Impact Insights

Week in Review 7/10/15

NEW ICD-10 FLEXIBILITY FOR PHYSICIAN PRACTICES… Earlier this week, CMS and the American Medical Association (AMA) announced what essentially amounts to a compromise on the transition to ICD-10 code sets.  The deadline remains October 1, 2015, and CMS reiterated that a valid ICD-10 code will be required on all claims as of that date.  However, for the first 12 months after the transition, Part B claims will not be denied solely because of the specificity of the ICD-10 code used.  In other words, CMS will not deny a claim just because a physician or practice uses the wrong code – provided the code used is at least from the right family.  An FAQ from CMS is available here.

Impact Advisors’ Thoughts: The first big takeaway here is that this is a joint announcement, as the AMA has arguably been the biggest and most vocal critic of the transition to ICD-10.  The second big takeaway is that the flexibility only pertains to Medicare Part B (outpatient) claims, so hospitals are not impacted by this announcement.

H&HN’s ANNUAL LIST OF “MOST WIRED” HOSPITALS…  One of the key themes in this year’s list was “Optimization,” as H&HN found hospitals are trying to get more out of the data being collected by core IT systems.  For example, 59% of “Most Wired” hospitals in 2015 (compared with 42% of all hospitals) are using population health tools to “empower care management workflow with data driven intelligence.”  Almost three-quarters of Most Wired hospitals report using a revenue cycle system in 2015 that “aggregates and measures cost of care across settings” – compared to 55% of all respondents.  Patient engagement was also a key theme this year, with a significant jump in the percentage of Most Wired hospitals that give patients to access the portal through a mobile app (from 58% in 2014 to 89% this year). Overall, 741 hospitals and health systems (representing a total of more than 2,200 hospitals) responded to the 2015 survey.  338 organizations were named “Most Wired.”

Impact Advisors’ Thoughts: Earning a spot on the annual “Most Wired” list is definitely a nice achievement for a hospital or health system, so congrats to all that were recognized!

PAYERS’ PERSPECTIVE ON HIE… An interesting study in JAMIA finds a disconnect between the vision that payer organizations have for health information exchange and the way HIE efforts have actually developed in the market.  Through interviews with 17 payer organizations, the authors found there was “strong agreement” among payers on the principles that constitute “optimal HIE” – and in the fact that current approaches to HIE fail to adhere to those principles.  However, the authors suggest part of the reason for this disconnect is because payers have largely been reactive to HIE “rather than attempting to shape HIE policies or lead the formation of HIE efforts.”

Impact Advisors’ Thoughts: Discussions about HIE are often just focused on EHR vendors and provider organizations.  Payers are an important – albeit sometimes overlooked – part of the equation too though, and this article does an excellent job of highlighting many of the considerations and challenges unique to the payer perspective.

IN CASE YOU MISSED IT… Becker’s Hospital Review provides an updated list of “50 Things to Know About ACOs – definitely worth a read whether you are following the latest news around ACOs or just trying to learn more about them!