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Category: Health Care Reform

Information Blocking: A New Term And The Promise Of A New Era In Electronic Health Information Sharing

With the breakneck pace at which new health information technology reports and regulations are released, the recent report from the Office of the National Coordinator for Health Information Technology (“ONC”)—on health information blocking—may have failed to hit the radar. But it should have, because of the key message it contains:

“[…] some business practices, though they may arguably advance legitimate individual economic interests, interfere with the exchange of electronic health information in ways that raise serious information blocking concerns. At some point, ONC believes that decisions to engage in such practices are unreasonable as against public policy […]”

Said more succinctly, when it comes to sharing electronic patient health information, public good should trump private gain. While it may seem like an obvious statement, it represents a tectonic shift in the narrative surrounding health information exchange (“HIE” – the electronic sharing of patient data across unaffiliated provider organizations).

For more than a decade, our federal strategy has largely left HIE to the market under the assumption that, if there is benefit to be created (and estimates suggest that there is), we should see the emergence of ways to capture that benefit. In practice, this means that HIE efforts have sprung up in various health care markets across the country, and where public money has been spent on HIE (largely at state and community levels), it has come in the form of one-time start-up funding, not a commitment of ongoing support or regulatory mandates for HIE participation.

What has been substantially underappreciated, however, is the fact that, for the key actors needed to enable HIE to occur—provider organizations and vendors—there might be more benefit, or at least more certain benefit, from not doing so. And as a result, these actors may behave in ways that interfere with the free-flow of patient information that is needed to improve health and health care.

With the release of the information blocking report, which was produced in response to a 2015 Omnibus bill request that introduced the term “information blocking,” ONC makes plain that this behavior will no longer be tolerated. This enormously exciting development means we might see real progress after decades of investment that has failed to convert into sustainable approaches to robust HIE. The key to such progress, however, lies in how well we can identify when information blocking is occurring. This will not be easy.

According to the report, if the behavior of provider organizations or vendors meets the following three criteria, they are considered to be engaging in information blocking:

  1. Interference. There must be “an act or course of conduct that interferes with the ability of authorized persons or entities to access, exchange, or use electronic health information.”
  2. Knowledge. “The decision to engage in information blocking [must be] made knowingly.”
  3. No Reasonable Justification. Conduct must be “objectively unreasonable in light of public policy.”

Read the full report here.

Contact Steven G. Cosby, MHSA, Group Health Insurance Broker and Agent with Cosby Insurance Group, with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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Expatriate Health Coverage Exemption Enacted in Omnibus Spending Bill

On December 16, 2014, President Obama signed into law a $1.1 trillion omnibus spending bill (H.R. 83, the Consolidated and Further Continuing Appropriations Act; Pub. Law No. 113-235) that includes important relief from the Affordable Care Act for certain health plans provided to expatriate employees.

The spending bill incorporates the Expatriate Health Coverage Clarification Act (the “Act”), which broadly exempts “expatriate health plans or expatriate health coverage,” employers that sponsor such plans, and “expatriate health insurance issuers” with respect to coverage under such plans from most otherwise applicable provisions of the Patient Protection and Affordable Care Act (“PPACA”) and the Health Care and Education Reconciliation Act of 2010 (“HCERA”) (together, the “ACA”).

Some important highlights of the Act are:

  • Expatriate health plans are exempt from most of the ACA insurance market reforms.
  • Expatriate health plans are exempt from the transitional reinsurance fee and the Patient Centered Outcomes Research Institute (“PCORI”) fee.
  • After 2015, expatriate health plans are exempt from the health insurer fee (“HIF”)– (with special transition rules applying in 2014 and 2015).
  • Employer-sponsored coverage for expatriates generally is exempt from the 40% high-cost plan excise tax in Code section 4980I, except for coverage provided to certain expatriates who are “assigned” to work in the U.S.
  • The employer “shared responsibility” mandate rules continue to apply, but expatriate health plans with respect to certain foreign employees working in the U.S. and certain U.S. expatriates working abroad are treated as “minimum essential coverage” under an “eligible employer-sponsored plan” for purposes of the employer and individual mandates.
  • The Code sections 6055 and 6056 reporting requirements continue to apply (with certain relief from the electronic delivery consent rules for individual statements).

Unless otherwise specified in the Act, the Act is effective on the date of enactment and applies only to expatriate health plans issued or renewed on or after July 1, 2015.

Read the full report here.

Please contact Steven G. Cosby, MHSA, Group Health Insurance Broker and Agent with Cosby Insurance Group, with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

Cosby Insurance Group - Group Health Insurance Broker and Agent

Emergency Care Visits Continue to Rise Since Implementation of Affordable Care Act

Three-quarters of emergency physicians report that emergency visits are going up, according to a new poll. This represents a significant increase from just one year ago when less than half reported increases. Rather than trying to keep people out of emergency departments, policymakers need to recognize the value of this model of medicine that people want and clearly need, according to the American College of Emergency Physicians (ACEP).

Most of the respondents to the poll report little or no reductions in the volume of emergency visits due to the availability of urgent care centers, retail clinics and telephone triage lines. About 90 percent of more than 2,000 respondents also say the severity of illness or injury among emergency patients has either increased (44 percent) or remained the same (42 percent).

“The reliance on emergency care remains stronger than ever,” said Michael Gerardi, MD, FAAP, FACEP, president of the ACEP. “It’s the only place that’s open 24/7, and we never turn anyone away. Rather than trying to put a moat around us to keep people out, it’s time to recognize the incredible value of this model of medicine that people need.”

More than one-quarter (28 percent) report significant increases in all emergency patients since the requirement to have health insurance took effect. In addition, more than half (56 percent) say the number of Medicaid patients is increasing.

These data correlate with another new report issued by Health Policy Alternatives, which found that efforts by policymakers and health insurance plans to drive Medicaid patients out of emergency departments and into primary care are not working. More than half of providers listed by Medicaid managed care plans could not offer appointments to enrollees, despite a provision in the ACA boosting pay to primary care physicians treating Medicaid patients. The median wait times was 2 weeks but over one-quarter of providers had wait times of more than a month for an appointment.

“There is strong evidence that Medicaid access to primary care and specialty care is not timely, leaving Medicaid patients with few options other than the emergency department,” said Orlee Panitch, MD, FACEP, chair of EMAF and emergency physician for MEPHealth in Germantown, Maryland. “In addition, states with punitive policies toward Medicaid patients in the ER may be discouraging low-income patients with serious medical conditions from seeking necessary care, which is dangerous and wrong. ”

The report — commissioned by the Emergency Medicine Action Fund (EMAF) — is titled “Review of the Evidence on the Use of the Emergency Department by Medicaid Patients and the Evolving Role of Emergency Medicine Physicians.”

Read the full report here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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