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Healthcare Journal of NEW ORLEANS
I
NOV / DEC 2014
51
Cindy Munn
Chief Executive Officer
Louisiana Health Care Quality Forum
have training in how to sup-
port patient engagement. In
the coming year, providers
and organizations should
develop and imple-
ment strategies to
provide this train-
ing. In doing so,
not only will they
surpass the requirements
of Meaningful Use, they’ll
also achieve higher patient
satisfaction levels, improved
outcomes, enhanced care quality and re-
duced costs.
Finally, as providers and organizations
prepare for the new year, they would do well
to remember that while 2014 was dubbed,
“Year of the Mandate,” in health care, 2015
will be “Year of the Penalty.”
Perhaps the most impactful of these pen-
alties are those related to the Meaningful Use
program. Congress mandated in theAmeri-
can Recovery and Reinvestment Act (ARRA)
of 2009 that beginning Jan. 1, 2015, payment
adjustments will be applied to Medicare-
eligible providers who have not achieved
meaningful use of Certified Electronic Health
Record Technology (CEHRT).
While there are some hardship exceptions
available – for newly practicing eligible pro-
fessionals who haven’t had time to attest to
meaningful use, for example – the reality is,
those who have not met the meaningful use
attestation guidelines will likely face declin-
ing Medicare reimbursements next year.
Another set of Medicare reimbursement
penalties will face those eligible providers
who have not participated, or been success-
ful, in the Physician Quality Reporting Sys-
tem (PQRS). Established by the Centers for
Medicare and Medicaid Services (CMS) and
made mandatory by theAffordable CareAct
(ACA) of 2010, the PQRS program is a quality
initiative designed to improve care coordi-
nation and delivery. It’s considered to be the
core of health care’s transition from a
volume-based payment mod-
el to one based on value, and
ACA established PQRS pay-
ment penalties.
For eligible profes-
sionals who report-
ed data on quality
measures for cov-
ered services provided
to Medicare Part B fee-for-
service beneficiaries and re-
ceived PQRS bonuses in 2013
and 2014, no penalties will be applied in 2015
and 2016, respectively. For those eligible
professionals who didn’t qualify for those
bonuses, there will be a 1.5 percent penalty
next year, and a two percent penalty in 2016.
Also looming in the coming year is the
transition to ICD-10. Required for every en-
tity covered by the Health Insurance Porta-
bilityAccountabilityAct (HIPAA), the compli-
ance date is Oct. 1, 2015. Although there have
been a number of delays in the past to the
ICD-10 implementation, HHS has decreed
that there won’t be any more delays going
forward.
While there are no specific penalties es-
tablished for non-compliance with the ICD-
10 transition, providers and organizations
would do well to remember that because
the transition is governed by HIPAA, there
could be sanctions for violations of HIPAA
transaction and code sets. Further, those who
haven’t made the ICD-10 transition by the
deadline may find that their claims payments
are delayed. Thus, HIPAA-covered entities
should start preparing now, if they haven’t
already, for the move to ICD-10.
Ultimately, for health care providers and
organizations, a focus on preparation should
be the mantra for 2015. While the health care
industry cannot predict everything that will
occur in the coming year, it can certainly be
prepared for what’s known. And preparation
is the key to success.
n
information given to themby their providers,
according to U.S. Health and Human Services
(HHS) data. This limits the ability of many
patients – even those with advanced literacy
skills - to adopt healthy behaviors.
According to HHS, the “primary responsi-
bility for improving health literacy lies with
public health professionals and the health
care and public health systems.”For this rea-
son, HHS urges providers and health care
organizations to use “plain language” when
discussing health issues with patients and
when developing patient-facing educational
materials.
However, for many providers, patient en-
gagement is also hindered by a lack of these
kinds of materials. Today’s busy health care
providers and organizations may not have
the time, the resources, the training or even
the staff available to produce these “plain
language” patient-facing materials.
Exacerbating the patient engagement
challenge is a lack of access among patients
to their personal health information, accord-
ing to theAmerican Health InformationMan-
agement Association (AHIMA).
“Health information must be timely, ac-
cessible, accurate and understandable in
order for it to be beneficial and useful to
consumers,” AHIMA reports, noting that
providers and organizations
should continuously review
and update policies related
to sharing health information
with patients.
U l t i m a t e l y ,
maintains AHI-
MA, education is
key in truly engag-
ing patients in their
care. AHIMA recommends
that this education be avail-
able on two levels - patients
should be provided with edu-
cation about how to access and use their
health information, and providers should