Category: Health Care Politics

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Health Care Politics Management Security

ADA comments on HIPAA Privacy Rule

From ADA News:

The ADA is asking the U.S. Department of Health and Human Services Office for Civil Rights to consider the burdens changes to the HIPAA privacy rule will impose on covered providers, including dentists.

Source: ADA comments on HIPAA Privacy Rule

Some of the changes OCR is proposing include:

These proposed changes include a 15-day timeframe for responding to requests for access; a proposal to permit patients to access, copy and photograph their protected health information at the time of their appointments; and a proposed requirement that covered providers develop fee schedules for providing copies of protected health information. Covered entities with websites would be required to post such schedules on their websites.

 

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Health Care Politics Security

Explaining the HIPAA Safe Harbor Act

Thank you to Danielle McKinley of PCI HIPAA

The HIPAA Safe Harbor Act amends Subtitle D of the Health Information Technology for Economic and Clinical Health (HITECH) Act act to require the Department of Health and Human Services (HHS) to consider whether organizations have “recognized cybersecurity practices” in place when investigating a data breach, and to be lenient with their fines or other enforcement actions if the practice has met all basic technical safeguard requirements.

This means that if a health care provider is following the basic HIPAA Privacy Rule provisions and safeguards to mitigate threats, the fine for a data breach should be lower.

Source: Explaining the HIPAA Safe Harbor Act

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Corona Pandemic Health Care Politics

Democrats, Republicans push for teledentistry to be legal in Texas

Teledentistry, the practice of consulting with dentists virtually, is not currently legal in Texas, but some state lawmakers hope to change that this legislative session.

Source: Democrats, Republicans push for teledentistry to be legal in Texas

The Texas dental practice act has been interpreted to require in person exchanges making tele dentistry illegal. Legislators have proposed new laws to change this.

As usual inside the box thinkers are opposed. If it worked for G.V. Black then it should be good enough for us.

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Health Care Politics Management

Tax Day

 

Delayed but still coming. Inevitable just like death,

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Corona Pandemic Health Care Politics

Codes concerning COVID-19 vaccine administration approved

This is nice…but.

In reaction to the ongoing COVID-19 public health emergency, the Code Maintenance Committee accepted and approved the inclusion of eight pandemic-related CDT procedure codes in CDT 2021 during its virtual annual session in March.

Source: Codes concerning COVID-19 vaccine administration approved

The new codes are for vaccinations and diagnostics.

I would like to see some real progress on telemedicine codes with real value. In other words not limited by old fashioned thinking.

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Corona Pandemic Health Care Politics Telemedicine

Telehealth used in 30.1% of visits during COVID-19 pandemic

Telehealth visits accounted for approximately 30% of total outpatient visits early in the COVID-19 pandemic, with uptake varying among specialties and by patient characteristics…

…Among specialties, telehealth was used at least once by 67.7% of endocrinologists, 57% of gastroenterologists and 56.3% of neurologists. However, the use of telehealth was considerably lower among some specialties, with just 3.3% of optometrists, 6.6% of physical therapists, 9.3% of ophthalmologists and 20.7% of orthopedic surgeons using teleh

Source: Telehealth used in 30.1% of visits during COVID-19 pandemic

From the ADA via Becker’s

The percentage of respondents by dental specialty who said they were using any kind of virtual service:

  • Pediatric dentist: 75.2 percent
  • Orthodontist: 62 percent
  • Prosthodontist: 42.3 percent
  • Dental surgical specialist: 38.5 percent
  • General practice: 33.1 percent
  • Periodontist: 32.3 percent
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Corona Pandemic Health Care Politics Telemedicine

Congress Gets Another Shot at Easing Telehealth Licensure Restrictions

From mHealth Intelligence:

The TREAT Act, which has the support of dozens of health systems and connected health organizations, would allow providers to bypass licensing rules and use telehealth to treat patients in any state during the coronavirus pandemic.

Source: Congress Gets Another Shot at Easing Telehealth Licensure Restrictions

I have often made the point that the primary barrier to increased acceptance of telemedicine is not the technology but the politics. This act is a good step but it is very limited. Hopefully it will lead to more permanent rules.

