By: Dan Cobb, Chief Technology Officer, HealthMEDX
The only constant in life is change. LTPAC providers, which include home care agencies, nursing homes, and rehab facilities, face a number of challenges in the coming months and years. This blog is designed as a heads-up for topics that will impact the industry (in no particular order). There are countless other trends, but we’ll focus on three in this posting:
- ICD-10-CM. The replacement for ICD-9 diagnosis codes was originally to be required by CMS in October 2013. But don’t let the delay to 2014 provide an excuse to put off your conversion project. ICD-10 is an entirely different coding structure from ICD-9. For example, primary pulmonary hypertension is 4160 in ICD-9, but I270 in ICD-10. There are 5 times as many ICD-10 codes and they do not match one-to-one with ICD-9. Your clinicians and billing staff will need the extra time to learn the new language and will likely need to convert existing patient records manually.
- Meaningful use. At first glance, meaningful use doesn’t impact LTPAC providers. Hospitals and physicians are required to demonstrate meaningful use of certified electronic health records to receive adoption incentives and to avoid penalties from CMS. Stage one of ONC-ATCB (Office of the National Coordinator for health IT – Authorized Testing and Certification Body) meaningful use is in place now. Stage two (2014) and three (2016) will likely include the requirement for hospitals and physicians to exchange data electronically with LTPAC providers. LTPAC providers that cannot exchange data that conforms to the meaningful use exchange standards may be shut out from hospital and physician post-acute referrals in the future. LTPAC software companies are beginning to certify their products to ensure compliance with future exchange requirements.
- Care coordination. There is a growing movement to coordinate care among not only LTPAC providers but with hospitals, physicians and other providers. A few movements in this area include:
- The upcoming Continuity Assessment Record and Evaluation (CARE) instrument is designed to eventually replace the MDS for nursing homes, the OASIS for home health and the IRF-PAI for inpatient rehab. The CARE assessment will begin in the hospital upon discharge. In LTPAC, additional CARE assessments will take place upon admission, significant change and discharge.
- Re-hospitalization penalties for hospitals will add focus to care coordination among hospitals and LTPAC providers.
- In addition, Accountable Care Organizations (ACOs) are designed to provide coordinated care for Medicare recipients. Standards-based health information change will be necessary to coordinate care.
New data standards, like the longitudinal care plan will emerge to supplement the information that is currently available for exchange.
ICD-10-CM, meaningful use and care coordination are just a few of the many changes taking place in the LTPAC industry. May we live in interesting times.
HealthMEDX’ electronic health record (EHR) HealthMEDX Vision version 7.1.10 has passed Certification Commission for Health Information Technology (CCHIT®) long term post-acute care (LTPAC) inspection, and is a CCHIT Certified® 2011 LTPAC EHR with additional certification for both the Skilled Nursing Facility and Home Health.
HealthMEDX has completed the full certification process including verification of implementation at client sites. “Completing the full certification of HealthMEDX Vision was a top priority across our organization” stated Dan Cobb, Chief Technology Officer at HealthMEDX. “This has been an important focus for HealthMEDX and one we have plans to keep up with as new certification criteria become available in the future.”
This certification has been achieved not long after HealthMEDX Vision 7.1.10 received ONC-ATCB 2011/2012 certification. Details on this certification can be found at http://www.cchit.org/products/2011-2012/arrafinalruleeligibleprovider/3419.
Read the official announcement here.
The only constant these days is change. This is true for the long-term and post acute care (LTPAC) health information technology (HIT) industry as well. The recently enacted Patient Protection and Affordable Care Act (HR 3590, a.k.a. the healthcare reform bill) contained a number of sections relevant to our industry. At the HealthMEDX User Group last month, I provided an outline of the extensive changes that are in store for us. A few examples: Grants will be available for long-term care HIT best practices demonstration and adoption. Payment bundling demonstrations will begin and pay for performance (called value based purchasing by CMS) will move closer to implementation. The bill seems to favor shifting patients from institutional care to home and community based care. Look for consolidation and collaboration among post acute providers as a result.
A remnant from 2009's ARRA Stimulus bill is the required study and report on EHR payment incentives for providers not receiving other incentive payments. The Secretary of Health & Human Services (HHS) is due to provide this report to Congress in June. The LTPAC stakeholder industry is working with HHS to express the importance of adoption incentives for LTPAC providers.
The MDS 3.0 is set to implement in October, however it remains to be seen whether nursing home reimbursement will be driven from RUG-III or RUG-IV. The healthcare reform bill delayed RUG-IV to 2011, but industry groups are lobbying for implementation this October.
LTPAC EHR certification for is in full swing. The Certification Commission for Health Information Technology (CCHIT) LTPAC workgroup has been hard at work for the past year, co-chaired by yours truly. Criteria will consist of core elements (applicable to certified home health, nursing facilities, inpatient rehab facilities, hospice, long-term acute care hospitals) plus criteria specific to certified home health and nursing facilities. Pilot testing for the criteria was conducted in May with publication of the criteria and test script scheduled for June. Starting in July, LTPAC vendors may begin applications to certify their applications. HealthMEDX is planning to certify Vision this summer.
Finally, mark your calendars for the 6th annual LTPAC Health IT Summit at the Hyatt Regency Baltimore Inner Harbor on June 7 and 8. This is the only conference that specifically focuses upon LTPAC HIT. An Interoperability Showcase is included, giving participants the opportunity to see the latest technology initiatives to connect systems and applications. It is a great venue to network with LTPAC HIT thought leaders and to keep up-to-date on recent and future developments. More information on the Summit can be found at http://www.ahima.org/events/ltchitsummit/. HealthMEDX will demonstrate standards-based data exchange in the Interoperability Showcase and I will be speaking in a general session on EHR certification and data exchange standards.
See you in Baltimore.
Dan Cobb, CTO, HealthMEDX