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EHR Incentive Programs: Where We Go Next (Message from Andy Slavitt and Karen DeSalvo)

Where We’ve Been

As we mentioned in a speech last week, the Administration is working on an important transition for the Electronic Health Record (EHR) Incentive Program. We have been working side by side with physician organizations and have listened to the needs and concerns of many about how we can make improvements that will allow technology to best support clinicians and their patients. While we will be putting out additional details in the next few months, we wanted to provide an update today.

In 2009, the country embarked on an effort to bring technology that benefits us in the rest of our lives into the health care system. The great promise of technology is to bring information to our fingertips, connect us to one another, improve our productivity, and create a platform for a next generation of innovations that we can’t imagine today.

Not long ago, emergency rooms, doctor’s offices, and other facilities were sparsely wired. Even investing in technology seemed daunting. There was no common infrastructure. Physician offices often didn’t have the capital to get started and it was hard for many to see the benefit of automating silos when patient care was so dispersed. We’ve come a long way since then with more than 97 percent of hospitals and three quarters of physician offices now wired.

It’s taken a tremendous commitment by physicians, hospitals, technologists, patient groups and experts from all over the country to make the progress we’ve made together in a few short years. The EHR Incentive Programs were designed in the initial years to encourage the adoption of new technology and measure the benefits for patients. And while it helped us make progress, it has also created real concerns about placing too much of a burden on physicians and pulling their time away from caring for patients.

Transitioning From Measuring Clicks to Focusing on Care

Last year, the Administration and Congress took two extraordinary steps to put patients at the center of how we pay for care and support physicians. First, the Administration set a goal that 30 percent in 2016 and 50 percent in 2018 of Medicare payments will be linked to getting better results for patients, providing better care, spending healthcare dollars more wisely, and keeping people healthy.  And, second, Congress advanced this goal through the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which considers quality, cost, and clinical practice improvement activities in calculating how Medicare physician payments are determined. While MACRA also continues to require that physicians be measured on their meaningful use of certified EHR technology for purposes of determining their Medicare payments, it provides a significant opportunity to transition the Medicare EHR Incentive Program for physicians towards the reality of where we want to go next.

What Comes Next

We have been working side by side with physician and consumer communities and have listened to their needs and concerns. As we move forward under MACRA, we will be sharing details and inviting comment as we roll out our proposed regulations this spring. All of this work will be guided by several critical principles:

  1. Rewarding providers for the outcomes technology helps them achieve with their patients.
  2. Allowing providers the flexibility to customize health IT to their individual practice needs. Technology must be user-centered and support physicians.
  3. Leveling the technology playing field to promote innovation, including for start-ups and new entrants, by unlocking electronic health information through open APIs – technology tools that underpin many consumer applications.  This way, new apps, analytic tools and plug-ins can be easily connected to so that data can be securely accessed and directed where and when it is needed in order to support patient care.
  4. Prioritizing interoperability by implementing federally recognized, national interoperability standards and focusing on real-world uses of technology, like ensuring continuity of care during referrals or finding ways for patients to engage in their own care. We will not tolerate business models that prevent or inhibit the data from flowing around the needs of the patient.

What This Means for Doctors and Hospitals 
As we work through a transition from the staged meaningful use phase to the new program as it will look under MACRA, it is important for physicians and other clinicians to keep in mind several important things:

  1. The current law requires that we continue to measure the meaningful use of ONC Certified Health Information Technology under the existing set of standards. While MACRA provides an opportunity to adjust payment incentives associated with EHR incentives in concert with the principles we outlined here, it does not eliminate it, nor will it instantly eliminate all the tensions of the current system. But we will continue to listen and learn and make improvements based on what happens on the front line.
  2. The MACRA legislation only addresses Medicare physician and clinician payment adjustments. The EHR incentive programs for Medicaid and Medicare hospitals have a different set of statutory requirements. We will continue to explore ways to align with principles we outlined above as much as possible for hospitals and the Medicaid program.
  3. The approach to meaningful use under MACRA won’t happen overnight. Our goal in communicating our principles now is to give everyone time to plan for what’s next and to continue to give us input.  We encourage you to look for the MACRA regulations this year; in the meantime, our existing regulations – including meaningful use Stage 3 – are still in effect.
  4. In December, Congress gave us new authority to streamline the process for granting hardship exception’s under meaningful use.  This will allow groups of health care providers to apply for a hardship exception instead of each doctor applying individually. This should make the process much simpler for physicians and their practice managers in the future. We will be releasing guidance on this new process soon.

These principles we’ve outlined here reflect the constructive and clear articulation of issues and open sharing of views and data by stakeholders across the health care system, but they also promote our highest priority – better care for the beneficiaries of the Medicare and Medicaid program and patients everywhere.