I am usually a big fan of local control in politics however the Internet has expanded the meaning of local. I cannot determine how it is in the best interests of our patients to not allow them to seek the best most timely care online simply because it is offered by a dentist in a different state. Or why insurance companies will not pay for a telemedicine appointment if the outcomes are good and the cost is lower.

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Health Care Politics Internet Management

Association moves to develop unified system to verify coverage, obtain cost estimates in real-time

From the ADA:

As a result, the ADA Council on Dental Benefit Programs is acting upon a directive from the 2020 House of Delegates to assess the development of a simplified system to verify coverage and obtain patient cost estimates in real-time before treatment begins.

Source: Association moves to develop unified system to verify coverage, obtain cost estimates in real-time

This is a nice start (better late than never) but what I really want to see is real time payments. When you complete treatment the claim is submitted electronically, adjudicated and the funds electronically transferred to the dentist’s account that instant. The technology is available.

I wonder why it has not been implemented already?

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Corona Pandemic Health Care Politics Telemedicine

U.S. lawmakers reintroduce House bill safeguarding access to telehealth

I am a huge fan of the concept of telemedicine and teledentistry. I believe it has the potential to reduce costs and improve care to a remarkable degree. This is critical to solving the “Healthcare Crisis”.

From  Healthcare IT News:

WHY IT MATTERS

The bill, which was first introduced in July 2020, would help safeguard access to virtual care after COVID-19 via four main provisions. According to a press statement from Thompson’s office, it would:

  • Eliminate most geographic and originating site restrictions on the use of telehealth in Medicare and establishing the patient’s home as an eligible distant site.
  • Authorize the Centers for Medicare and Medicaid Service to continue reimbursement for telehealth for 90 days beyond the end of the public health emergency.
  • Make permanent the disaster waiver authority, enabling Health and Human Service to expand telehealth in Medicare during all future emergencies and disasters.
  • Require a study on the use of telehealth during COVID, including its costs, uptake rates, measurable health outcomes, and racial and geographic disparities.

The bill avoids some of the thornier issues around telehealth, such as coverage parity or interstate licensing issues, while making permanent broadly popular policies such as eliminating geographic and originating site restrictions.

Source: U.S. lawmakers reintroduce House bill safeguarding access to telehealth | Healthcare IT News

The primary barriers to the acceptance of telemedicine are not technological but political. Government, especially regulatory agencies, professional associations (including the ADA) hospitals, insurance companies and others all have a vested interest in the status quo and an incentive to block the acceptance of robust telemedicine.

One of the few good things to come from the Covid 19 pandemic is the use and acceptance of telemedicine.

This is why IMHO telehealth has such tremendous potential.

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Artificial Intelligence Diagnostics Future Tech Health Care Politics

Deep Medicine; What I am reading right now

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Health Care Politics Telemedicine

GOVERNOR CUOMO SIGNS DENTAL TELEHEALTH BILL

It should have been titled the ANTI Dental Telehealth Bill.

From NY State Dental Association:

The amendment protects dental patients by requiring that dental telehealth providers identify themselves to patients and provide their New York State license number. It also stipulates that patients undergo proper examinations, necessary X-rays, and reviews of medical and health history before treatments can begin by a licensed dental practitioner.

Source: GOVERNOR CUOMO SIGNS DENTAL TELEHEALTH BILL

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Health Care Politics Telemedicine

ADA updates teledentistry policy

This is very disappointing.

Dentists who deliver, direct or supervise teledentistry services should be licensed in the state where the patient receives services unless otherwise authorized by a state’s dental board, according to the policy. Patients have the right to know the identity and qualifications of oral health practitioners involved in the teledental encounter, costs they are responsible for in advance of the delivery of services, and be actively involved in treatment decisions, according to the policy.

Source: ADA updates teledentistry policy

I am happy that the ADA is addressing the issue however it is upsetting that they have fallen back on old ways of thinking that limit the application of new technology. I am afraid there is more politics here than patient care.

Does the ADA really believe that my friend Dale Miles, one of the best dental pathology and radiology specialists in the country cannot diagnose a CBCT that was sent to him via the Internet from a dentist in a state that Dale is not licensed in?

