healthcare systems will embrace chronic care management as this, as well as other CMS programs, encourage population health.

 

Surescripts announces Surescripts Complete EPA, which allows electronic prior authorization.  Epic will make the solution and DrFirst will make the solutions available to providers using their solutions.  Complete EPA proactively informs prescribers of medications requiring prior authorization in the workflow of electronic prescribing.  It enables real-time information exchange between providers and pharmacy benefits managers.  In some cases the approval status is known before the patient leaves the office.

Impact Advisors’ Thoughts: A 2009 study published in Health Affairs reports that provider interaction with health plans costs $23-$31 billion a year. Physicians spend an average of eight hours a week at an annual cost of $7,000 on forms, faxes, and phone calls for prior authorization; and prior authorization has long been the weakest link in the e-prescribing process.  Not only does the prior authorization process generate huge administrative costs, the delay causes 20%-30% of patients to lose interest in therapy and to abandon prescribed medications at the pharmacy.

Electronic prior authorization is a huge step forward in Health Information Exchange between providers and health plans that holds great promise to improve care while decreasing costs.

 

Uber, the mobile app that allows you to order a private driver from your phone, recently took its first step into healthcare delivery.  Uber leveraged the reliability and efficiency of the Uber platform to launch a one-day pilot program, UberHEALTH, in partnership with Vaccine Finder to allow users in Boston, Washington DC, and New York City to order free flu shots this past Thursday from 10 a.m. to 3 p.m.  Uber users were able to order up to 10 shots in one location. The company’s drivers took Registered Nurses to the site to administer the shots. Though some people did receive shots, some consumers who tried to take advantage of the promotion faced hurdles.

Impact Advisors’ Thoughts: There were obviously challenges with Uber’s flu shot pilot, however the pilot speaks to a quickly-growing trend toward the desire to increase mobility in healthcare with “just in time” scheduling.  With the resurgence of house calls,  growing telehealth industry, and innovations like UberHealth it seems that the race is on to develop further disruptive innovations to reach people where they are; meeting the consumers need for healthcare that is convenient and cost-effective.

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