The challenge with any change is moving from principles to reality. The process will be ongoing, not an instant fix and we must all commit to learning and improving and collaborating on the best solutions. Ultimately, we believe this is a process that will be most successful when physicians and innovators can work together directly to create the best tools to care for patients. We look forward to working collaboratively with stakeholders on advancing this change in the months ahead.

January 19, 2016 I Written By

John Lynn is the Founder of the blog network which currently consists of 5 blogs containing over 11,000 articles with John having written over 5500 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 18 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10

With less than three months remaining until the nation switches from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures, The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) are announcing efforts to continue to help physicians get ready ahead of the October 1 deadline.  In response to requests from the provider community, CMS is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set.

Recognizing that health care providers need help with the transition, CMS and AMA are working to make sure physicians and other providers are ready ahead of the transition to ICD-10 that will happen on October 1.  Reaching out to health care providers all across the country, CMS and AMA will in parallel be educating providers through webinars, on-site training, educational articles and national provider calls to help physicians and other health care providers learn about the updated codes and prepare for the transition.

“As we work to modernize our nation’s health care infrastructure, the coming implementation of ICD-10 will set the stage for better identification of illness and earlier warning signs of epidemics, such as Ebola or flu pandemics.” said Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services. “With easy to use tools, a new ICD-10 Ombudsman, and added flexibility in our claims audit and quality reporting process, CMS is committed to working with the physician community to work through this transition.”

“ICD 10 implementation is set to begin on October 1, and it is imperative that physician practices take steps beforehand to be ready,” said AMA President Steven J. Stack, MD.  “We appreciate that CMS is adopting policies to ease the transition to ICD-10 in response to   physicians’ concerns that inadvertent coding errors or system glitches during the transition to ICD-10 may result in audits, claims denials, and penalties under various Medicare reporting programs.  The actions CMS is initiating today can help to mitigate potential problems.  We will continue to work with the administration in the weeks and months ahead to make sure the transition is as smooth as possible.”

The International Classification of Diseases, or ICD, is used to standardize codes for medical conditions and procedures. The medical codes America uses for diagnosis and billing have not been updated in more than 35 years and contain outdated, obsolete terms.

The use of ICD-10 should advance public health research and emergency response through detection of disease outbreaks and adverse drug events, as well as support innovative payment models that drive quality of care.

CMS’ free help includes the “Road to 10” aimed specifically at smaller physician practices with primers for clinical documentation, clinical scenarios, and other specialty-specific resources to help with implementation. CMS has also released provider training videos that offer helpful ICD-10 implementation tips.

The AMA also has a broad range of materials available to help physicians prepare for theOctober 1 deadline.  To learn more and stay apprised on developments, visit AMA Wire.

CMS also detailed its operating plans for the ICD-10 implementation. Upcoming milestones include:

  • Setting up an ICD-10 communications and coordination center, learning from best practices of other large technology implementations that will be in place to identify and resolve issues arising from the ICD-10 transition.
  • Sending a letter in July to all Medicare fee-for-service providers encouraging ICD-10 readiness and notifying them of these flexibilities.
  • Completing the final window of Medicare end-to-end testing for providers this July.
  • Offering ongoing Medicare acknowledgement testing for providers through September 30th.
  • Providing additional in-person training through the “Road to 10” for small physician practices.
  • Hosting an MLN Connects National Provider Call on August 27th.

In accordance with the coming transition, the Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of services after September 30, 2015, nor will they be able to accept claims for both ICD-9 and ICD-10 codes.

Also, at the request of the AMA, CMS will name a CMS ICD-10 Ombudsman to triage and answer questions about the submission of claims. The ICD-10 Ombudsman will be located at CMS’s ICD-10 Coordination Center.

July 6, 2015 I Written By

John Lynn is the Founder of the blog network which currently consists of 5 blogs containing over 11,000 articles with John having written over 5500 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 18 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

New Medicare data available to increase transparency on hospital and physician utilization

Data serves as a rich resource to clearer look into Parts A and B costs, services, and trends

As part of the Administration’s efforts to promote better care, smarter spending, and healthier people, today CMS is posting the third annual release of the Medicare hospital utilization and payment data (both inpatient and outpatient) and the second annual release of the physician and other supplier utilization and payment data. The announcement was made at the annual Health Datapalooza conference in Washington, DC.

“These data releases will give patients, researchers, and providers continued access to information to transform the health care delivery system,” said acting CMS Administrator Andy Slavitt. “It’s important for consumers, their providers, researchers and other stakeholders to understand the delivery of care and spending under the Medicare program.”

