That’s a WRAP —

Looking back over the last 14 weeks, I have learned so very much about myself through this health policy blog. First, I learned that I can blog! I have always been incredibly scared to put my own thoughts and ideas out into the never-ending world of cyberspace! I learned that I can maneuver through the blog website, adding pictures; but, I never did quite master how to incorporate a video into my posts! (Hence, you never saw a video on this blog!) Second, I learned how to write a blog focusing on academic issues while focusing on my health policy topic. This was a big gain for me because I am only able to write academically or for fun; never both together J. Third, I learned more about the health policy process. I learned that there are many steps, many people involved, but that one voice can truly create a HUGE change. There is a lot of political influence behind the policy process, but I learned that the role of government is to represent the voices of those who they represent. Thus, if I have an idea and I voice that opinion, it can be heard and taken further if it is seen as urgent and needful.

Overall, this blog has served many purposes for me! Not only was it a requirement for the class, but it provided me the opportunity to learn in a way I never had before. I have worked so many hours on my DNP project relating meaningful use and messaging through the patient portal at a FQHC in Arizona; I am very passionate on making the patient portal more meaningful to patients. My DNP project has opened many eyes to how new the patient portal is, what potential benefits exist, but how very many barriers exist and perhaps many issues that were not thought of prior to implementation. When I began this blog, I had only briefly thought of the oddity of the mandate for providers to use the patient portal, yet there is no way to be reimbursed. Now, after 14 weeks of blogging about it, I have learned that there are many issues behind the patient portal and reimbursement. I predict that as more information is gleaned through research, there may need to be changes to the patient portal and meaningful use mandates. But for now, I am going to continue to support the need for providers to receive financial compensation for their time spent using the patient portal!

Wake up, People!!

The Problem: Providers are Unable to Bill for their Time Spent working with the Patient Portal

 

So many people do not understand how public policy affects their everyday life. It is the driving force behind so many things from transportation, to healthcare, to the basic freedoms we continue to enjoy. There are several of my friends who have no interest in knowing about governmental affairs or the political things that are doing on around them. It seems that the most likely person to take charge is one, like my brother, who is a history major with a passion for government and policy. How do we help people understand that policy, of any type, but specifically health policy is worth their time and interest?

First, I think consumers need more information and improving consumers’ access to such information would be helpful (Kraft & Furlong, 2015). We live in a time when there is information at our fingertips, but so much of that information is not accurate and many do not wish to sort through the junk to find the right information. I think that there should be commercials discussing various health policy issues and/or presentations on social media, but presented in an unbiased way. I also think it would be good if patients understood that the patient portal was created for their use and yet providers are not being reimbursed for their time. In my opinion, there will be a small percentage of the population who think that providers should work for free, but many will probably agree that their time is worth financial compensation.

Second, there are leaders within the policy process that can work to help others understand and participate within the policy process (Longest, 2010). Their role cannot be overlooked because they have such power to influence those around them. I think that making sure we know one of these people can be powerful in our lives as we understand how important policy is in our lives. Therefore, we can make friends or acquaintances with those policy leaders to help facilitate our participation.

Lastly, there needs to be a spark in the population to encourage their participation (Kraft & Furlong, 2015). Perhaps providing informational sessions or making it a requirement in high school would help to inspire the upcoming generations to take charge of their political issues. I wonder if billboards would be effective. We need to get out the information that every person can participate in the policy process from small means to very large and elaborate means. It would be important to emphasize that by simply writing a Congress person is participating, but also encouraging their basic participation in staying current on public affairs. This is huge! The more people who are paying attention to how health policy or policy in general affects them, the more likely we are to reduce the disconnect between the individuals’ lives and policy (Kraft & Furlong, 2015).

