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News April 2018

Washington Watch

Electronic Health Records – Stuck in the 1990s?

By Alan M. Schlein

Lack of patient health data access often leads to duplicate testing and unnecessary treatments, increasing costs for consumers, doctors, hospitals and health systems. Medicare continues to push forward on its efforts, but those efforts have so far, gone nowhere.

Recently I needed some medical records sent from my previous doctor to a new specialist. I was stunned when this thoroughly modern medical practice told me the only way they could send them quickly was with a fax machine. When was the last time you used a fax machine? 1990s technology in 2018?

Efforts to develop a standardized electronic health record (EHR) system to make it easier for the sharing of your medical records between doctors have been planned since that fax machine was the latest technology invention, but only with limited success. Most medical practice and hospitals now have their own EHR systems, but problems continue in efforts to share records between competing facilities.

Lack of patient health data access often leads to duplicate testing and unnecessary treatments, increasing costs for consumers, doctors, hospitals and health systems. Medicare continues to push forward on its efforts, but those efforts have so far, gone nowhere.

At a recent speech, Seema Verma, who heads the Centers for Medicare and Medicaid Services (CMS), noted that "providers also continue to find it difficult and burdensome to use EHRs. In the era of artificial intelligence, machine learning and precision medicine, fax machines continue to be the go-to technology for providers transmitting health information."

Verma wants to change that and detailed the federal agency's plans to implement a health data exchange system that ensures patients have control of their own health data. But she stressed the agency will not be able to achieve this kind of system "until we put the patient at the center of our healthcare system Until patients can make their own decisions based on quality and value, health care costs will continue to grow at an unsustainable rate," she told a health information technology conference in Las Vegas in March.

Right now, 78 percent of doctors and 96 percent of hospitals use electronic health records. But gaining access to them has long been a challenge in the U.S. because it's in the providers' financial interest to keep a tight hold on patient information.

As many of us have learned, patients often have to go from one doctor's office to another to gather up copies of your own medical records. More often than not, it's difficult and sometimes impossible to put together your complete medical files – especially if you've had surgeries at two or more different hospitals or lived in multiple states.

Verma predicts that one in every five dollars spent in the U.S will go toward the healthcare industry by 2026. "When providers don't have timely patient information readily available, tests are repeated, and we are paying for unnecessary treatments," she said. "All this drives up costs and puts patient safety and quality of care at risk."

HIPAA, the health care privacy law, further complicates sharing medical records. Part of the blame, she acknowledges, is due to outdated Medicare regulations, most of which were designed to suit a health care system using paper-based records back in the fax era. "In many ways, EHRs have merely replaced paper silos with electronic ones, while providers, and the patients they serve, still have difficulty obtaining health records," she said. "For the fortunate few who do ultimately obtain their records, the information is often incomplete, and not always digital or understandable."

A new initiative, the MyHealthEData initiative, which will be led by the White House Office of American Innovation, aims to allow patients to obtain electronic versions of their medical records from all of their providers, regardless of whether they are in the same physician practice or hospital system. The hope is to also allow doctors to more easily share your records at your request.

Verma's own CMS is planning to upgrade its Blue Button program, which provides traditional Medicare enrollees with their claims data. The overhaul will let developers build phone and computer apps that will allow patients access to their own information. Right now, though, seniors can only obtain their data by downloading PDF files.

The agency will also push Medicare Advantage and Obamacare exchanges to release their data to patients in a secure format and will specify what information (hopefully in electronic form) that hospitals must share with patients when they are discharged. Right now, hospitals and doctors' offices are not required to give you a copy of your medical records.

Non-Skilled In-Home Care Coming to Medicare?

In what some doctors and medical groups see as a "precursor" to expanding home care services to all Medicare patients, the Centers for Medicare and Medicaid Services (CMS) proposed a plan in February that would potentially add private duty home care as a supplemental benefit to Medicare Advantage plan in 2019.

The policy change marks the first time that CMS has allowed an item or service to be eligible as a supplemental benefit that covers daily maintenance. Along with non-skilled in-home care supports, Medicare will also include portable wheelchair ramps and other assistive devices and modifications when patients need them.

Calling it "a big win for patients," CMS Administrator Seema Verma said the priority is to "have more choices and lower premiums" for seniors on Medicare. "We are focused on addressing the specific needs of beneficiaries and providing new flexibilities for Medicare Advantage plans to offer new health-related benefits," she said.

The new policy enables supplemental benefits if they "compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization," CMS said.