The Medicare hospital utilization and payment data consists of information for 2013 about the average amount a hospital bills for services that may be provided in an inpatient stay or outpatient visit. The hospital data includes payment and utilization information for services that may be provided in connection with the 100 most common Medicare inpatient stays and 30 selected outpatient procedures at over 3,000 hospitals in all 50 states and the District of Columbia. The top 100 inpatient stays represented in the hospital inpatient data are associated with approximately $62 billion in Medicare payments and over 7 million hospital discharges.

The Medicare Part B physician, practitioner, and other supplier utilization and payment data consists of information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. The data also shows payment and submitted charges, or bills, for those services and procedures by provider. It allows for comparisons by physician, specialty, location, types of medical services and procedures delivered, Medicare payment, and submitted charges. The new 2013 dataset has information for over 950,000 distinct health care providers who collectively received $90 billion in Medicare payments. Hospitals, physicians, and other health care providers determine what they will charge for services and procedures provided to patients and these “charges” are the amount the hospital or provider generally bills for the service or procedure, but the amount paid is determined by Medicare’s physician fee schedule or other payment methodologies. CMS protects beneficiaries’ personal information in all its data releases.

“Data transparency facilitates a vibrant health data ecosystem, promotes innovation, and leads to better informed and more engaged health care consumers,” said Niall Brennan, CMS chief data officer and director of the Office of Enterprise and Data Analytics. “CMS will continue to release the hospital and physician data on an annual basis so we can enable smarter decision making about care that is delivered in the health care system.”

The Administration has set measurable goals and a timeline to move Medicare toward paying providers based on the quality, rather than the quantity, of care they give patients. These data releases are part of a wide set of initiatives to achieve better care, smarter spending, and healthier people through our health care system. Open sharing of data securely, timely, and more broadly supports insight and innovation in health care delivery.

Today’s data release adds to the unprecedented information recently released on Medicare Part D prescription drugs prescribed by physicians and other health care providers.

To view a fact sheet on the 2013 hospital charge data, visit:

To view a fact sheet on the 2013 Medicare Part B physician data, visit:

June 1, 2015 I Written By

John Lynn is the Founder of the blog network which currently consists of 5 blogs containing over 11,000 articles with John having written over 5500 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 18 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Raj Ambay, M.D., David Rosman, M.D. and Susan Strate, M.D. Join Independent Physician Advisory Board of OptumInsight

Added diversity of clinical and surgical practice expertise to help OptumInsight drive innovation to enhance patient care and physician-patient relationships

EDEN PRAIRIE, Minn., Sept. 15, 2011 – OptumInsight (formerly Ingenix) announced that Raj Ambay, M.D., David Rosman, M.D. and Susan Strate, M.D., have joined its independent Physician Advisory Board. The Board guides the company’s efforts to safeguard health information and helps ensure its innovations help enhance patient care and patient-physician relationships.

“Dr. Ambay, Dr. Rosman and Dr. Strate add considerable depth and diversity of expertise to a Board working to ensure that OptumInsight supports physicians in their efforts to improve patient care outcomes, manage their practices efficiently and secure sensitive health information,” said Andy Slavitt, CEO of OptumInsight. “With guidance from the Board, we are helping to make patient care, regulatory compliance and business decisions simpler for our physician clients, and to drive innovation that makes a positive difference in the health of populations.”

Dr. Ambay is a plastic surgeon for the Tampa Institute for Plastic Surgery and the James A. Haley Veterans Hospital in Tampa, Fla. He is an advocate for using technology to improve safety, communication, efficiency and patient outcomes. In 2009, Ambay was elected to the American Medical Association (AMA) Board of Trustees, and he has served as a member of the Board of Directors of the National Board of Medical Examiners. He is also a Major in the U.S. Army Reserve. More about Dr. Ambay is here.

Dr. Rosman is a staff radiologist in the Division of Abdominal and Interventional Radiology at Massachusetts General Hospital, and serves as medical director of Mass General Imaging in Worcester, Mass. He is also an Instructor in Radiology at Harvard Medical School. He has served on the AMA Board of Trustees and in various roles in the American College of Radiology. More about Dr. Rosman is here.

Dr. Strate is a clinical and anatomic pathologist, overseeing laboratory operations with three north Texas hospitals and working with several rural community health centers as a consulting physician for peer review and quality assurance. Since 1996, Strate has served as president of the Texompa Independent Physicians Practice Association, and she is a member of the AMA House of Delegates. She also served in leadership positions in the Texas Medical Association, where she focused on quality and patient safety, and legislative and socioeconomic issues. More about Dr. Strate is here.

The OptumInsight Physician Advisory Board is a multidisciplinary group of expert, practicing physicians who guide the company’s efforts to engage doctors and develop innovative solutions that support better patient care and practice administration. Board members advise the company in such areas as data privacy and security, analytic and consultative processes and administrative services. The board also is available as a resource to physicians and communities seeking to advance their use of health IT and analytics.