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Corona Pandemic Health Care Politics Internet Telemedicine

Physicians Should Be Allowed To Practice Across State Lines—and Not Just During a Pandemic

From Reason.com:

The COVID-19 pandemic is straining all the country’s health care resources right now—including the supply of physicians. In response, nearly all 50 states are temporarily suspending regulations to allow physicians to practice across state lines and to encourage the use of telemedicine, which lets patients interact with doctors remotely via audio or video…

…Medical professionals are typically licensed on a state-by-state basis, so a doctor licensed in one state can’t practice in another without receiving an additional license. The patchwork of licensing requirements across states is a major obstacle to the use of telemedicine because physicians are generally only permitted to provide telemedicine services to patients in states where they are licensed.

Source: Physicians Should Be Allowed To Practice Across State Lines—and Not Just During a Pandemic – Reason.com

State licensing restrictions and limited insurance reimbursement are two primary obstacles restricting the growth of tele-medicine and tele-dentistry. Both obstacles have been reduced in response to the pandemic shutdown. This may be the silver lining in the pandemic. It seems we can do just fine in fact do better with fewer restrictions and regulations.

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Corona Pandemic General Health Care Politics

Red Tape Pandemic

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General Health Care Politics Management

More than a third of U.S. healthcare costs go to bureaucracy

From  Reuters:

Over one third of all healthcare costs in the U.S. were due to insurance company overhead and provider time spent on billing,…“The average American is paying more than $2,000 a year for useless bureaucracy,” said lead author Dr. David Himmelstein,

Source: More than a third of U.S. healthcare costs go to bureaucracy – Reuters

Interesting statistics. I am not surprised. The author makes the case that health care costs could be reduced by consolidating under a single payer plan like Canada or Great Britain. I am not sure of that. Historically centralized command and control planning has resulted in shortages and lower quality.

The health care crisis is not a crisis of care but a crisis of affordability. I believe we will do much better lowering costs and increasing access using technology and free markets. Some people ague that health care is a special case where free markets will not work. Heath care is a necessity not an option. However the same could be said of food. High tech and free markets have resulted in abundant food available at lower cost than at any previous time in human history. Command and control systems inevitably end up with shortages.

Whatever, it is a clear indication of the dysfunction of our current system that one third of health care payments go to bureaucracy.

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General Health Care Politics Software

Amazon, Google, Microsoft, IBM renew pledge to support health data interoperability

From FierceHealthcare:

The six companies and competitors—Amazon, Google, IBM, Microsoft, Oracle, and Salesforce—announced a renewed commitment to interoperability at the CMS Blue Button 2.0 Developer Conference.

The companies also are throwing their sizable weight behind recent interoperability proposed rules from the Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare & Medicaid Services (CMS). The CMS and ONC’s proposed rules focus on the use of HL7’s Fast Healthcare Interoperability Resources (FHIR) as an open standard for electronically exchanging healthcare information.

Source: Amazon, Google, Microsoft, IBM renew pledge to support health data interoperability | FierceHealthcare

Interoperability or more accurately the complete lack of interoperability is a huge problem in medicine and dentistry. Hopefully having the power of these tech giants pushing for interoperability will finally get things moving. In the dental world Henry Schein has also made public statements committing the company to interoperability. This is all good but so far there is very little progress.

More:

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Health Care Politics

The U.S. can slash health-care costs 75% with 2 fundamental changes — and without ‘Medicare for All’

From MarketWatch:

As the Democratic presidential candidates argue about “Medicare for All” versus a “public option,” two simple policy changes could slash U.S. health-care costs by 75% while increasing access and improving the quality of care.

These policies have been proven to work by ingenious companies like Whole Foods and innovative governments like the state of Indiana and Singapore. If they were rolled out nationally, the United States would save $2.4 trillion per year across individuals, businesses, and the government.

Source: The U.S. can slash health-care costs 75% with 2 fundamental changes — and without ‘Medicare for All’ – MarketWatch

Click through and read the whole thing.

