The first OCR fine for 2017 was issued to Presence Health for delay in notifying 836 patients of a breach experienced in 2013. Presence Health met the requirement of notifying HHS of the breach within 60 days after the end of the calendar year in which the breach is discovered (notification took place January 31, 2014).
There have been many articles written about the need to investigate a potential breach, and establish what happened, how it happened and do a thorough job in getting as complete as possible, the names of all individual affected by the breach so that notification can take place. What you don't want to do is forget the breach notification rule that states that for a breach of any size, patients must be notified "without unreasonable delay, but in no case longer than 60 days." Certainly, there are a few exceptions like law enforcement delay and other rare situations, but the rule is clear.
The fine is significant enough, but remember that along with the OCR fine, generally comes a corrective action plan (CAP). In this particular case, there was a requirement to revise existing policies and procedures related to the Breach Notification rule. Training materials would also need to be updated and provided to appropriate workforce members with documentation of the date the training was provided. Evidence of compliance with the CAP is always required.
A couple of key takeaways include noting that the OCR will investigate all breaches and that it generally takes a good bit of time for the OCR to make their determination based on information requested and provided. The fine, if infractions are identified will follow and the CAP will take resources and an investment on the facility's part. Breaches and their impact are significant and the financial costs associated with them run deep.
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HIPAA Compliance audits are scheduled to resume later this year with an anticipated 1,200 to be conducted between 2014 and 2015. The word is that 800 covered entities will be audited and 400 will be completed for business associates. The interesting twist is that covered entities will be asked to provide names of their business associates and it is anticipated that the selection may come from this submission.
The initial round of audits was referred to as "friendly" audits, conducted by KPMG, a contractor for the OCR. This round will be manned by OCR staffers who, as we speak, are being trained for this mission. Important for all interested parties to keep in mind that the funding for this project will come from fines assessed based on organizations who have failed to prepare properly for HIPAA compliance.
Since over 25 million dollars in penalties have been assessed thus far due to "willful neglect," meaning disregard for attempting to comply with the requirements of the final rule, it can be reasonably expected that OCR auditors will be swift to levy fines for those who have failed to take steps to prepare.
We've been given ample time to prepare. After all the HITECH Act of 2009 laid the foundation for business associate compliance and the Final Rule was published in January 2013. So for all the procrastinators out there, the clock is ticking at a heightened pace and you cannot delay any longer. Get the facts, scale up or down to the size of your organization and just get it done!
In a couple of recent articles that are not connected, there is an underlying connection. One, in "For the Record" discusses The Hazards of Note Bloat and the unintended consequences of having a lot of information that doesn't truly say much about the complexity of the patient's condition, not to mention that it is "difficult to view, notes lengthen and errors accumulate." But wait, aren't EHRs supposed to reduce errors? The article goes on to explain how narrative (dictation/transcription) notes have been reduced, but not completely eliminated. It also discusses speech recognition and its implementation this month.
The next article talks about the value of outsourcing as a cost-savings process to reduce costs and how this is happening in a big way in Canada. This model has been shown again and again to be cost effective and many hospitals across the US have already embraced this practice to help reduce costs.
In yet another article, 3 major healthcare groups were identified as having caught the financial flu and are not doing particularly well at this time.
In reviewing the 3 unrelated articles, it became apparent that there may be a myopic view of how to balance reducing costs with optimal EHR utilization. Consider this. EHRs are here to stay. We need them and the value they bring to healthcare overall. What we don't need is documentation that doesn't improve the quality of the patient encounter. We need streamlined, content-rich, not bloated notes that drone on endlessly with what the previous note stated. We need to optimally enable physicians so they have the time to see a growing patient population, not spend endless hours doing their own data entry. We also must get the level of detailed specificity now that will be needed as the ICD-10 date edges ever closer. Healthcare organizations must be fiscally healthy enough to provide care and continue to be viable as baby boomers get to Medicare age. So yes, they do absolutely need to cut costs in the right places but keep those that enhance their revenue capabilities.
Here's the conundrum in summary. If healthcare organizations and hospitals focus only on reducing costs at the expense of eliminating medical transcription/editing, they are using a tunnel vision approach that will reduce costs but will simultaneously fail to optimize reimbursement. Complete, detailed documention renders optimal coding, which leads to appropriate and optimal reimbursement. If this process becomes muddy through "note bloat" or abbreviated input from extremely busy clinicians, the revenue cycle process may breakdown and the endless cycle of trying to reduce costs and not optimize documentation will continue.
Stop the broken cycle of cost-cutting measures as the only option. It's time to see the bigger opportunity and realize the value gained in the outsourced model of quality dictation/transcription and speech editing process to capture all the details needed for ICD-10 today. This can get healthcare organizations over the financial flu and on the road to recovery. By adopting a practice of excellent documentation practices, these 3 unrelated items can become related in a way for long-term success with the EHR and improve patient outcomes as one of the most important goals.
