Posts Tagged ‘electronic medical records’

D-Day For Obamacare Means Big Changes For Healthcare

Tuesday, May 27th, 2014

MOBs are getting ready to take center stage as healthcare moves into more of a localized, outpatient setting.

By John Driscoll, President, Alter+Care

The first of this year was to be Obamacare’s D-Day. Though some changes kicked in earlier — the right to keep kids on your health plan until they turn 26, for example — the big provisions like the individual mandate became law this year. The ramifications from a medical and economic standpoint have been written about amply. In regards to the healthcare real estate industry, there are two very large trends: the consolidation of providers and the move to outpatient as the new center of healthcare delivery.

Part of the Obamacare plan to improve outcomes is the concept of the Accountable Care Organization. ACOs are essentially consortiums promoted as bigger, better models that manage health at the population level across a broader swathe of the healthcare specialties.  An ACO might include a hospital, various specialty groups, a  surgery center, imaging, emergency department and even nursing homes, with all payments made to the head of the ACO – usually the hospital – and then distributed to the rest of the group.

It’s now all about the team. As a result, the ACO has caused the biggest wave of consolidation I’ve ever seen in the sector. Consider that a quarter of specialty physicians and 40 percent of primary care physicians are already employed by hospitals. This number is up from 5 percent and 20 percent, respectively, in 2000. Some larger specialty practices are combatting this trend by merging with other practices to avoid being purchased by healthcare systems or hospitals.

Some independent practices are moving out of condominium office buildings and joining together to acquire office buildings. The costs of maintaining small independent space can become burdensome, especially as the technological pressures on integration and connectivity are imposed. Chances are, information technology financing will become an ever-increasing part of medical office loan commitments. Some IT expenditures are in the $30,000 to $50,000 range, while multi-specialty groups have larger expenditures to fund.

In order to lower costs and operate more efficiently, hospitals have migrated services from expensive acute-care environments to technologically enabled outpatient facilities. The hospital-centric model of the past has already given way to a hub-and-spoke network in most markets, where outpatient centers provide convenient and accessible care to patients and refer volumes to affiliated inpatient facilities. So what’s next? As it develops, hub and spoke will become a distributed model of care. It will result in providers who are physically dispersed, yet highly integrated through technology. Electronic medical records and advances in medical information technology will allow discrete providers to operate as a team. Primary care doctors will act as gatekeepers, coordinating and overseeing care regimens across this broad network.

The presence of this “patient-centered medical home” model means large MOBs (rather than hospitals) will become the hubs, while smaller specialty sites have become the spokes.  Think of the last time you visited a hospital for a procedure as opposed to a medical office building located in your community. Some systems are even leasing space in retail malls. As a result, the MOB is the definitive center not only of care, but also of healthcare real estate.

Last year was a banner year for outpatient services, and the investment community jockeyed to scoop up prized MOBs. There was a total of $4.98 billion-worth of MOB sales through the third quarter of 2013. This is compared to MOB sales of $5.21 billion for all of 2012. This has resulted in an average sales price of $231 per square foot, which is very strong with cap rates in the 6 percent range. If you extend the numbers out to sales of all buildings leased by healthcare providers, including doctors’ offices, urgent care clinics, diagnostic labs, imaging centers, the total reached $6.67 billion last year.  This was the second-highest number we’ve experienced in 13 years with a sales price of $270 per square foot. When you consider that 90 percent of the $1 trillion of healthcare property overall is still owned by hospitals, it is certain we are only at the beginning of this shift toward third-party real estate ownership.

To meet the challenges of distributed care and cost reduction, developers and operators of healthcare assets will need to think about the particular mix of services and programming in every building. This will result in the consolidation of redundant and inefficient facilities, while in other cases it will mean extending into preventive health and wellness to achieve population health management goals.

This article first appeared in Western Real Estate Business.

CMS Issues Revised Guidelines for Electronic Medical Records Adoption

Thursday, July 29th, 2010

Physicians/hospitals could receive $27 billion to use electronic medical records.  The federal government has issued revised standards for the “meaningful use” of electronic medical records that will financially reward physicians and hospitals who adopt the new technology. According to the Department of Health and Human Services, physicians and hospitals could receive as much as $27 billion over the next decade if they put patients’ medical records on computer instead of paper.  Physicians can be paid up to $44,000 under Medicare and $63,750 for Medicaid.  Depending on their size, hospitals have the potential to receive millions of dollars.  In 2015, hospitals and physicians face financial penalties under Medicare if they fail to use electronic medical records by the deadline.

Dr. Donald Berwick, the new administrator of the Centers for Medicare and Medicaid Services (CMS) said electronic medical records will lead to “better, smoother care, more reliable care.”  Department of Health and Human Services (HHS) Secretary Kathleen Sebelius said “Only 20 percent of doctors and 10 percent of hospitals use even basic electronic health records.”  Taking a slightly different perspective, Richard J. Umbdenstock, president of the American Hospital Association (AHA), said the new standards are an improvement over the rules initially proposed but was not convinced that doctors or hospitals would adopt the new technology.

Some physicians believe that using electronic medical records will reduce errors and save patients’ lives.  The new standards are flexible and require physicians to meet 15 specific requirements, as well as another five selected from a list of 10 objectives.  To fulfill the new standards, physicians will have to submit 40 percent of prescriptions electronically.  “We are delaying some of the more ambitious requirements,” said Dr. David Blumenthal, the national coordinator for health information technology.

