First off, assign a Meaningful Use coordinator. Someone whose job it is to make sure the new processes are being followed, and objectives and measures are being met. Some clinics are assigning an in house staff member while others are using an outside consultant. Also determine which clinic staff will have authority to review and release patient information via the patient portal as data is updated from the EMR.

The Meaningful Use coordinator needs to understand each objective and measure that must be met for Stage 1, and what their clinic’s strategy is to meet those objectives. Note that all of the optional (menu set) objectives in Stage 1 become mandatory (core set) objectives in Stage 2. While it may be tempting to put off the optional Stage 1 objectives until they become mandatory, now is a good time to take advantage of the shifts in workflow to implement new processes that will improve efficiency over the longer term.

You don’t want to expend energy on a temporary workflow solution that will need to be replaced in 18 months to address the Stage 2 requirements.  On your journey to meeting the Meaningful Use objectives, why have one or two stopovers when you can take a direct flight that will get you there faster?

Next, identify which certified technology you will use to report on each measure. Your EMR will be used for some, while your patient portal will be used for others. The objectives Navigating Cancer’s Patient Engagement Portal solves include:

1. Give patients electronic copy of their health information (Core #12)
2. Record key patient demographics (Core #7)
3. Record smoking status (Core #9)
4. Give patients clinical summaries for each office visit (Core #13)
5. Protect electronic health information (Core #15)
6. Exchange key clinical information among providers (Core #14)
7. Give patients timely electronic access to their health information (Menu #5)
8. Provide patient-specific education resources (Menu #6)
9. Provide summary of care record for referrals (Menu #8)

The objectives in plain text are solved with no work required by clinic staff, they are either built into the portal or are completed by patients during registration. The remaining four objectives in bold will require an action by clinic staff to release information from the clinic to the patient’s account on the portal. The following is an overview of the new workflow to release patient information using Navigating Cancer’s Patient Engagement Portal:

1. A patient’s medical information is updated in your practice’s EMR
2. Approved lab results, vitals, medications, problems, medication allergies and clinical summaries after a patient’s visit become available for clinic staff to review in the Navigating Cancer staff dashboard.
3. Clinic staff are informed that new information is available to be released to patients, with a deadline for when it must be released in accordance with the Meaningful Use objectives.
4. Authorized clinic staff decides whether to release or withhold specific items to the patient’s portal account.
5. The patient is sent a notification that they have new information in their patient portal, which they can access securely by logging into their portal account.

While changes to familiar workflows may cause some anxiety among staff, thinking through and adopting consistent processes will make it easier to achieve Meaningful Use with minimal disruption. More importantly, patients will have easier access to their medical information and helpful resources so they can be more engaged in their care, which studies have shown leads to a better quality of life and better health.

Related Links

• List of Stage 1 Meaningful Use Rules
• What is a patient portal?
• Navigating Cancer’s Patient Engagement Portal

Giving Patients Access to their Health Information is a post from: Navigating Cancer

1. Improve health care quality, safety, efficiency and reduce health disparities
2. Engage patients and families in their health care
3. Improve care coordination
4. Improve population and public health
5. Ensure adequate privacy and security protections for personal health information

The Stage 1 Meaningful Use rules were released in 2010, and consist of 15 mandatory core items and 10 optional menu items, of which providers had to select 5. The Stage 2 rules consist of 17 compulsive core items, and 5 selective menu items, of which providers must pick 3.

While Stage 1 was focused on having providers show they had the ability to use electronic health information in a meaningful way, Stage 2 takes the next logical step to actually doing it. Providers must use their certified EHR technology for a greater percentage of their patients, provide information to patients more quickly, and must go beyond providing electronic access to patient health information by attesting that patients actually access that electronic information.

For example, in Stage 1 clinical summaries must be provided to patients for more than 50% of all office visits within 3 business days. In Stage 2, those clinical summaries must be provided within 24 hours. Further, for Stage 2, providers must attest that more than 10% of all unique patients have viewed, downloaded or transmitted their electronic health information to a third party. This is significant as it’s the start of measuring patient engagement, and will require providers to take an active role in engaging patients in their care.

