Tuesday, April 8, 2014

How Is your Organization Administering and Managing Health Risk Assessments?

Launch HRA

Patient Centered Health Risk Assessments are a valuable tool that can be used to identify and capture opportunities for prevention, identify injury risks, reduce modifiable risk factors, and alert providers of an urgent health need.

How are you ensuring that all of your patients complete an annual HRA?

 The Patient Protection and Affordable Care Act of 2010 included several provisions intended to improve the health of Americans and prevent the onset of preventable chronic conditions.

Section 4103 of the ACA, establishes a Medicare Annual Wellness Visit beginning in 2011 that includes a Health Risk Assessment (HRA) without cost to beneficiaries.

Other provisions of Section 4103 include:

·         Establishing standards for interactive, telephonic, or web-based programs used to furnish HRA’s, and

·         Determining ways of using the HRA in the formulation of a personalized prevention plan for beneficiaries.

The law also requires that HRA’s are easily accessible to beneficiaries and that support is provided to those wishing to complete an HRA.

The statute recognizes the critical nature of follow up services by encouraging integration of HRA’s with health information technology (HIT), including electronic medical records (EMR’s), and personal health records (PHR’s) and by leveraging these technologies in developing patient self-management skills and by the management of, and adherence to, provider recommendations, as a means of improving the health of beneficiaries.

In addition to regulatory encouragement, HRA’s offer providers an opportunity to engage with Medicare members in new ways while tackling the benefits of prevention.

Consider the value of administering and managing your HRA’s through a “Learning Health Care System”…

One where personalized assessments, and prevention planning would be available anytime, anywhere, and on any device.

One where experiences are captured, stored, and then used to create individualized learning pathways that promote health literacy, prevention and chronic disease self-management.

Imagine the possibilities!

Click on the image above to launch the new HRA Experience from mHealth Games.

Lawmakers look to expand, regulate telemedicine in Florida, but House Senate bills far apart

MIAMI — The calls may come in the middle of the night and from hospitals more than an hour away. Someone is having a stroke and is en route an emergency room in the Florida Keys, but there aren't any neurologists on call.

Within 15 minutes, a University of Miami neurologist pops onto a computer screen and can order an IV drug that should be given within three hours. It's that sort of potentially life-saving technology that some lawmakers say will drive down health care costs, while also addressing serious doctor shortages around the state.

A Senate bill would increase the use of telemedicine in Florida and establish requirements for health providers who treat patients remotely. A companion bill is also making its way through the House, but that bill doesn't require doctors to have a Florida license — only that they be licensed in their home state and registered in Florida.

"If we didn't have an access problem we wouldn't be here today ... everyone would rather see the doctor face to face, but when your mother is having a stroke in rural Florida and the choice is having a doctor via telehealth versus having no doctor," said Rep. Cary Pigman, an emergency room physician who supports the bill.

The Senate bill requires doctors providing telemedicine services to patients within the state to be licensed in Florida or meet an alternative requirement. For example, an insurer using a doctor that's in-network in another state would also be allowed to treat a Florida patient. The bill recently passed a Senate committee, but has two more stops before it's heard on the floor. Dozens of other states have passed legislation supporting telemedicine.

The Senate bill also would require Medicaid to reimburse for telemedicine services and allow doctors to negotiate payment rates with insurers. The House bill doesn't address payments.

"If you're a patient in Florida and you have a specific heart defect and the guru is a doctor in Philadelphia, you should be able to consult with her," said Republican Sen. Aaron Bean, who is championing the bill.

But critics worry that requirements for doctors in other states could compromise patient care. Some say that doctors practicing telemedicine in Florida should be licensed here.

"It may be the wave of the future, but I still think we need to concentrate on the patients and the bottom line is these (out of state) doctors are not licensed in Florida so they don't have the same accountability," said Sen. Dorothy Hukill, who voted against the bill.

Bean said they will be held accountable through the insurance company or the doctor's network they practice within.

Rep. Gayle Harrell, voted for the bill, but noted it still has problems.
"I also need to know what my recourse action should be should some malpractice incident take place," she said.

She also wants to see a website created where people can find information about the out-of-state doctors who may be treating them. After all, she noted, patients can't walk into the office of an out-of-state doctor and see medical degrees on the wall.

The Florida Chamber and several other groups, including ones representing nurse practitioners, physician assistants, nurses and pharmacists all support the bill.

But the powerful Florida Medical Association is strongly opposed, worrying it doesn't require treatment by a licensed Florida physician or mandate a review of the patient's medical history. The organization said such technology holds great promise, but does not support the bill in its current form.