As I have been saying for a while now the “healthcare crisis” is not a crisis of care it is a crisis of affordability. What if we really could reduce healthcare costs by 75% by implementing the ideas in the linked article? Let’s say the article is too optimistic and we only reduce costs by 50%? Total costs were reduced by 50% WOW. A very good case can be made that our current insurance based, central command and control systems have been the primary cause of the affordability crisis.

I believe there is even greater potential in new digital technology to reduce costs even further. Look here for a recent example of how this will work.

There are three reason this is important.

  1. There is a digital technology component to the crisis and I believe changing technology will totally disrupt the healthcare system.
  2. Where medicine goes dentistry is sure to follow.
  3. I am a person and I am a customer of the healthcare system. I want it to work better and cost less.
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Health Care Politics Management Paperless

Patient handoffs to post-acute care providers still largely a manual process, hindering effective care coordination

From FierceHealthcare: Medicine is stuck with a 1980’s “Sneakernet”

There is a big push both from the private market and federal policymakers to improve interoperability and open up access to health data through smartphone apps and other digital tools.

But on the front lines of healthcare, the way patient information is shared remains largely a manual process done through a combination of faxes, emails, phone calls and paper records, according to a recent study on transitions of care.

Source: Patient handoffs to post-acute care providers still largely a manual process, hindering effective care coordination | FierceHealthcare

The linked article is all about medical records, nevertheless the same issues apply to dentistry.

There is virtually no interoperability in dentistry.

At this time none of the major providers of dental management software follow standards that allow for the exchange of patient data. Let’s suppose you have a complete digital patient record of every one of your patients. This includes their demographic info like name address and phone number. Insurance info. A complete up to date health history. Recent radiographs. Charting, diagnosis and treatment notes. One of your patients decides to move to the other side of the country. There is no way that you could transfer her complete digital record to her new dentist. Just as in the article above you would be stuck using “a combination of faxes, emails, phone calls and paper records.”

You could not transfer the data from Dentrix to Eaglesoft. You could not even transfer the data to another Dentrix user.

Ideally the electronic dental record should be a specialized subset of a universal electronic medical record. However electronic records in medicine have proven to be more difficult to deploy than was anticipated. In large part this is due to the much bigger stakeholders in medicine including the physicians, hospitals, government, insurers and others. In the meantime dentistry is held hostage to medical gridlock.

Henry Schein has talked a lot about interoperability. They are by far the biggest company in dentistry and having them pushing interoperability has to be a good thing. Nevertheless at this time there is very little actual ability to share data. At this point I would be happy just to be able to send my electronic record to another Dentrix user.

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General Health Care Politics Management Paperless Security

New Medicare initiative aims to fill holes in patient health records

The Centers for Medicare and Medicaid Services on Tuesday unveiled a new initiative that aims to connect the dots between a patient’s health records held by different providers.

The Data at the Point of Care, or DPC, demonstration seeks to bridge the data gap by connecting Medicare’s Blue Button — a tool that allows Medicare patients to download their health records and save them in computer files or apps — directly to a patient’s doctor. A doctor could then see claims data from a patient’s other providers that might not be accessible otherwise.

Source: New Medicare initiative aims to fill holes in patient health records

This seems like a good step in the right direction. That is the direction of complete shared online records. I believe there is great potential value in online digital records BUT:

The initiative in the linked article is based on a Medicare program. Since dentistry is not part of Medicare (Thank you) it will not apply to us.

The initiative appears to be focused on claims data. This is a very good way to allow different physicians treating the same patient for different conditions to get an idea of what the patient is being treated for, and what procedures may have been undertaken, however it is a far cry from an actual complete record.

Security remains the elephant in the room. Until we can be confident our data is secure people will be reluctant to have all their personal medical info stored online and available as needed.

 

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Health Care Politics Security

House votes to lift ban on federal funding for unique patient identifier

From FierceHealthcare:

Although HIPAA initially required the creation of a health identifier in 1998, Congress overruled the legislation, barring federal agencies from investigating or creating patient identifiers out of privacy concerns.The American Health Information Management Association (AHIMA) voiced its support for efforts in Congress to repeal an “archaic ban that has stifled innovation and industry progress for nearly two decades.”

Source: House votes to lift ban on federal funding for unique patient identifier | FierceHealthcare

Hmmm. I wish I trusted them more.