The consumer needs to take part in supporting the providers receiving financial compensation for their time spent working with the patient portal. I wish that there had been more consumer voices during the planning stage of the electronic health record and patient portal creation. I do not believe that the patient portal was truly created based on patient perspective. I think it was created by those who are so far removed from patient care, but the same ones who make all the decisions. If providers are mandated to use the patient portal and communicate with consumers, then that technology better be meaningful to the consumer. This is where consumers need to take part in the policy process to either support or provide insight into what might not be worthwhile to them. Providers should be reimbursed for their time working with the patient portal, but not if the patients are not using such technology. And then if the patients are not using it, then there needs to be a reevaluation and changes made before providers are mandated to prove meaningful use of something that is not meaningful to patients anyway. The role of the consumer, patient, or population in general cannot be overstated!

References

Kraft, M. E., & Furlong, S. R. (2015). Public Policy: Politics, Analysis, and Alternatives (5^th ed.). Thousand Oaks, CA: CQ Press.

Longest, B.B. Jr. (2010). Health policymaking in the United States (5th ed.). Chicago, IL:Health Administration Press.

Sustaining the Change

The Problem: Providers are Unable to Bill for their Time Spent using the Patient Portal

 

So if there is a policy change, meaning, if we can make it to where providers are now able to bill for their time spent using the patient portal, how do we sustain that innovation? It is important to remember that change in healthcare is just like change in any other type of system; it requires analysis, modification, repeat implementation, and then this cycle continues, perhaps indefinitely (Longest, 2010). Perhaps in the healthcare field, it is more important to have the repetition because things change so rapidly, with newer technology available and changes to how things are done. Nevertheless, the process needs to be followed.

If I am speaking hypothetical, suppose my suggestion of policy change, allowing providers to bill for their time using the patient portal, was supported by Medicare and Medicaid, as well as other interest groups, such as private insurance companies, then how would I support this change? First, I would recognize that it will take time to truly work out all of the kinks in this policy change. For example, there might need to be education and communication on the specific requirements for proper documentation to ensure honest reimbursement. Second, there would need to be someone to monitor the documentation and reimbursement. Third, there would need to be an analysis of how all of this is working out, perhaps after 6 months to 1 year. The analysis would look at provider satisfaction, but most importantly comparing the patient portal use with reimbursement as well as the adequacy of patient messaging through the patient portal. It would be interesting to see if the use of the patient portal is in fact a cost-saving measure, as initially hypothesized. Lastly, it would be necessary to have the continued support of the reimbursement companies, which can be obtained through adequate research and data to support the need for paying providers for their time with the patient portal. It is important to remember that the timing of this policy change is unknown, but I predict it will take at least several years before it is fully implemented and sustained, especially since the patient portal is still a new idea and we are only beginning to understand the use of such.

Now, what if there are issues? Well, that is one thing to be expected. For example, I expect there to be issues with proper documentation and thus, a need for more education and communication on this. I would expect a need for additional provider meetings or online broadcasts to discuss this. Furthermore, I would hope that websites, such as the American Academy of Nurse Practitioners and other provider sites would house the information for this policy change. Also, the information would be available online in other places, such as Centers for Medicare and Medicaid Services website, which is where all the information is available for reimbursement for Meaningful Use (CMS, 2015). Such a website would be ideal for housing this information and help to ensure that providers knew specifically what was expected. Other issues I foresee would be if patients are not actually using the patient portal, yet providers are sending messages through there. Should that be reimbursed? That would be something to be discussed and definitely something to hopefully monitor. With technology, monitoring just about everything online is possible!

In my opinion, it takes one voice, with the right support, to make the change. However, it takes a little bit more than that to sustain the change. It is all too easy to return to the old way of doing things. And this is why it is important to have a monitor, perhaps an organization or team that overlooked the patient portal and documentation to support provider reimbursement. I don’t expect much backlash from the provider perspective; however, this monitoring would help the payers see that their money is in fact going to good use, which would decrease backlash from those individuals and serve to sustain the innovative policy change!