While EHRs are going in rapidly across the country, it's important to remember that the demand for value in reducing costs, improving patient safety and providing access to more Americans still leads the charge when it comes to why we move to electronic systems in health care. One of the best ways to enhance the value in EHR systems data mining and research is to keep a robust, detailed record of each individual patient who has a unique history unlike any other. Medical transcription/editing captures details provided by clinicians that are crisp and precise filled with data and information that can get us to the goal of improved patient outcomes through the application of secondary healthcare data. There are a number of reporting agencies that are making results available to anyone who is interested in taking a look. Organizations like the Leapfrog Group, Health Grades, Bridges to Excellence along with a score of others, provide information on various diseases and outcomes. Some secondary data use reporting is required such as core measures reporting. And when I say required, I mean that there is a 2% penalty in market-basket outcomes if you choose not to report. It is probably reasonable to anticipate that the number of hospitals reporting outcomes and the agencies to which they report will also increase. This is why it is a key fundamental and logical approach that the use of dictation and medical transcription or medical editing with speech recognition tools will be the best way to capture these necessary details and be able to produce content-rich results when reporting outcomes to continuously improve care. Nine of 10 Healthcare executives agree in a survey conducted by Pricewaterhouse Coopers (PWC) that secondary use of health information will significantly improve the quality of care and that those benefits will improve in the future. A clear two/thirds anticipate a huge increase within the coming two years. (1) Consider the AMIA findings of the gains that can be made from the expansion of knowledge about diseases, treatments and make strides in public health along with advances in privacy and security. (2) There is much to be gained as we move into this era of using secondary data to advance healthcare and this can best be achieved if we continue to capture the details provided by clinicians through the dictation and interpretation process. The outcomes, however, will only be as good as the content from which the information comes - that's why dictated/transcribed reports are a gold mine of information. To in any way short-cut details will severely limit the wide-range of benefits.
We have talked about change - now let's shift the focus to another word that we must keep close at hand and that's "hope." In difficult times when the economy is down, it's hard to remain hopeful when the headlines are less than encouraging. But if you have your health, a job, and a place to live, you are ahead of about 1/3 of the world's population. We've heard growing up that it is so important to be thankful for all we have, but often it is easier to see what we don't have and what would be nice to have and we lose focus on all that is right with our lives, our jobs and our future. The other day, I signed up online for a 401K plan with my employer. It was a great process and the 401K plan itself is a great one with a well-known company with many offerings. But I was less than excited to see the return rate of the investment choices. All but 2 were in negative numbers (and had been for longer than 2 years) and the 2 that weren't were less than 2 points each. Pretty discouraging and I nearly considered not signing up. But then I got to thinking that this big economic situation we are in won't solve itself. It is going to take each of us to do a few things to help us turn this thing around. We have to keep on moving forward every single day. So where do we find hope? Suggestion #1. Watch President Obama on Wednesday night, 7/1 during his live Town Hall meeting. Better yet, submit a question and get involved. I agree that we can't fix the economy without fixing healthcare at the same time - it is too great an issue and this is something that not only affects everyone, it costs everyone. Let's get it solved. Suggestion #2. I read somewhere recently that we have to give up all hope of creating a better yesterday. Yesterday is gone, but there is still time today to be the best you can be, make a difference for someone else, contribute where you can, and take a first step of many to have a hopeful, realistic tomorrow. Tell someone you appreciate them and ask your boss how you can help your company be more successful. You may be surprised at the response. Suggestion #3. No matter your current situation, challenge yourself to create a positive outlook for tomorrow. Rather than seeing things as hopeless, envision that this is a difficult situation and then set out to make tomorrow better than the day before. Ask yourself what should I do next to get back on track. We cannot undo the past and we also should not worry about the future. The past is gone, the future is not here yet, but our opportunity today is large and alive. Healthcare reform will happen. We have had the opportunity to speak to the decision-makers about meaningful use and we have continued to speak up and our voices are being heard. What if we all decided that the most important thing we could do is work together as a profession and help healthcare decision-makers realize how valuable our contributions are? What if we help make the point that healthcare reform can take place better with us meaning that EHR systems are in use, nationwide with narrative text? What if we decided that the issues we sometimes take issue with in this profession are really not big issues at all? What if we all finally realized that as healthcare evolves, we need to be right in step with it and engage in the process? That's meaningful use of all of our time. That would spell a very hopeful future!
Have you heard of the Health Story Project? Have you heard about CDA4CDT? Perhaps you have heard about the +20 billion dollars (and likely more) set aside for health IT as part of the stimulus package for economic recovery and healthcare reform? Maybe you have heard that the EHR is targeted for nationwide implementation by a goal date of 2014? If you answered yes to any of these questions, then every MT will want to learn more about the Health Story Project. Here's why. One of the objections to narrative text in the EHR is that it is not searchable or minable for data research. Because currently, it is in free-form without an established standards and formats it does not lend itself well to easy tagging for search processes (more). A shift to templated systems or point and click technology alone cannot capture the relevant details and unique circumstances of each patient admission. Something that we can all agree on is that the potential to improve patient care, reduce costs, eliminate redundancy in testing and to gain efficiencies via e-prescribing absolutely exists by migrating to electronic records. The best way to do that and keep the details present, to ensure that DRGs continue to be optimized and to ensure that patient safety comes first, Health Story provides that process. The Health Story Project by way of CDA4CDT (clinical documentation architecture for common document types) is a process that allows narrative text to be translated in the EHR as searchable, retrievable text. Since more than 80% of physicians prefer dictation and transcription as the method of choice for documenting patient encounters, this process is the way to ensure that the continuation of dictation and transcription will be able to deliver the structured text research outcomes while providing a level of granularity and detail that can only be captured through the dictation medium.What you can do? Urge your MTSO employer to join the Health Story Project and the many MTSOs who are using this process to enable full functionality of hospital EHR systems while still allowing physicians to record patient encounters in the method that is their preference and the one that allows them more patient care time. Don't work for an MTSO? No problem, talk about it at your hospital - and if your hospital outsources any of their work, ask them to include a request for CDA4CDT in their RFPs. The time has come for us to take an active role in our future and beginning to have conversations about relevant strategies to help ensure your success and career are here today. Click here to learn more from a physician's perspective.