Technology can help oncology providers encourage patients to view their electronic health information by alerting them when tests and labs are available to be reviewed. With our Patient Engagement Portal, clinic staff control which health information is released to individual patients and when, can see if it’s been reviewed by patients, and easily schedule email reminders to encourage patients to access their personal health information. We have years of experience building consumer web experiences and surveys show that patients find our site easy to use.

Other notable changes from Stage 1 to Stage 2 include:

• A secure message was sent using certified EHR technology by more than 10% of unique patients. This is a new rule for Stage 2 that was not part of Stage 1. Our Patient Engagement Portal supports secure messaging between patients and their health care team with an intuitive user interface that is easy to use.
• Summary of care record must be transmitted using certified EHR technology for more than 65% of referrals or transition of care to another provider. This increased from 50% in Stage 1, and was moved from an optional rule (menu set) to required (core set). In addition, for more than 10% of referrals or care transitions, providers must use certified EHR technology that connects with a different organization using a different certified EHR vendor. This will require that certified EHR vendors support the exchange of electronic health information with other vendors. Navigating Cancer supports the CCD format and can exchange information with other Health IT systems.
• Patient-specific education resources identified by certified EHR technology must be provided to patients for more than 10% of all office visits. This was moved from an optional rule (menu set) to a required rule (core set) as well. Once clinic staff has released a diagnosis, our Patient Engagement Portal becomes personalized to each patient based on their condition. Diagnosis specific educational resources from trusted experts will be delivered to them automatically with no additional work required by clinic staff.

The attestation period for Stage 2 will begin in 2014, a delay of one year for providers that attested for Stage 1 in 2011. If you are planning to attest for Stage 1 in 2012, the attestation period for Stage 2 also begins in 2014. If you are attesting for the first time, you must attest for a 90-day period. If you have already attested for Stage 1 or plan to attest by the end of 2012, your attestation period for Stage 2 will be the 2014 calendar year. CMS is accepting comments until May 7, and it’s expected the rules will become final this summer.

As noted above, two of the primary goals of Meaningful Use have been to improve care coordination and engage patients and families in their care. The Stage 2 rules are starting to require that health care providers use certified technology to actually fulfill these goals, rather than just showing that they can do it. This will change how patients and providers interact, and will introduce a new era in the doctor-patient relationship. Technology such as our Patient Engagement Portal will play a critical part in this new relationship, enabling a more robust and efficient way to communicate and share important health information with patients and providers.

Related Links

• Patient Portals: the Gateway to Patient Centered Care and Meaningful Use
• Navigating Cancer’s Patient Engagement Portal
• Digital Patient Engagement: Next Steps in the Provider-Patient Relationship, Oncology Business Review guest article by Gena Cook

Stage 2 Meaningful Use Criteria is a post from: Navigating Cancer

Navigating Cancer’s CEO, Gena Cook, contributed a guest article in the March issue of Oncology Business Review (OBR). In it, Gena discusses how the doctor-patient relationship will evolve as new federal regulations that have made patient engagement a top priority begin to take effect.

Technology will play a critical role in connecting patients and providers, enabling a more robust and efficient way to communicate and share important information including medical records and educational resources.

In addition, Gena shares results from our recent Patient Engagement survey that helps define successful patient engagement.

You can read the full article on the Oncology Business Review website.

Related Links

• Patient Portals: the Gateway to Patient Centered Care and Meaningful Use
• What is a Patient Portal
• Navigating Cancer’s Patient Engagement Portal

Oncology Business Review Guest Article is a post from: Navigating Cancer

But what do patients want? Are they interested in engaging in their care? We conducted a survey* of 295 cancer patients and found that a large majority, 72%, were interested in using online tools and resources to help manage their care and recovery.

