Site moved to, redirecting in 1 second...

224 posts categorized "Hospitals"

January 29, 2015

Better, Smarter, Healthier: Medicare and Value Based Purchasing

EvolutionThe big announcement this week from Medicare -- setting forth specific targets for a historic shift away from fee-for-service reimbursement in order to reduce costs and improve quality -- is less than it seems.

Medicare has been talking about value based purchasing for decades now, and thus far has taken baby steps towards implementation. Even the strides taken in recent years, and the targets laid out this week for the future, don't really leave FFS medicine in the dust. ACOs and other MSSP innovations don't entirely move away from FFS reimbursement; they just add cost and quality kickers as part of a retrospective reconciliation.

CMS identified four categories of payment and targets related to each of these categories.

  • category 1—fee-for-service with no link of payment to quality
  • category 2—fee-for-service with a link of payment to quality
  • category 3—alternative payment models built on fee-for-service architecture
  • category 4—population-based payment

Continue reading "Better, Smarter, Healthier: Medicare and Value Based Purchasing" »

November 14, 2014

HIPAA: Liability to Private Parties for Violations

Judge flickr ccThis week, Connecticut joined at least nine other states (DE, KY, ME, MN, MO, NC, TN, UT, WV -- see cases cited in the opinion, linked to below) in recognizing that, while HIPAA does not create a private right of action for violation of privacy, it does constitute a standard against which the actions of a defendant in such a case will be judged. In other words, if a covered entity or business associate or downstream contractor releases PHI other than in accordance with HIPAA (i.e., for treatment, payment or health care operations purposes, or to or at the direction of the data subject or his or her legal representative), the breach of the HIPAA rule may be the basis for a finding of a breach of a duty of care in a state court negligence action.

As the Connecticut Supreme Court observed in its opinion in Byrne v. Avery Ctr. for OB GYN, which was released earlier this week:

[A]ssuming, without deciding, that Connecticut's common law recognizes a negligence cause of action arising from health care providers' breaches of patient privacy in the context of complying with subpoenas, we agree with the plaintiff and conclude that such an action is not preempted by HIPAA and, further, that the HIPAA regulations may well inform the applicable standard of care in certain circumstances . . . .

Continue reading "HIPAA: Liability to Private Parties for Violations" »

October 14, 2014

Apple HealthKit - Epic Integration at Ochsner Health System - David Harlow Interviews Dr. Richard Milani

Apple-healthkitThe first health system to announce that it had integrated HealthKit into its Epic EHR is Ochsner Health System in Louisiana. It is a 12-hospital, 40-clinic operation with over 900 physicians. I spoke recently with Dr. Richard Milani, Ochsner's Chief Clinical Transformation Officer. He was enthusiastic about the improvements in clinical outcomes realized to date through homegrown integrations of things like Withings scales, and sees significant expanded potential using the Epic-HealthKit integration including dissemination of data to clinicians for more efficient and effective management of care and presentation of data to patients in a way that may motivate behavior change to improve health status.

Continue reading "Apple HealthKit - Epic Integration at Ochsner Health System - David Harlow Interviews Dr. Richard Milani" »

August 11, 2014

Practice Pointers in the Wake of the Johns Hopkins Hospital Privacy Settlement

An OB/GYN at Johns Hopkins was fired last year after a colleague reported her suspicions about a "pen-like device" that was always around his neck, and that turned out to be a camera. He had secretly photographed 7,000 patients over ten years while conducting pelvic exams. Ten days later he committed suicide. Last month, the hospital agreed to settle the class action lawsuit brought by patients whose privacy had been violated for $190 million.

Continue reading "Practice Pointers in the Wake of the Johns Hopkins Hospital Privacy Settlement" »

May 23, 2014

The Affordable Care Act: How Provider Organizations Can Succeed Under Health Reform

The Affordable Care Act has triggered many changes in the health care delivery system. Learn about the health reform-inspired approaches to redesigning care that work (or don't work) for management of chronic conditions, including diabetes -- from ACOs to bundled payments to patient centered medical homes.

I recently had the opportunity to present to the domestic affiliates of Joslin Diabetes Center on this topic.

Continue reading "The Affordable Care Act: How Provider Organizations Can Succeed Under Health Reform" »

April 24, 2014

Hospital Readmission Data for All Payors

HCUPEfforts to reduce hospital readmissions have been focused on a handful of diagnoses and on government payors (primarily Medicare). In order to get a handle on the roughly 15% of the U.S. health care spend that goes to readmissions, it is vital to have a better understanding of what these readmissions are for, who is experiencing them, and why. Not every readmission is a preventable readmission -- though health reform wonks are pretty highly focused on preventable readmissions for specific diagnoses (starting with acute myocardial infarction, heart failure and pneumonia).