Dr. Ambay, Dr. Rosman and Dr. Strate join Board Chairman Joe Heyman, M.D., F.A.C.O.G, and founding members Stuart Cohen, M.D., M.P.H., F.A.A.P.; Willarda V. Edwards, M.D.; C. Martin Harris, M.D.; Alice A. Loveys, M.D., F.A.A.P., F.H.I.M.S.S.; Andrew Nordine, M.D., M.S., F.A.A.P.; Gregory Reicks, D.O., F.A.A.F.P.; and Salvatore Volpe, M.D., F.A.A.P., F.A.C.P., C.H.C.Q.M.

About OptumInsight
OptumInsight provides health information, technology and consulting services. Commercial health plans, physicians, hospitals, life sciences companies, government agencies and other organizations that comprise the health care system depend on OptumInsight solutions and insights to improve their performance. OptumInsight is part of Optum, a leading information and technology-enabled health services company dedicated to making the health system work better for everyone. Visit or for more information.

September 26, 2011 I Written By


OptumHealth, which supports and delivers population health solutions that address the physical, mental and financial health needs of individuals and organizations, will retain its name but adjust its brand positioning to fit the new Optum brand. Ingenix, a leading health information and analytics, technology, services and consulting business, will become OptumInsight.

Single brand simplifies offerings for the broad health services marketplace
MINNETONKA, Minn. (April 11, 2011) – UnitedHealth Group (NYSE: UNH) today announced that the company’s health services businesses will unify their market presence under the master brand Optum™.

This brand unification is focused on making it easier for the broad health services marketplace to understand and access the company’s full range of capabilities that help participants throughout the health care system improve health, increase efficiency and create a better overall experience for consumers.

“Just as our distinct health benefits businesses market under the UnitedHealthcare master brand, our individual health services businesses will now align their market engagement under the Optum brand, as the next step in the evolution of our two business platforms,” said Stephen Hemsley, president and CEO, UnitedHealth Group.

The change reflects increased coordination and collaboration among three leading health services companies that are committed to addressing meaningful and positive change across the health care system: OptumHealth™, which will retain its name; OptumInsight™, which will replace the Ingenix name; and OptumRx™, which will replace the Prescription Solutions name. These combined businesses serve more than 60 million people, have more than 30,000 employees, and in 2010 reported combined revenues of $25 billion, giving Optum as a whole the scale of a FORTUNE 100 enterprise.

“We are aligning these businesses to better match the way we serve clients and the way our clients access health services,” said G. Mike Mikan, CEO of Optum. “This step will make it simpler for clients to connect with the broad expertise and innovative capabilities across our businesses, so we can help them improve population health, reduce the cost of care and make health care work better for everyone. Clients will know they can come to Optum for all their health services needs.”

OptumHealth, which supports and delivers population health solutions that address the physical, mental and financial health needs of individuals and organizations, will retain its name but adjust its brand positioning to fit the new Optum brand. Ingenix, a leading health information and analytics, technology, services and consulting business, will become OptumInsight. PrescriptionSolutions, which specializes in the delivery, clinical management and affordability of prescription medications and consumer health products, will become OptumRx. The three companies will continue to operate under the leadership, respectively, of Dawn Owens, CEO of OptumHealth, Andy Slavitt, CEO of OptumInsight, and Jacqueline Kosecoff, CEO of OptumRx. Migration to the new brands is expected to take place over the next 12 months.

The Optum businesses serve care providers, including 250,000 professionals or groups and 6,200 hospital facilities; more than 270 state and federal government agencies; over 2,000 independent health plans; two of every five FORTUNE 500 employers; 2,200 global life sciences companies; and one in every five U.S. consumers. Together, these businesses help organizations address significant challenges such as improving clinical performance, implementing new models for care delivery and reimbursement, complying with new regulations, and reducing administrative and financial burdens. Optum’s deep understanding of the needs of the multiple participants across the health ecosystem enables it to deliver collaborative solutions that provide the insights and care to help build sustainable health communities.

About Optum
Optum is an information and technology-enabled health services business platform serving the broad health care marketplace, including care providers, plan sponsors, life sciences companies and consumers. Its business units – OptumInsight, OptumHealth and OptumRx – employ more than 30,000 people worldwide.

About UnitedHealth Group
UnitedHealth Group (NYSE: UNH) is a diversified health and well-being company dedicated to helping people live healthier lives and making health care work better. With headquarters in Minnetonka, Minn., UnitedHealth Group offers a broad spectrum of products and services through two distinct platforms: UnitedHealthcare, which provides health care coverage and benefits services; and Optum, which provides information and technology-enabled health services. Through its businesses, UnitedHealth Group serves more than 75 million people worldwide. Visit for more information.

April 19, 2011 I Written By