Different Levels of Patient Engagement

When asked what specific tools and resources they were interested in using, a large majority of cancer patients showed interest in passive engagement, while almost half expressed interest in more active engagement. From the survey:

• 77% are interested in reading cancer education materials online from expert sources.
• 74% are interested in having access to their medical records securely online.
• 47% are interested in recording their symptoms and side effects during treatment in an online health journal.
• 46% are interested in using an online guide to help them plan for their doctor visits.

This data shows that patient engagement can’t be lumped into one catchall category; there are different levels of engagement that patients are willing to participate in. What we’ve labeled passive engagement are activities that could be described as lean back activities, reading information and gaining knowledge. Active engagement activities can be described as lean forward, where patients are entering data, tracking their health, and providing feedback to their healthcare team.

This has peaked our interest to delve further into the levels of patient engagement to see what differences there may be between actively engaged and passively engaged patients during their cancer journey. If one set of behaviors results in more positives than the other, how can we encourage those behaviors?

Desire for Education

When asked about specific activities, 75% of patients expressed interest in learning about their condition, treatment options and side effects. When asked about specific education topics, learning about survivorship and how to prevent a recurrence was the number one subject cancer patients wanted to know more about, with 80% of survey respondents expressing interest. Rounding out the top 5 topics of interest is:

1. How to Prevent a Recurrence (80%)
2. Nutrition (76%)
3. Side effects – what to expect and how to manage them (73%)
4. Treatment options – surgery, chemotherapy, radiation, etc. (66%)
5. Personal experiences from other survivors (51%)

As the survey captured responses from patients that were pre-treatment, in treatment, and post treatment, the ranking of the responses varies slightly when filtered for where patients are in their cancer journey. For example, when we filtered the responses to remove patients who were post treatment, the most popular education topic was nutrition, instead of survivorship, with 83% expressing interest. We will incude more findings from patients that are pre-treatment and in-treatment in the March issue of Oncology Business Review (OBR).

Interested in Using Health IT

Patients have shown a strong desire to be engaged in their care, especially in learning about treatments, side effects and nutrition. They also showed a strong interest in accessing this information online through Health IT.

When asked about specific Health IT features, the most popular item patients wanted was having access to their test and lab results, with an overwhelming 88% selecting this option. The other top features patients were interested in include:

1. Access to test and lab results (88%)
2. Secure messaging with their doctor and healthcare team (77%)
3. Having access to their medical records securely online (74%)
4. Requesting and scheduling appointments (72%)
5. Requesting prescription refills (68%)

One of the biggest concerns we’ve heard from practices about adopting Health IT is the fact that cancer predominantly affects an older population, and that elderly patients aren’t comfortable using the Internet. We’ve found the opposite to be true, with 71% of our survey respondents over the age of 55, and no significant difference in the responses when we filtered the answers for this population.

Summary

Cancer patients want to be engaged in their care, with some more active than others in their level of engagement. At a minimum, the majority wants to learn about their condition, treatment options, and how to manage side effects, while having access to their health information including tests and labs.

Oncology practices are on the fast track to adopt certified EHR and patient portal technology to provide patients with access to their health information, but not all solutions have features to engage patients in their care. We’ve developed our Patient Engagement Portal to go beyond just providing access, to engage patients with personalized educational resources and care management tools so they can be active participants in their care, without placing an extra administrative burden on healthcare staff.

Our survey shows patients want to be engaged in their care, now it’s up to healthcare providers to take advantage of the tools and resources Health IT provides to make it easier and more efficient to do so.

*Survey conducted via email in June 2011 and January 2012 of cancer patients pre-treatment, in treatment, and post treatment with a 95% confidence level and a 5.5% margin of error.

Related links

• Past, Present and Future of Patient Engagement
• Navigating Cancer’s Patient Engagement Portal
• What is a Patient Portal?

Patient Engagement Survey Results is a post from: Navigating Cancer

Published in the January/February 2012 issue, Gena provides an overview of how patient portals will play a central role in solving the Meaningful Use objectives of providing patient centered care.

Click here to read Gena’s article and learn how patient portals are already supporting Meaningful Use, increasing efficiency, and improving patient satisfaction. Two case studies describe patient portal implementation and use in the oncology practice setting.