References

Centers for Medicare and Medicaid Services. (2015). EHR Incentive Programs. Retrieved from http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html

Longest, B.B. Jr. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.

Money, Money, Money

The Problem: Providers are Unable to Bill for their Time Spent on the Patient Portal

 

Money, money, money; reminds me of the song on the Broadway musical Mama Mia. Money is the foundation of so many things and healthcare is not immune. The process of budgeting money for healthcare is similar to budgeting your own checkbook, except that it is much larger sums of money that will impact a much larger number of people. It requires Congress, who follows procedures already in place, to determine how to use taxes to benefit the greater good (Longest, 2010). Lately, so much attention has been placed on the price of healthcare, the debt to which the United States is in related to healthcare, and further discussion has taken place on how to reduce the price of healthcare while improving outcomes. With the patient portal and the electronic health record, the intention was to not only allow patients greater access to their health information, but to reduce costs. The idea was that this innovative technology system would decrease the time providers spent with paper charting, but the potential is that if these systems are linked together, then all tests, procedures, and provider notes can be shared across the variety of disciplines and specialties, reducing duplicate and unnecessary testing. The patient portal can also help to reduce costs if patients can communicate with their provider, getting answers to their questions without having to come into the office and using up the providers’ time unnecessarily (HealthIT, 2014).

 

Having patients communicate with their providers through the patient portal has the potential to reduce costs, but right now, the time providers spend working with the patient portal is not a billable service. And so what do we do? Who is going to finance this issue? Well, first, it is important to remember that the Centers for Medicare and Medicaid (CMS) currently provides reimbursements for facilities and providers who prove meaningful use of the patient portal; this includes their use of the patient portal (CMS, 2014). Thus, as the role of CMS is to support and enforce health policy, perhaps they can help finance the reimbursement for providers who spend time communicating with their patients through the patient portal. In addition, so much money has already been poured into the accumulation of and use of the electronic health record and patient portal, that the support of CMS to reimburse providers can, in my opinion, improve providers’ use of the patient portal. This is important as several studies within a systematic review showed that the degree of provider involvement has a direct impact on patient involvement in the patient portal (Amante, Hogan, Pagoto, & English 2014).

 

So the solution is to finance the reimbursement of providers’ time by gaining the buy-in of CMS, which is Medicare and Medicaid, which are two of the biggest sources of medical reimbursement overall. Thus, if we can gain the buy-in of this group, then other insurance companies and payers will hopefully support it as well. The overall intention is to reduce healthcare costs and improve patient outcomes, but without shorting the providers for all the time they spend doing their job, which is communicating with patients and providing quality patient care.

References

Amante, D.J., Hogan, T.P., Pagoto, S.L., English, T.M. (2014). A systematic review ofelectronic portal usage among patients with diabetes. Diabetes Technology & Therapeutics, 16(11), 7840793.

Centers for Medicare and Medicaid Services. (2014). Stage 2. Retrieved fromhttp://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html.

HealthIt.gov. (2014). Patient Portal Benefits Patient Care and Provider Workflow.Retrieved from http://healthit.gov/providers-professionals/patient-portal-benefits-patient-care-and-provider-workflow.

Longest, B.B. Jr. (2010). Health policymaking in the United States (5th ed.). Chicago,IL: Health Administration Press.

The Problem: Providers are Unable to Bill for Their Time Spent using the Patient Portal

I know many providers who spend tons of time responding to patient messages through the patient portal. I have mentioned this concept in previous blog posts, but just the other day I was talking with a provider who says he reserves at least 1 hour each night, if not more, after his office hours, to read the large volume of messages he receives from patients. Often these messages are detailed and require multiple messages to and from the patient to deal with the problem. However, this provider, similar to so many others, is unable to receive any type of monetary compensation for such communication, although this communication is being tracked and is a measure that will determine the facility’s or providers’ meaningful use of health technology. The solution to this problem, giving providers reimbursement for their time spent communicating with patients through the patient portal, requires innovation and change agents!