Here's the data from 2011, thanks to HCUP (the Healthcare Utilization and Cost Project) at AHRQ:

Continue reading "Hospital Readmission Data for All Payors" »

February 26, 2014

HIPAA compliance audits coming; bits of detail emerge. Get ready now!

HIPAA cad logoOCR planning for the next round of HIPAA compliance audits continues.

A new information collection request will be filed soon (two months from now or so), according to the HIPAA audit questionnaire burden estimate published Monday, February 24. (H/T Art Gross, HIPAA Secure Now.) The filing shows that OCR intends to administer 1200 questionnaires to a mix of covered entities and business associates. The questionnaires are estimated to take 30 minutes to complete.

Once those questionnaires hit the street, the full force of OCR will not be far behind. In light of the latest multimillion dollar HIPAA penalty -- this one levied by the Puerto Rican government against an organization that might actually be around long enough to cough up the big bucks, as opposed to Cignet (and there's no telling what OCR might do in addition to that) -- let's just say it behooves all covered entities and busienss associates out there that have not yet put their house in order from a HIPAA/HITECH compliance perspective to do so now.

Do not pass Go. Do not collect $200. Go directly to: HIPAA Compliance.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

October 10, 2013

Google Glass in Surgery: Hangout on Air

HOA: Google Glass in Surgery

I took part in a Google+ Hangout On Air yesterday hosted by Kathi Brown on the use of Google Glass in surgery.

Host:  Kathi Browne
Glass Explorer and Healthcare Social Media Evangelist


Dr. Heather Evans
Trauma/General Surgeon and Assistant Professor, University of Washington

Jacob Friedman
Project Manager for Epic Systems

Ismail Nabeel
Glass Explorer in Surgery at Ohio State

David Harlow
Healthcare Lawyer and Consultant for The Harlow Group LLC

Check it out!

I'll be speaking with Kathi via Hangout on Air Sunday October 20, 8 pm ET, about the current HIPAA/HITECH landscape. See you then.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

September 20, 2013

Upcoming Speaking Engagements and Conferences

Friendship Pins No 89 David HarlowYour faithful HealthBlawger will be out and about at a number of conferences and events over the next month or so, mostly in Boston, speaking, moderating and just hanging out ("on air" and in real life).

I hope to see you at one or more of these. See descriptions below for links to registration and in some cases, discount codes.

Keep an eye out for "Friendship Pins" -- my jacket from The Walking Gallery, pictured over there to the left -- and I will be in or near it.

If you are organizing a conference a little further down the road, please consider including me as a keynote speaker or otherwise. We should talk.

StrataRx: Where Big Data Meets Healthcare

September 25-27, 2013, Boston, MA

Discount code: HARLOW will get you 20% off registration.

I'll be speaking in the data liquidity track on patient consent to use of data and holding office hours.

Continue reading "Upcoming Speaking Engagements and Conferences" »

August 26, 2013

Leverage: Preventable readmissions and a recent OIG advisory opinion

MM900323824Medicare's excess readmission penalty policy (up to a 1% ding in IPPS Medicare payments to hospitals that have excess readmissions for acute myocardial infarction, heart failure and pneumonia in FFY 2013, going up to 2% in 2014 -- and adding in measures for hip and knee replacements and acute episodes of COPD patients -- and 3% thereafter) has resulted in some hospitals experiencing multimillion-dollar pay cuts. Over the next couple of years, the potential exposure will triple, upping the ante from the relatively low stakes hospitals have faced thus far.

The excess readmission penalty program (if the penalties are high enough) will force hospitals to become enmeshed in post-discharge care to a degree not hitherto seen in the FFS world. This is of a piece with leverage exerted by other health reform innovations. For example, the cost and quality improvements called for in the ACO program will lead health systems to apply changes to management of all patients' care, not just Medicare patients' care (because running multiple parallel systems is impractical). In essence, by design or otherwise, various aspects of health reform and financial incentives attached to them require greater integration of effort across previously more-disjointed elements of the health care "system," as well as departures from the traditional FFS mode of thinking and acting.

Continue reading "Leverage: Preventable readmissions and a recent OIG advisory opinion" »