Medicare Advantage plans have been very popular over the past few years, with one in three people with Medicare or about 19 million beneficiaries enrolled in a Medicare Advantage plan in 2017 according to the Kaiser Family Foundation. Medicare Advantage plans continue to grow, and CMS reports that the number of plans which cover all Medicare services but are offered through other insurance providers, increased from 2,700 to more than 3,100.

The Medicare Advantage proposal prompted a huge reaction, including more than 1200 comments to the overall Medicare Advantage proposal. Groups like Almost Family and LHC Group, both big players in these plans, strongly supported expanding access to Medicare Advantage and ultimately to all Medicare patients. Both see a huge opportunity that could bring higher payments. Right now, Medicare Advantage rates are about 95 percent of the traditional Medicare fee-for-service.

While the idea of including hospice benefits as a supplemental benefit in Medicare Advantage plans was floated last year, the announcement did not include hospice. But it might indicate that additional changes could be added in the future as the number of Medicare Advantage plans keeps growing.

New Medicare Cards Coming in April

Speaking of old-school technology, your new Medicare ID card will be arriving the old-fashioned way, via the US Postal Service. If you barely glance at your mail before you throw it in the garbage because of a deluge of junk mail, be on the lookout for this one.

Starting in April and continuing for a year, Medicare will be sending out new ID cards to its 55 million beneficiaries. This will be the first replacement of the cards since Medicare started in 1965. The cards have only one purpose – to help prevent identity fraud. The old cards will be valid for another year, but health care providers must change their records. To avoid confusion, it is important to notify all your health providers when you receive the new number.

Until now, the number on the current Medicare ID card (called a Health Insurance Claim Number of HICN) is the person's Social Security number. This number is used not only by the Social Security Administration but also by state Medicaid agencies, health care providers, health plans and the US Railroad Retirement Board.

If someone else gets hold of your number it can open you up to all kinds of identity fraud, and misuse. Congress finally changed the law in 2015 which required the Centers for Medicare and Medicaid (CMS) to replace the old numbers with new ones and give them a new name: Medicare Beneficiary Identifier (MBI). On Capitol Hill, House Ways and Means Health Subcommittee chairman Peter Roskam, R-Ill., and Earl Blumenauer, D-Ore., are pushing legislation to update your Medicare card with smart card technology to help prevent Medicare fraud.

The new Medicare cards will be rolled out over the next year and will go to all Medicare beneficiaries. But there is a huge exception – people who are enrolled in a Medicare Advantage plan (like an HMO or PPO) will continue to use the plan's ID card as their main card for Medicare. Medicare Advantage companies already have a unique ID number that is not your Social Security number, something that was changed years ago. Also, Medicare prescription drug plans will continue to assign and use their own cards.

The new Medicare MBI numbers will have 11 digits and will be assigned randomly so they will not have any hidden or special coding or meaning. They will combine single digit numbers and upper case letters, and will be printed on regular-weight paper. They will be a little smaller than the old ones – about the size of a credit card. They do not indicate gender.

People in the Middle Atlantic states (Delaware and Maryland) and western states like California and Oregon will get them first. After June, CMS will roll out mailings to five more geographic regions. People in Kentucky, Louisiana, Michigan, Puerto Rico, and a few other states will be the last to receive the new MBIs. You can check the government's Medicare.gov website for the schedule.

New Cards Bring on New Scams. Be Wary

While the new Medicare ID numbers were set up to prevent ID fraud, so far it's had the opposite result. So here are seven key pointers so you don't find yourself a victim of fraud:

  • Expect more efforts by scammers to mislead Medicare beneficiaries as the new cards start rolling out.
  • There is absolutely no charge for the new card;  remember this is free and comes directly from Medicare.
  • Anyone who calls saying they are calling from Medicare is not telling the truth. Medicare will not make uninvited calls to beneficiaries.
  • The new card provides the exact same benefits as the old one. Don't get talked into thinking changes are being made.
  • The new Medicare card is valuable so keep it in a safe place and don't give it to anyone except your health care providers. Unfortunately, many ID thefts are carried out by friends and family members who have "borrowed" someone's Medicare ID card. Also remember that your old card has your Social Security number on it, so be to put it away somewhere safe as well.
  • If you think you've been a victim of medical identity fraud, the Federal Trade Commission has information about what to do at their website, https://www.consumer.ftc.gov/articles/0171-medical-identity-theft.
  • Finally, if you need to update your address, go to www.ssa.gov/myaccount or call 1-800-772-1213.

[Also contributing to this column were EHRIntellence.com, NextAvenue.org/PBS.org; and HomeHealthcarenews.com]

Alan Schlein runs DeadlineOnline.com, an internet training and consulting firm. He is the author of the bestselling “Find It Online” books.

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