Related links

• What is a patient portal?
• 8 Steps to Get Ready for Meaningful Use Attestation
• Navigating Cancer’s Patient Engagement Portal

ACCC Oncology Issues Guest Article is a post from: Navigating Cancer

What is Patient Engagement?

Since the early days of the Internet we have witnessed a rise in patient engagement as patients have gone online to self diagnose symptoms, learn about their condition and treatment options once they receive a diagnosis, and connect with communities of like patients to learn from their experiences.

According to a 2010 PEW Research Center study, 83% of Internet users have used the Internet to search for health information, making this activity the third most popular for all online adults. To date this has happened outside of the patient/provider relationship, and can sometimes lead to misinformation and false hopes about unproven treatments. It can also lead to patients finding out about treatment options that have saved their lives, which they otherwise may have not known about.

Why is Patient Engagement Important?

Studies have shown that patients who are engaged in their care report a better quality of life and are more involved in treatment decisions with their health care team. A study by the advocacy group Kidney Cancer Canada found that patients who were engaged in their care rated their health higher, were more proactive in researching their health concerns, and acted more quickly to receive second and third line treatments when first line treatments failed.

Using Health IT to Power Patient Engagement

With the adoption of new technologies such as electronic health records (EHR’s) and patient portals, and new care models such as the Oncology Medical Home, patient engagement can become part of an oncology practice’s care model. Patients want to receive information from their doctor and healthcare team, and are going to the web when their questions and concerns aren’t being addressed. In a 2010 NCI Survey published in the journal Oncology, people’s trust in information from healthcare professionals had increased while their trust in health information from the Internet had waned between 2002 and 2008.

Using new patient portal technology, doctors can automatically provide patients with electronic copies of diagnosis specific patient education materials, and care management tools to track and report their treatment side effects, all under the clinic brand, which patients know and trust.

Patient Engagement from the Patient Perspective

Studies confirm patient engagement is beneficial, federal programs and advocacy organizations are encouraging practices to adopt technology and programs that will help engage patients, but what do cancer patients want? We surveyed our members to find out and will release the results in the coming weeks. Preliminary data confirms that a wide majority of cancer patients are interested in using online tools and resources to help manage their care and recovery, and are especially interested in reading cancer education materials from expert sources.

Engaging patients in their care is becoming an important part of the evolving patient/provider relationship, and as new standards of care and technology are implemented best practices will evolve for achieving positive outcomes. We’re excited to have a leading role in engaging patients in their care through health IT by providing the patient portal technology that will enable all stakeholders to realize the benefits of patient engagement.

Past, Present and Future of Patient Engagement is a post from: Navigating Cancer

HITECH Incentives for the Meaningful Use Objectives Peak in 2012

Probably the biggest issue that everyone is focused on is achieving the Meaningful Use objectives this year. Most of the practices we have spoken with were focused on the eRx Incentive Program in 2011 and are now turning their attention to the HITECH incentives for 2012. We haven’t yet spoken with a practice that isn’t planning to attest for HITECH this year. The big issue I see is how quickly practices can prepare to be able to attest. Most practices were upgraded to the HITECH certified versions of the EHR late last year, and now practices are starting to think through their patient portal strategy and implementation.  From there, they can start the work of ensuring that they are actually using the systems in a way to achieve the objectives.

As more and more patient portals are implemented, patients will start to receive electronic access to parts of their health record through the CCD (Continuity of Care Document) standards. This will be a good first step in implementing patient centered care. Some portals go further than just solving the basic health IT regulatory requirements, such as Navigating Cancer’s Patient Engagement Portal, which has been shown to increase patient satisfaction and save practices time and money. At the end of the day, that’s what all Health IT vendors should be focused on— creating a useful service for both providers and patients, not just creating features to meet requirements.

