Navvis Right Now: Issue 11 – February 16, 2019

February 16, 2019

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CMS’s New Rules Could Ease Patients’ Access to Health Records

The WSJ reports that the Trump administration is proposing steps aimed at improving patients’ access to their own health data, bolstering efforts to bring information including insurance claims, hospital and doctor records to digital devices such as smartphones. CMS and the Office of National Coordinators (ONC) unveiled two major proposed regulations closely watched by health and technology companies, amid a growing flood of health data that has become an ever-more-valuable asset. The draft rules touch on a broad array of issues, including technology standards that are supposed to help unlock digital data stored in the electronic health records used by hospitals and doctors to track patients’ care. One of the new proposals says that patients must be able to electronically access all of their health information held in a health-care provider’s electronic record, including details such as doctors’ notes, and the patient can’t be charged for the material. The new proposal also includes a requirement for hospitals to provide digital notifications about patients who are admitted, transferred or discharged. These would go to other health-care providers that see those patients. The proposal makes such reports a condition of participating in the Medicare program, a very powerful regulatory hammer. The new proposals would also require health insurers offering government-backed plans such as Medicare Advantage, managed Medicaid and Affordable Care Act exchange coverage to open up new digital pathways to claims data for consumers, including information on costs of services and carves out seven exceptions to the law’s mandate, when a company might legitimately decline to share data. (See attached WSJ article or here for the Interoperability and Patient Access Proposed Rule fact sheet.)

Takeaway: Administrator Verma said in her speech this week, “the days where data is trapped in unusable silos are numbered.”  “In putting out this proposed rule and investing in projects using FHIR standards, I’m doubling down on the need for additional standards … we want the entire HIPAA designated record set made available electronically and fast. It is time to accelerate this process and give patients and providers ALL of the data that they need.” Where Meaningful Use was intended to create interoperable records, EHR companies built silos with each company hoping it would become the dominant player. In the 2018 and 2019 final rules, CMS included interoperable requirements for hospitals, SNFs and home health facilities paving the way for this proposed rule. CMS also linked alternative payment models such as ACOs and BPCI-A requiring a high percentage of participants to use certified electronic health records (which meet FHIR standards) to qualify for advanced alternative payment model (A-APM) 5% bonuses.  In addition, the Medicare Advantage 2020 Call Letter propose star ratings linked to interoperability standards to accelerate the adoption. The aim of this proposed rule is to ensure providers have timely and meaningful notification and records upon patient discharges, and patients have the ability to access and share their records and become engaged consumers in their own health. Lastly, CMS included a RFI asking all stakeholders to comment on the path forward for patient matching and ways to share post-acute data.

CVS Unveils HealthHub Store Design

CVS Health has unveiled three redesigned health-focused concept stores in the Houston market, according to CNBC. The pilot stores, called HealthHubs, have space for services to help customers manage such chronic conditions as diabetes, hypertension and asthma. Each store also has an expanded health clinic with a lab for blood testing and health screenings. The stores will have respiratory specialists and dietitians on staff. Beyond those services, there are also wellness rooms equipped to handle yoga classes and seminars. While the new stores have less space for greeting cards, seasonal items and general merchandise, consumers can buy more health-focused products, such as medical equipment and supplies for diabetes care and sleep apnea.

Takeaway: The redesigned stores are part of the company’s vision in acquiring Aetna to help CVS move beyond a pharmacy chain and become a more convenient healthcare provider. The stores new classes, seminars and screenings are not limited to Aetna members but are available to all consumers.  “We’re pleased and surprised pleasantly with the ecosystem of healthcare that we’ve created here and how approachable it is, how much people are interested in it, and there are certain things we can take to all stores,” CVS Pharmacy President Kevin Hourican.