When I first started the doctoral program at ASU, I was unfamiliar with the words innovation, innovator, and innovative. I mean, I knew the basics of such terms, but boy has my mind been opened over these past 3 years! Here’s a bit of what I’ve learned and what I think.

Innovation is the introduction of change, but based on evidence or experience (Crenshaw & Yoder, 2013). It is not an invention, nor is it not necessarily new ideas. It is more likely new organization of old ideas. Furthermore, it is the application of an idea or a process to make change (Unterschuetz, Hughes, Nienhauser, Weberg, & Jackson, 2008). So the first characteristic of an innovator and change agent would be one who recognizes the need for change and is able to combine the current method with slight tweaking in order to meet the needed change.

Innovation is observation fueled by humans to create change. It is ideas combined with action, but it takes perseverance. One cannot expect results overnight, and it is a “continuous spirit of creative evolution” (Kelley, 2005). It creates a disruption in the current way of doing things, and this makes some people uncomfortable (Jaramillo, et al., 2008). As a nurse, I have seen the effect disruption can have on a work setting; making innovation difficult if others are not willing to make the change. Thus, the second characteristic of an innovator and change agent would be one who is a hard worker, never allowing barriers to prevent the change from happening. I think that a change agent has to be a really good leader, with the ability to persuade others to the importance of the change.

Innovation requires risk, not only the risk related to whether or not the change is good or bad, but risk to the leader who needs to have power to redefine from what was being done to what is now the goal (Unterschuetz, Hughes, Nienhauser, Weberg, & Jackson, 2008). Therefore, another characteristic of an innovator and change agent is one who views that change as important enough for the risk; one who remains levelheaded and perseveres.

Leadership is no longer a dictatorship, but is a team-focused effort (Davidson, 2010). Therefore, lastly, another characteristic of an innovator and change agent is one who works as a team player, who values the insight and opinion of others in order to create an influential and sustainable innovative change.

“Leadership is not a job description; rather, it is influencing others to contribute to a positive outcome” (Byram, 2000).

In order for the positive outcome, or change, to happen – providers to have the opportunity to bill for their communication with patients through the patient portal – I need to be the innovative change agent and group myself with others who are invested in this problem. Besides the associations that support providers, as mentioned in a previous post, with what other innovative change agents can I join forces?

 References

Byram, D.A. (2000). Leadership: A skill, not a role. AACN Clinical Issues: Advanced Practice in Acute & Critical Care, 11(3), 463-469.

Crenshaw, J.T., & Yoder, P.S. (2013). Creating an environment for innovation: The risk-taking leadership competency. Nurse Leader, 11(1), 24-27.

Jaramillo, B., Jenkins, C., Kermes, F., Wilson, L. Mazzocco, J., & Longo, T. (2008). Positive deviance: Innovation from the inside out. Nurse Leader, 6(2), 30-34.

Kelley, T. (2005). The ten faces of innovation. New York, NY: Doubleday.

Unterschuetz, C., Hughes, P., Nienhauser, D., Weberg, D., & Jackson, L. (2008). Caring for innovation and caring for the innovator. Nursing Administration Quarterly, 32(2), 133-141.

Change Theory

The Problem: Providers are Unable to Bill for their Time Using the Patient Portal

A lot of solutions to problems are drafted each day, many addressing issues within health policy. But how are these ideas selected, worked out, and implemented? What makes it something worth working with? Well, the ideas must be feasible for implementation, with specific suggestions on what changes to make. Second, it must be valued as important to the people, whether that means the organization, the government, or the individual – it must be important. Lastly, the idea must address future problems that may arise. The idea-maker must consider the future and how this specific solution, or idea, will endure that future (Kingdon, 2011). Once the solution is determined feasible, important, and capable of being a long-term solution, it is ready implementation and to make the change.