Don’t delay!  These incentives peak in 2012, and the last date to start the 90-day attestation period is October 1. Working back from this date, practices should be evaluating and selecting their certified EHR and Patient Portal vendors now to leave enough time to implement, adopt and reach the baseline measures before starting the attestation process.

Practices who don’t meet this deadline will miss out on $18,000 per provider in 2012. Don’t leave money on the table!

More info:

• Click here to download a copy of the Meaningful Use objectives
• Eight steps to get ready for Meaningful Use attestation
• Oncology patient portal case study: learn how one practice is saving $100 per doctor, per month

Medical Home & Accountable Care Organization (ACO) Models

There is a lot of talk about Medical Home and ACO models throughout healthcare.  For oncology clinics, it’s less clear how ACO models will be implemented. There is much more talk about defining a Medical Home in oncology and creating the right measurement and reporting tools to support this initiative. Payers are starting to look for opportunities to pilot these models and to take baby steps in supporting initiatives that help practices create an oncology Medical Home. We’re seeing a variety of different pilots with payers including shared savings models, alternative payment models, and the mandated use of technology to deliver the most cost effective, quality care.

Health IT definitely has a role in these new models. Simple features, implemented correctly, could have a massive impact in managing costs and providing better care. For example, one feature of our Patient Engagement Portal is a Daily Health Journal, which includes a side effect tracking tool that can be used to help alert providers when interventions may be necessary to help patients manage the side effects of treatment. Providing their care team with the right information at the right time could prevent patients from having to visit the emergency room, an important cost driver to be avoided if possible.

Another example is the use of technology to better manage the advanced directives process in oncology, which is a key driver of managing costs and ensuring that patient’s wishes are taken into consideration at the end of life. Using technology to simply ask patients their wishes and then sending them information about the process could go a long way in educating patients on the importance of planning.  Easy to use reporting tools could also help healthcare providers manage the process and assist them in communicating more effectively on this very important, but also delicate topic.

More info:

• Risks and benefits of ACO and Medical Home care models
• Example of an oncology medical home

Commission on Cancer Guidelines

As part of the new Amercian College of Surgeons (ACoS) Commission on Cancer (CoC) guidelines, cancer programs that seek CoC accreditation must implement continuum of care programs by 2015 including a survivorship care plan (with a treatment record summary of care), psychosocial distress screening, and a patient navigation process.

In recognition of the importance of survivorship, this month the Center for Medicare & Medicaid Services (CMS) established two new reimbursement codes for cancer treatment planning and care coordination. The codes will go into effect April 1, 2012 and will allow providers to be reimbursed for the time and expertise they dedicate to cancer treatment planning.

For each program Health IT can be used to plan, track and communicate with patients, making it easier for providers to be reimbursed for their time and to aide in the communication process. Clinics using our Patient Engagement Portal can easily provide patients with a treatment record summary as part of their transition to survivorship care. In the coming years, we’ll likely see more and more providers  communicating with patients via secure email messages, especially with Stage 2 Meaningful Use, which will provide them with incentives to use a simple mechanism that is already part of our daily lives to improve communication with their patients and improve efficiency.

This communication will be very important to effectively support navigation and survivorship programs in the coming years and to track and manage patients in the most effective and cost efficient way.

More info:

• American College of Surgeons 2012 Commission on Cancer guidelines
• CMS establishes cancer treatment planning and care coordination reimbursement codes

Patient Centered Care from the Patient Perspective

Patient Centered Care is now on the national healthcare agenda and as a result is an opportunity for healthcare professionals to receive incentives for adopting new technology and for payer pilots to try new approaches. At the same time, new accreditation standards are pushing providers and payers in the same direction. What do patients think about this transformation?

We surveyed 250 patients from clinics who are using the Navigating Cancer Patient Engagement Platform and an overwhelming 74% responded that they were interested in using online tools and resources to help manage their care and recovery. Seventy five percent are specifically interested in learning about their condition, treatment options, and how to manage side effects.

When provided with a list of online tools and resources, patients were most interested in having secure access to their medical records.We will publish the full survey results soon, but initial responses show that patients want to be more active in their care, and are very interested in using technology to help them manage their condition.