"This will revert Florida back to the days of the Wild West where anyone with a bottle of whiskey, a pocket knife and Skype can practice medicine. That's what happens to the bill in its current form, said David Custin, a lobbyist for the group.

Several hospitals around the state have had success with telemedicine in recent years, helping patients in rural areas connect to specialists or getting multiple consultations conducted simultaneously for acute emergency cases. University of Miami neurologist Dr. Gustavo Ortiz has done more than 600 consultations since their program's inception in 2009.

Telemedicine saves money by reducing hospital and ER admissions and doesn't require medical transportation, supporters say.

Dr. Kim Landry, an emergency room physician and EMS medical director for four counties in the Panhandle, began a pilot program where 911 responders connect patients remotely to an ER doctor for a quick evaluation.

"Eight out of 10 times, they don't require transport to the hospital, so in a lot of cases, it's made life easier for a lot of sick patients," said Landry, who found those results after testing the program in nursing homes.

During a recent consultation, University of Miami dermatologist Dr. Anne Burdick asked an assistant at a Fort Pierce county health clinic to zoom the camera in on some scaly, white patches on a 10-year-old boy's legs. The boy is often kept indoors and complains of constant itching at night. Burdick, who diagnosed him with eczema, modified his prescriptions and added a monthly bleach bath to reduce bacteria. The boy was one of five pediatric patients seen remotely from her Miami office that day.

Burdick, who estimates 40 percent of her practice includes telemedicine patients, also does medical consultations for two cruise lines, the Indian Health Service and a weekly program for school children.

"For some areas in the state, it's going to be impossible to get specialists to that area and so telemedicine is really the best option, " said Burdick. "The bill will be a really good step forward for Florida."


Previous Medicaid expansions by states did not erode perceived access to care

Bottom Line: Previous expansions in Medicaid eligibility by states were not associated with an erosion of perceived access to care or an increase in emergency department (ED) use.
Background: In January 2014, the Patient Protection and Affordable Care Act (ACA) expanded Medicaid eligibility so coverage in the public insurance program could be offered to more low-income Americans. However, some have suggested that the demand for medical services created by Medicaid expansion may erode access to care for individuals already enrolled in Medicaid, which can be restrictive.
How the Study Was Conducted: The authors examined previous Medicaid expansions to gauge self-reported perceptions of access to care and the use of ED services by enrollees. The authors examined data from 1,714 adult Medicaid enrollees in 10 states that expanded Medicaid between June 2000 and October 2009, and from 5,097 Medicaid enrollees in 14 bordering states that did not expand Medicaid.
Results: In Medicaid expansion states, the proportion of Medicaid enrollees reporting poor access to care declined from 8.5 percent before the expansion to 7.3 percent after the expansion. In the control states where Medicaid was not expanded, enrollees reporting poor access to care remained constant at 5.3 percent. The proportion of Medicaid enrollees reporting emergency department use decreased from 41.2 percent to 40.1 percent in expansion states and from 37.3 percent to 36.1 percent in states that did not expand Medicaid.
Discussion: "We found no evidence that expanding the number of individuals eligible for Medicaid coverage eroded perceived access to care or increased the use of emergency services among adult Medicaid enrollees."
Authors: Chima D. Ndumele, Ph.D., of the Yale School of Public Health, New Haven, Conn., and the Brown University School of Public Health, Providence, R.I., and colleagues.
JAMA Intern Med. Published online April 7, 2014. doi:10.1001/jamainternmed.2014.588.

Editorial: Health Insurance is Not Health Care

In a related editorial, Mitchell H. Katz, M.D., director of the Los Angeles County Department of Health Services and a deputy editor of JAMA Internal Medicine, writes: "The Congressional Budget Office estimates that by 2022 there will be 12 million new enrollees into Medicaid. Although this is an unprecedented leap forward in providing low-income Americans with health insurance, it is important to remember that health insurance is not health care. Health insurance is a financial mechanism for paying for health care. It is not the care itself, or even a guarantee of care."
"The gap between health insurance and health care can be particularly challenging for many Medicaid recipients to bridge. Studies have shown that a substantial proportion of physicians do not accept new Medicaid patients," he continues.
"Therefore, amid the optimism that millions of previously uninsured persons will gain Medicaid coverage, there is a fear that the newly insured will not be able to find physicians who will care for them, or that the influx of new enrollees will make access harder for those persons who already have Medicaid. In this vein, the results of the study by Ndumele et al in this issue of JAMA Internal Medicine are reassuring," he notes.
JAMA Intern Med. Published online April 7, 2014. doi:10.1001/jamainternmed.2014.598.