The Change Theory, developed by Kurt Lewin, gives background into the process of making changes (Nursing Theory, 2013). Currently, providers use the patient portal to communicate with their patients. Such communication can involve laboratory results, answers to patient questions or concerns, and medication refill requests. These are just a few of the topics frequently seen in patient portal messaging. The first step in the Change Theory is to unfreeze, or get rid of the old way of doing things. This can be difficult, especially in the healthcare world. Thus, for this specific problem, it is suggested that payers, such as insurance companies, Centers for Medicare & Medicaid Services recognize the need for reimbursement for the providers’ time. Furthermore, those that advocate for providers, along with the providers, need to voice the problem they see. By increasing the power of those who are in favor of the change, it can help to counteract those who are against the change (Kingdon, 2011). Those who might oppose the change would include payers, who are currently getting this service of providers communicating through the patient portal for free.

The next step is the change phase where all involved as encouraged as to a new way of thinking (Nursing Theory, 2013). This is where the real work takes place. This phase will take time as payers discuss with providers, determine the best way to get reimbursement, and figure out a new way to code for such time. Likely, this step in the change theory will take the longest, with trial and error initially being involved.

Lastly, refreezing is the final stage in the change theory. This is where the change is solidified, considered a new way of doing things, and such refreezing prevents others from going back to doing things the old way (Nursing Theory, 2013). Therefore, once the kinks are worked out and providers have the proper code number, payers acknowledge this payment code, and providers are able to bill for their time on the patient portal, it will become the way things are done. It will become second-nature and people will forget the days when providers spent time communicating through the patient portal without getting paid for their time.

As to the specific recommendations for reimbursement and billing, that will come later. It is the purpose of this post to recognize the change theory and how it applies to this current health policy problem. The refreezing stage is so vital to sustaining a change, and I have often seen it skipped and people simply return to doing things the old-fashioned way. Thus, through recognizing the steps in the change theory and understanding each step’s importance, it can be hoped that the health policy change can be sustained. Have you seen any changes that were not sustained due to the refreezing stage being overlooked?

References

Kingdon, J.W. (2011). Agendas, Alternative, and Public Policies, Update Edition (2^nd ed.). London: Longman Publishing Group.

Nursing Theory. (2013). Lewin’s Change Theory. Retrieved from http://www.nursing-theory.org/theories-and-models/Lewin-Change-Theory.php.

HIPAA, Cybersecurity, and the Patient Portal

The Problem: Providers are Unable to bill for their Time using the Patient Portal

Almost 20 years ago, The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was signed. It was created to protect patient’s personal health information from being used in an improper manner, while providing the patient access to his or her health information. It also addressed protecting electronic health records by creating national standards for the use and protection of electronic health information (USDHHS, n.d).

Under HIPAA, individuals can make requests for their medical information and should have a timely response. The individual has a right to all records, including billing, case management records, and any item that includes the patient’s health information that is collected and used. Electronic copies of the patient chart can be available in a variety of formats and the individual may download at any time (USDHHS, n.d). Such concept supports the idea that the electronic health record can reduce the number of unnecessary tests, improve communication between providers, and improve quality of care while decreasing costs. If patients can have unlimited access to their medical information, then this would further help with transparency between providers and patients. If a patient is going to a follow-up appointment with a specialist, he or she would have the primary care provider’s notes and possibly copies of the x-ray in hand. This would eliminate the common problem today where the specialist does not receive the primary care provider’s note or any test results, leading to duplicate testing and/or delay of care.

We know that life is not black and white; there are always exceptions. With electronic health information, there are some exceptions to what has already been discussed. The first is information from psychotherapy does not have to be disclosed. Certain information from clinical laboratories, inmate requests, and other requests that may violate HIPAA can be withheld from the patient as well. Furthermore, any information which might be harmful to the patient can be withheld from the patient (USDHHS, n.d).