Transforming Health Care Through Patient Centered Care

All in all, the future looks bright for healthcare consumers. Patients will start receiving electronic access to parts of their healthcare record as well as tools and information to be an active participant in their care and an important member of the healthcare team. The use of technology will facilitate this process and we’re working really hard to be a part of the transformation by providing easy to use, low cost tools to enable the best healthcare provider and patient relationship imaginable.

Using Health IT to Achieve Patient Centered Care is a post from: Navigating Cancer

Rose provides some history and focus of COA’s Patient Advocacy Network (CPAN) as well as agenda and registration information for this year’s event. We’re excited to be participating and hope you can join us.

COA Patient Advocacy Network and Program
by Rose Gerber, Director of Patient Advocacy/Breast Cancer Survivor, Community Oncology Alliance

I am pleased to share the news that Greg Maxfield, VP of Business Development at Navigating Cancer, will be one of our speakers during our patient advocacy program at our upcoming conference. Also speaking is distinguished guest, Utah Attorney General and colon cancer survivor, Mark Shurtleff.  I am inviting each of you to attend and/or help us identify cancer survivors/advocates that would be interested in attending our conference to learn more about becoming a cancer care advocate.

Since 2003, COA, a non-profit organization has been advocating for cancer patients and their oncologists. COA’s primary objective is to protect and foster the community oncology delivery system, thus ensuring that cancer patients have access to high quality care in their communities. Each year COA’s annual national conference attracts oncologists, practice administrators, nurses and various health care professionals from across the U.S.

The Community Oncology Alliance Patient Advocacy Network (CPAN) was created to provide a forum for patients, caregivers, survivors and all interested members of the cancer community to become more active participants in advocating for cancer care. Our patient advocacy program has a very unique leadership team.  In addition to my extensive advocacy experience, I am also a breast cancer survivor.  Our program is enhanced by Rick Frame, MD, a practicing medical oncologist at Utah Cancer Specialists in Salt Lake City. Dr. Frame serves as the Medical Chairman for CPAN.

In February 2011, during COA’s 6^th annual conference, we launched our inaugural patient advocacy conference program. The patient advocacy program ran parallel to COA’s general conference track and was designed to educate and empower cancer patients and survivors in understanding how national policy issues ultimately impact local cancer care.  Some of the issues that our attendees learned about included understanding the various types of cancer advocacy, how to lobby congress and how to use traditional and social media in reaching advocacy goals. The program was a success. Over 40 cancer survivors/advocates representing multiple cancer types and 14 states were in attendance.  A very notable and memorable guest was Utah Attorney General, Mark Shurtleff. Mr. Shurtleff is a colon cancer survivor and a patient of Rick Frame, MD. I am pleased to share that Mr. Shurtleff will be returning to our conference, once again inspiring his fellow cancer survivors.

Sample Agenda

Our March 2012 conference will provide cancer survivors/advocates with valuable information.  A sampling of educational sessions include Patients Access to Quality Care, An Introduction to COA’s and COA’s Key legislative Issues, How Patients and Nurses Can Collaborate in Advocating for Cancer Care, Understanding How Insurance Policies Impact Cancer Patient Care, The Business Side of Patient Care, Accountable Care Organizations and Medial Homes & Accountable Care Organizations – What Are They and Why Should Patients Care?

In addition to networking with peers from across the U.S., advocate attendees will also have the opportunity to interact with physicians, nurses, administrators and various health care and industry professionals by joining the main conference luncheon educational sessions, and during exhibit hall visitation.

We are actively seeking conference attendees. The registration process is simple and the patient advocacy program costs are very affordable. COA has secured very affordable hotel rates at Caesars Palace and advocate attendees pay a registration fee of only $75.  Click here for more information on registration fees and COA’s main conference track.

I hope to see you in Las Vegas!