Finding the Right Line Between Healthcare Privacy and Accessibility

Tuesday, July 27th, 2010

Privacy versus accessibility duking it out in the healthcare arena.  One of healthcare’s biggest challenges is balancing the sharing of health information with the need to assure patient privacy.  Although privacy has been assured since the implementation of the 1996 HIPAA law, the issue of patient consent is now at the forefront because the American Recovery and Reinvestment Act’s (ARRA) financial support of electronic medical records has reignited interest in data-sharing and patient privacy rights.

Providers must be able to show that they are sharing information to improve patient care to be eligible to receive subsidies to acquire electronic healthcare records-keeping technology.  Conversely, the stimulus bill modifies HIPAA and allows patients to demand that their records for a treatment or service not be shared with their insurance company if they pay the full cost directly.  Also included in the stimulus bill is a ban on selling patient data.

Federal officials believe that protecting patient privacy is critical to developing a national health information exchange that patients trust.  Doug Fridsma, acting director of the Office of the National Coordinator for Health Information Technology (ONC) said “We always put in here that privacy and security is paramount.” The government “plays an integral role in assuring trust and ensuring privacy and security of health information.”  Because the ONC has come under criticism for being insincere about privacy, the organization is now under pressure to release privacy and security policies.

According to Fridsma, “It’s going to be an iterative, incremental approach.  We have a lot of moving parts.  I’ve been trying to do as much as I can to support the work that’s been going on and to at least keep the channels of communications open.”

Stimulus Bill Releases $1 Billion for Electronic Healthcare Records

Thursday, February 25th, 2010

Federal government provides first $1 billion installment of $19 billion for electronic healthcare record funding.  The Obama administration has released approximately $1 billion from the American Recovery and Reinvestment Act stimulus bill. The money is a downpayment on funding access to health information technology for more than 100,000 hospitals and primary-care physicians.  Another goal is to train people for careers in healthcare and information technology.  A total of $19 billion for healthcare information is contained in the stimulus bill.

Department of Health and Human Services Secretary Kathleen Sebelius announced that $750 million of the initial $1 billion will be used to help hospitals and physicians convert to electronic health records.  “We are at a point in the United States where only 20 percent of doctors and 10 percent of hospitals have even basic electronic health records,” Sebelius said in a teleconference.  “These grant awards, the first of their kind, will help develop our electronic infrastructure and give doctors and other healthcare providers the support they need as they adopt this powerful technology.”

Physicians Offered Incentives to Switch to Electronic Record Keeping

Thursday, January 28th, 2010

Physicians receive government, corporate incentives to adopt electronic record keeping.In 2011, physicians will be eligible for extra payments from federal health insurance programs if they implement electronic medical record systems. The extra money is courtesy of President Obama’s American Recovery and Reinvestment Act stimulus bill signed into law early last year.  To help physicians – especially those in small practices – pay for the several thousand dollar systems, private insurers are also offering financing incentives of their own.

UnitedHealth Group, for example, is offering interest-free loans to small practices that start using Ingenix CareTracker, an internet-based system.  Chicago-headquartered Allscripts-Misys Healthcare Solutions, Inc., is offering a six-month, no-payment program for qualified buyers of its electronic healthcare records software.

Under the federal legislation, physicians who start using electronic medical records can receive more than $40,000 in Medicare payments over a five-year period.  At present, the Obama administration is soliciting comments on new regulations to “lay a foundation for improving quality, efficiency and safety through meaningful use of certified electronic health record technology.”  Although electronic records keeping will cut paperwork, control costs and create a more efficient system, physicians have been slow to adopt the technology because of the high cost of purchasing the equipment.

Even though 75 percent of Americans patronize doctors in small practices, less than 15 percent of physicians now use electronic records systems.  UnitedHealth, which says its CareTracker system can cost less than $7,000 annually, is “helping physicians overcome the challenge of funding their upfront investment – the biggest barrier in implementing health information technology,” said Bill Miller, executive vice president of Ingenix, the firm’s health information technology subsidiary.

Marcus Welby, M.D., May Be Healthcare Reform Solution

Tuesday, July 7th, 2009

Marcus Welby may be making a comeback – not to your television screen – but to your doctor’s office.  Partisans on both sides of the healthcare reform issue in Congress agree that general practitioners should play a starring role in unifying America’s disorganized delivery system.1

“Patient-centered medical home” – meaning a primary-care physician’s office that people visit for most of their medical needs – is the name being give to this vision.  This GP would monitor everything from flu shots to chronic disease management to weight loss and organize care with other practitioners.  According to a 2004 study, if every patient had a healthcare home, the resulting efficiencies could cut costs by 5.6 percent, or $67 billion per year.

This surprisingly simple solution streamlines a wasteful system that consumes 18 percent of the American GDP and a responsibility that falls primarily on private industry, which covers 60 percent of people with healthcare insurance.  IBM, which last year spent $1.3 billion on its employees’ healthcare – the equivalent of one month of the company’s income – has already bought into the concept.

Critics caution that the medical home is overly reminiscent of the “gatekeeper” model of 1990s managed care programs.  Supporters counter that this concept is intended to benefit patients versus insurers.  It’s more akin to practicing medicine 1950s-style, but with digital technology such as electronic medical records to assure a 21st century twist.