Now, there is the scary concept of cybersecurity! I call it scary because I have spoken with many individuals who are leery of the patient portal because of the risk of someone hacking into their health information similar to how people are hacking into bank accounts and stealing others’ identities. Thankfully, in 2013, President Obama signed into effect the need for a cybersecurity framework for all facilities to use in order to reduce their risks. Furthermore, the Office of the National Coordinator for Health Information Technology (ONC) is constantly creating educational opportunities regarding cybersecurity. It is important to remember that keeping health information private is a shared responsibility between the public, private, and individual sectors (HealthIT.gov, 2015). As the use of the patient portal and the electronic health record continues to increase, adhering to HIPAA and other policy regulations is crucial to protecting the patient.

Lastly, the patient portal is a part of the electronic health record. It contains patient information, such as laboratory results and visit summaries, and also allows for patients to securely email their provider questions. According to HIPAA, there must be written consent to share patient information via the patient portal and through the electronic health information exchange (HealthIT.gov, 2015). Once providers have this consent and begin to communicate with their patients through the patient portal, he or she should be able to bill for this service. However, it is not necessary to bill for time spent uploading visit summaries or medication lists as this is an understood part of patient care – allowing patients access to their health information. But if the provider is taking time having a “virtual” visit with the patient, answering his or her questions, providing suggestions and making recommendations, such should be a billable service.

 References

HealthIT.gov. (2015). Privacy & Security. Retrieved from http://healthit.gov/providers-professionals/cybersecurity-shared-responsibility.

U.S. Department of Health & Human Services. (n.d.). Health Information Privacy. Retrieved from http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/healthit/index.html.

Private Sector Interviews

The Problem: Providers are Unable to Bill for their Time using the Patient Portal

 

When I first was interested in this subject, I did a Google search to see if providers could bill for anything related to patient portal communication. I did not find any information on the ability to bill specifically for patient portal messaging, but I did find that providers can bill for telephone visits and e-visits limited to rural health (Priority Health, 2014). So I began thinking that perhaps such billing could be transferred to the online equivalent, and not limited to rural health.

I decided to interview a couple of individuals who are key players within the private sector; both are from a specific healthcare organization here in Arizona. This healthcare organization is very large, with many hospitals and outpatient clinics located in the Phoenix area. I first interviewed Jason, who is the lobbyist for this private sector organization. His role is to lobby for those things that will benefit this specific organization; he spends many of his days at the Capitol discussing various issues with legislators. While talking with him, he had not yet heard of any reimbursement options for provider use of the patient portal. Furthermore, he did not think this was a particularly big problem yet as he had not heard any discussion on this topic. However, he did mention telehealth; but again, there is no real consistent reimbursement for it. He related that Medicare/Medicaid made up about 50% of the payers for this particular healthcare organization, yet they only paid a small percentage of what was actually billed. For example, Medicare pays 92 cents on the dollar and Medicaid pays about 62 cents on the dollar. Therefore, they overcharge through the commercial market to make up for that. Otherwise, there would be little profit and the organization would cease to exist. It was an eye-opener as to how little reimbursement is received from the public sector, which in turn affects the public sector (J. Bezozo, personal communication, February 3, 2015).

Interviewing a lobbyist was very informational; however, we mostly discussed the health policy process and touched a little on billing. I wanted to know more specifics on the patient portal, so I met with Cheryl, who is the Patient Financial Services director for one hospital within this healthcare organization. She expressed to me that currently there is no reimbursement set up for providers who use the patient portal. However, she did say that soon those who belong to this healthcare organization can call a provider to get care over the phone. For example, if the patient is having a cough and fever, he or she can call the provider and the provider will diagnose over the phone and send prescriptions to the pharmacy. The provider can then bill for this telephone visit. Cheryl expressed her opinion that if this type of visit was billable, then it should be the same for patient portal use and she thought that soon this would be addressed. We discussed the patient portal further. It is currently being used in the outpatient settings, where patients can view their mediations and some labs, while being able to communicate with the provider. The portal is also available to patients who are discharged from the hospital; however, there is no inpatient data that is available for them on the portal. Nevertheless, it is in the plans to have hospital records available for patients on the patient portal, allowing them access to their charts to help with follow-up appointments (C. Ralls, personal communication, February 27, 2015).