Rose Gerber
Director of Patient Advocacy
www.coaAdvocacy.org
860-287-1586
roseg@coacancer.org

Navigating Cancer to speak at annual COA Conference is a post from: Navigating Cancer

Medical Home Ingredients – All Good Things

Image source: ACO Summit www.acosummit.com

This past year seems to have included every letter of the alphabet soup of changes and challenges, from ACO, ASP, CMS, FDA, GPCI, NCCN, PCMH, SGR and all of the other acronyms in between.  It seems like we can’t get through even a few sentences before spewing out one of the alphabetized words. And yet, two of these concepts seem to have withstood the test of time – ACOs and PCMH.  Does this mean that they both have staying power?  Let’s explore………………

ACO’s are Accountable Care Organizations.  When the final rule of this HHS (ooops – we forgot one – Health & Human Services) concept came out in May 2011, there was a mad dash to see if cancer “care” was incorporated into this final version, since it was not addressed in the proposed rule.  The cancer community apparently noticed the glaring omission and shared the following commentary.

*The word “cancer” was mentioned in the proposed rule even more frequently than it was in the final rule.  Most of the mentions in the final rule were in reference to the comments stemming from the proposed version, and the majority of those were in the context of screenings.  There was not a single quality measure for cancer care in the preliminary or final ACO rules.  This seems to indicate that cancer care, in general, is not readily understood by policy makers; for if this concept had been truly grasped, the criteria with which to measure the efficient and high quality delivery of such care would have likewise been addressed. In that the treatment of cancer is, in fact, one of the top five most expensive health care conditions, this void or omission speaks to the lack of understanding.

* Bigger is not necessarily Better – One would think that if a larger, more consolidated regional healthcare delivery system were able to deliver a higher quality, more efficient model of cancer care, they would have done so.  Several recent studies have indicated that private, more community oriented, cancer care is less expensive to both payers and patients.  Some would argue the point that patient and family satisfaction is also higher in the community setting.

* Risk versus Benefit – The whole concept behind an ACO model is participant sharing of the collective (supposed) savings that would be realized after years 1, 2 or 3 of participation. However, in order to participate in this potential profit, a provider may be asked to forfeit their culture and identity and become part of a larger organization that could possibly move at the pace of country molasses on a cold winter day.  Many providers do not view this potential benefit worthy of the risk and autonomy they may lose – particularly as it relates to cancer care.

* Us versus Us – Probably the largest drawback to an ACO model is the fact that it pits this integrated delivery system against itself with regard to savings.  So then, this model actually morphs a care organization into a new payment model that has the potential to actually minimize capital investments into the delivery model.  After all, capital investments could translate into lost savings, particularly when the return on investment extends to any multiplier of 3 years.

The alternative to the ACO is the Medical Home.  This model has built in incentives that create value for all stakeholders in real time.  A brief description follows:

* All good things – The oncology medical home is the home for all good things, whether it be unique and different payment models that recognize or reward quality, value, and efficiency, or simply tools and technologies that enhance the patient and family experience.  If it is good and helps promote quality, value or efficiency – it belongs under the umbrella of a medical home.

* Led by Stakeholders – The Oncology Medical Home model is steered by representative stakeholders for the mutual benefit of all cancer care stakeholders.  These stakeholders include: patients, providers, payers, communities, employers and patient advocacy organizations.  One of the core beliefs of the oncology medical home is that all will benefit if the components of quality, value and efficiency are emphasized, promoted and recognized.

* Support Network – Stakeholders drive the decision-making process of standardizing measures and recognition.  However, a talented peer group within the cancer care community will help to identify, endorse and implement the tools, templates and technologies that will assist teams in achieving their maximum quality, value, efficiency, and ultimately reward, with minimal financial or administrative burden.

* Us versus Them – In order to demonstrate quality, value or efficiency within this model there must be:

a) A standard set of measures

b) Automation to produce these measures without administrative burden

c) A repository to compare yourself against the peers not only in your specialty but other specialties.

This ongoing competition to continually improve while being rewarded for achieving improvements gives this model staying power, while at the same time, driving down costs and eliminating inefficiencies.