Utah GOP shrinks Medicaid expansion

Politico reported that Utah Gov. Gary Herbert on Monday signed legislation adopting a limited expansion of the state’s Medicaid program, defying voters who in November approved the full Obamacare program through the ballot. Under the new GOP-written plan, Utah will ask the Trump administration for permission to implement unprecedented restrictions on the health coverage program for the poor, while insuring about 60,000 fewer people than the Obamacare expansion would have and initially costing the state tens of millions of dollars more. (The original vote called for expanding Medicaid to roughly 150,000 adults and the vote passed by 53% and the current proposal is only to cover 90,000 people.) Herbert, in a statement, said the legislation “balances Utah’s sense of compassion and frugality.” Critics decried the legislation. “The legislature is trampling on the clear will of voters, and it’s stripping tens-of-thousands of Utahns of access to care in the process,” However, it’s still possible Utah could later fully expand Medicaid. If the Trump administration refuses the state’s plan, the legislation includes a trigger automatically adopting the Obamacare expansion while adding requirements for some enrollees to work or remain on workplace health insurance coverage if available.

Takeaway: At the heart of the issue is the States and Federal government share in the costs of Medicaid. In Utah, the government pays about 68 percent of the costs. Under ObamaCare when the states choose to expand Medicaid, the federal government pays 90% of the costs which is much higher than the traditional Medicaid program coverage. In Utah, the Governor is asking the administration to pay the 90% while limiting the coverage which sets a new precedent.  The Governor stated that the actual costs to deliver the Medicaid expansion are higher than what was forecasted and what voters approved. Both Massachusetts and Arkansas tried a partial expansion as well and the requests were not approved. However, the Administration is expected to approve the waiver with the partial expansion.

AI to Detect Common Illness Rivals Performance of Experienced Physicians

Researchers in both the U.S. and China have built a system using artificial intelligence (AI) that automatically and successfully diagnoses common childhood medical conditions after processing clinical data, according toThe New York Times. The researchers published a paper on the system in Nature Medicine. They said the system was highly accurate and one day may help physicians diagnose complex conditions. The system relies on a neural network that can learn tasks by analyzing large amounts of data. The researchers looked at the records of about 600,000 Chinese patients who received treatment at a pediatric hospital during an 18-month period. The system learned to link common medical conditions to specific patient information that physicians, nurses and other technicians collected. When the system was tested on unlabeled data, it rivaled the performance of experienced physicians. It was more than 90% accurate at diagnosing asthma vs. the accuracy of physicians in the study ranged from 80-94%. The system was 87% accurate in diagnosing gastrointestinal disease, compared to physicians’ accuracy of 82-90%.

Takeaway:  AI has already made advances in radiology and many believe it will optimize radiologists’ workflows, facilitate quantitative radiology, and assist in discovering genomic markers. “AI-lite” is already being used in radiologyincluding computer-aided detection for cancer, auto-segmentation of organs in 3D postprocessing, natural language processing to facilitate critical results reporting, consultation of best guidelines, and quantification and kinetics in postprocessing. However, deep learning algorithms have not made their way into widespread clinical use.

Medicare at 50

VOX and Politico reported that Senator Debbie Stabenow (D-MI) is introduced the “Medicare at 50” bill. Stabenow believes a Medicare buy-in would make a big difference for older Americans who can, even under Obamacare, face steep prices in the individual market and would likely be able to offer lower premiums because Medicare typically pays doctors and hospitals lower prices than private insurers. When the Congressional Budget Office scored a more limited Medicare buy-in plan (one that let older Americans start buying in at 62), it estimated that the premiums for the public plan would be about $7,600 annually — significantly lower than the average $15,300 premium on the Obamacare markets that a 64-year-old without ACA tax credits currently faces.

Takeaway: Stabenow’s Bill is a revised version of a proposal she has authored in previous sessions of Congress lowering the buy-in from 55 to 50. This bill has a higher likelihood of moving forward with bi-partisan support, because it leaves private insurers in place compared to Medicare For All. It would also create competition amongst private insurers with a Medicare at 50 type elective plan. This type of bill is also a step closer to Medicare for All. According to a new Kaiser Family Foundation survey, 77% of Americans expressed support for a Medicare for 50 and older type plan.


Disclaimer: This blog includes content gathered from other published sources, not authored by Navvis, and is presented as information only. As with any news story, this information may have changed since its publication date. Commentary included with the information is the opinion of its authors, and is not indented to provide legal or regulatory advice or guidance to the reader. Navvis does not represent the accuracy of or assume liability for the content presented herein.