What does all of this mean for the private sector and healthcare policy? Well, based on my last post, I felt that getting the public sector on-board with my health policy issue was the key. However, after learning more about the private sector, I recognize that the private sector has a role in making and implementing health policy (Longest, 2010). Thus, I can’t go wrong with gaining the support of either the public or the private sector; however, both would be nice!

 References

Longest, B.B. Jr. (2010). Health policymaking in the United States (5th ed.). Chicago, IL:Health Administration Press.

Priority Health. (2014). Phone and e-visit Billing under Medicare. Retrieved from http://www.priorityhealth.com/provider/manual/billing-and-payment/services/phone-and-e-visits/medicare-billing.

Let’s Discuss Medicare, Medicaid, & the Affordable Care Act

The Problem: Providers are unable to bill for their time spent using the Patient Portal

Medicare and Medicaid are health insurance programs under the Social Security Act of 1965. Medicaid is a federal and state entitlement program for those who are low income or have limited resources. Medicare, on the other hand, is for all people over the age of 65 and other select individuals such as those with end-stage renal disease (Longest, 2010). As of 2013, 52.3 million Americans were on Medicare, and with the aging population, this number is expected to increase to 79 million by 2030 (National Committee to Preserve Social Security & Medicare, 2015; AARP, 2009). Today, Medicare and Medicaid combined cover 100 million people (CMS, n.d.).

 

A few weeks ago I discussed the policy-making process (https://bmorganhie.wordpress.com/2015/02/10/policy-making-and-schoolhouse-rock/). I mentioned that after the problem is addressed and policy is created, there must be enforcers and regulators of that policy. The Centers for Medicare & Medicaid Services (CMS) is the regulatory agency within the government that acts as administration; they create standards and rules as a part of their overseeing the Medicare/Medicaid process (CMS, n.d.). However, have you noticed that the rules set out by CMS dictates most of what the healthcare does in general? It has been my experience that insurance companies and other payers follow the same recommendations as set forth by CMS for reimbursement and billing of Medicare/Medicaid patients. Therefore, in my opinion, the true key to making change relating to reimbursement is to get the buy-in of CMS.

In March 2010, President Obama signed into effect the Affordable Care Act (ACA), which addressed a variety of healthcare issues including coverage, reimbursement, and many others. It also supported the use of the Electronic Health Record (EHR), while encouraging the meaningful use of that technology (American Health Tech, 2014).

So, as CMS is the enforcers of policy, they did their job to further support and encourage meaningful use. CMS has provided a financial reimbursement incentive to providers and facilities that have an EHR, including a patient portal, and are able to show meaningful use (CMS, 2014). This has sparked the attention of many, due to the large financial impact of such intervention. However, the reimbursement is based upon patients having access to their health information, specifically medications, laboratory results, and some progress notes. The CMS incentive does not specifically address providers’ time spent responding to patient messages through the patient portal. I do not think that providers should be paid to simply post their progress notes onto the portal, as this is a simple checked box on the EHR. However, when a patient messages his or her provider to ask about a medication, or a question about a symptom, the provider should be able to bill for time spent responding to this message. I have seen that some patients send their provider a very long message to simply say he or she has some edema in their ankles. This takes time for the provider to comb through the message, answer the question, and possibly follow-up depending on the message content. Perhaps CMS should offer a way for providers to bill for their time, perhaps under a separate billing code or as part of the managed-care option. It seems that when the EHR and patient portal was initially discussed, not all of the needs were adequately addressed. If I can get the attention of CMS and encourage their support in reimbursement for patient portal use, I firmly believe other payers would get on the train and support this. Do you agree?