The Medical Home Model is a process that invites and encourages innovation in all things; patient-oriented workflows, integrated and coordinated care, a variety of reimbursement models, and an enhanced identity by the provider team.  This innovation, with an emphasis on demonstrated achievement, creates a place of comfort and care; a place that any cancer patient would want to call home – a place for all good things.

Bo Gamble has been involved in healthcare for over 30 years, and the last 13 years in cancer care. He has a passion for all good things in cancer care.

Related Links

• Example of a Patient Centered Oncology Medical Home
• Patient Portals: the Gateway to Patient Centered Care and Meaningful Use
• Community Oncology Alliance (COA)

Medical Home vs. Accountable Care Organization is a post from: Navigating Cancer

Most of the oncology practice administrators we speak with are planning to attest for the Meaningful Use incentives in 2012. While it may seem like there’s plenty of time between now and then, there are specific steps that will impact how soon you should get started on implementing and adopting your solution. Below are the 8 steps in the Meaningful Use attestation process, and a timeframe for how long each step could take.

1. Evaluate and select a certified EHR and patient portal. (1-2 months)
2. Implement a certified EHR or upgrade your current EHR to the certified version. (1-2 months)
3. Implement a certified patient portal. (1 month, can be done simultaneously with EHR implementation)
4. Integrate your certified EHR and patient portal with your practice management and lab systems. (1-2 months)
5. Begin using the new system, run weekly reports to achieve baseline for the 20 Meaningful Use measures. (1-3 months)
6. Once you reach baseline, you can start the attestation process, which takes 90 consecutive days. (3 months)
7. Answer attestation questions on CMS website.
8. Receive your federal incentive check.

To qualify for the 2012 incentives, you must begin the attestation period no later than October 1, 2012. Working backwards from that date, if you haven’t yet selected a certified EHR or patient portal you should start the evaluation process in January/February. If you already have an EHR, you should upgrade to the certified version in March to have enough time to integrate with internal systems, reach baseline, and start the attestation period. However, the sooner you begin the process the more cushion you’ll give yourself to absorb any unforeseen issues that may arise during the process.

If you haven’t yet selected a certified EHR or patient portal, you should start the evaluation process in January/February 2012, and start implementation by March 2012.

Meaningful Use Attestation Process

Below are the steps in the Meaningful Use attestation process. Step 1 you can do now, the others won’t begin until you’ve integrated and have started using your certified EHR and patient portal.

1. Register on CMS website. You can do this now before you have a certified EHR and patient portal if your state has launched their incentive program. Check your state’s status here.
2. Decide which of the menu set measures you will attest for. There are 15 core set measures, and 10 menu set measures. You must attest for all 15 in the core set, and select 5 of the 10 from the menu set. Here’s a list of all 25 Meaningful Use objectives and the specific measures you must meet for Stage 1.
3. Once you have all your technology systems in place, run reports from your systems to show how you are doing for each of the Meaningful Use measures.
4. Once you reach baseline for each Meaningful Use measure, start attesting. Track results over a 90-day consecutive period.
5. Run a report from your technology showing that you passed all the Meaningful Use measures over the 90-day period. You do not need to submit this report, but need it in case you are audited.
6. Enter the results for 20 Meaningful Use measures on the CMS website. Here are some screenshots with examples of questions.
7. Celebrate your accomplishment!

HITECH incentives peak in 2012, and the sooner you select and start to implement your Meaningful Use technology solutions the more likely you’ll meet the October 1 attestation deadline.

Have you gone through the attestation process? We’d love to hear about your experience. Please leave a note in comments below.
How long was your process from when you started evaluating technology solutions to when you finished the 90-day attestation period?
How long did it take for your practice to reach baseline once you began using the technology and before you began the 90-day attestation period?

Related Links

• Navigating Cancer’s Patient Engagement Portal
• Free download of Stage 1 Meaningful Use Objectives and Measures
• Why patient portals are necessary to qualify for HITECH incentives

How to Attest for the Meaningful Use Incentives is a post from: Navigating Cancer