References

AARP Public Policy Institute. (2009). The Medicare Beneficiary Population. Fact Sheet 149. Retrieved from http://assets.aarp.org/rgcenter/health/fs149_medicare.pdf.

American HealthTech. (2014). A Brief History of Electronic Health Records (EHR). Retrieved from http://www.healthtech.net/post-acute-care-blog/bid/114719/a-brief-history-of-electronic-health-records-ehrs/.

Centers for Medicare & Medicaid Services. (n.d.). CMS.gov. Retrieved from http://www.cms.gov/.

Longest, B.B. Jr. (2010). Health policymaking in the United States (5th ed.). Chicago, IL:bHealth Administration Press.

National Committee to Preserve Social Security & Medicare. (2015). Fast Facts about Medicare. Retrieved from http://www.ncpssm.org/Medicare/MedicareFastFacts.

The Problem: Providers are unable to bill for their time in using the Patient Portal.

How does the public sector influence healthcare policy, specifically to help the underinsured, uninsured, and to decrease health disparities? Well, the first task is to understand what the public sector is. It is the government-controlled portion of the economy (InvestorWords, 2015). As you can guess, the public sector has a major influence on helping the uninsured and underinsured. Furthermore, it is very influential in decreasing health disparities as the government can allocate funds to various programs to help ease the burden of medical costs on individual and families (Kraft, 2015). However, the bottom line is always money and therefore, there must be a balance of providing help to such individuals without putting the US in more debt than it already is.

So, what is the solution? Well, if we can create a healthcare system that is more available at a lower cost, then that would be helpful. Sounds easy, right? Well, the electronic health record and patient portal was in part created to help make the patient’s record available to patients at all times, as well as allow for electronic sharing of patient results and information across multiple disciplines. This is called health information exchange (HealthIT, 2014). If this is utilized correctly, then unnecessary or duplicate diagnostic tests can be avoided, thus reducing healthcare costs. Furthermore, if patients have access to their medical information, errors can be reduced as continuity of care is improved with this information. If providers are able to communicate with their patients via the patient portal, able to answer questions about their care or medications, this can also help reduce costs associated with coming into the office. Will this help the uninsured and underinsured? I personally think so.

Most Americans have access to the internet; many are using smart phones and constantly post pictures on various social media websites. Therefore, regardless of insurance or health status, all Americans can have access to their medical information through the patient portal. They will be able to ask questions to their provider, able to have accurate medication lists, able to view progress notes from each provider they see, and I trust that the patient portal will have more capabilities the longer it is in use. I really think it would be awesome if the patient portal also had patient-specific educational information, to where patients looked to their provider’s portal for answers to health questions rather than simply doing a google search. With the current use of the patient portal, providers do not bill each time they send a message to the patient, and this needs to be addressed before the patient portal grows even bigger with more capabilities/options I previously described.

The US healthcare system is moving away from the fee-for-service reimbursement for care toward a managed care idea. Managed care would mean that healthcare services would be organized and managed as a whole rather than billing for each service (Kraft, 2015). There are benefits to both types of reimbursement. However, with the patient portal, I think that this is a way to further organize and coordinate care for patients and reduce healthcare costs as I described above. Therefore, providers should be reimbursed for their patient portal use as an aspect of managed care. Do you think that providers would utilize the patient portal more if they saw a financial benefit for themselves and their practice for the use of the patient portal?

References

HealthIT. (2014). Health Information Exchange. Retrieved from http://www.healthit.gov/providers-professionals/health-information-exchange/what-hie.

InvestorWords. (2015). Public Sector. Retrieved from http://www.investorwords.com/3947/public_sector.html

Kraft, M. E., & Furlong, S. R. (2015). Public Policy: Politics, Analysis, and Alternatives (5^thed.). Thousand Oaks, CA: CQ Press.