Health Care Current: December 10, 2013
This weekly series explores breaking news and developments in the U.S. health care industry, examines key issues facing life sciences and health care companies and provides updates and insights on policy, regulatory and legislative changes.
by Asif Dhar, Principal, Deloitte Consulting LLP and Managing Director, Deloitte Health Informatics LLC
For more than ten years, I’ve struggled with how to live a healthier lifestyle. And, as a person who lives in both the two worlds of data geek and health care patient, I’ve thought about how new technologies and advancements could help others in a similar situation gain more control over their health and lifestyle.
It’s no secret that we are in the middle of the largest data explosion in history. According to an IDC forecast, the total amount of data is more than 2.7 zettabytes (2.7 billion terabytes). That number could grow to more than four zettabytes by the end of this year.1 This decade, information is growing at a factor of 44—from 0.8 zettabytes in 2009 to an expected 35.2 zettabytes in 2020.2
Health care organizations are driving this growth at an even faster pace. A report from ESG Research predicted that data managed by the average hospital is likely to grow to 665 terabytes by 2015, up from 168 terabytes in 2010. Much of this can be attributed to the move towards electronic health records.3 With the adoption of increasingly sophisticated digital medical imaging, diagnostics, genomics and yes, social media, it may seem like the wave of data in health care is more like tidal wave. Add to it persistent computing following us everywhere—the smartphone in our pocket, Fitbit on our hip and smart watches on our wrist, capturing every step, every location we’ve visited and every health search term we’ve entered—this tidal wave is probably closer to a tsunami.
The question many health care organizations will be searching for the answer to is, “can we possibly deal with this data, instead of being crushed under its weight?” Big data employs a host of useful technical and architectural approaches to large, complex data sets, creating incredible analysis. But, these methods are not a panacea.
Let me explain…
Some years back I had about of gallstone pancreatitis that kept me in the hospital for two weeks. The days in the hospital, my follow on recovery, surgery and recovery again increased my awareness of my weight and unhealthy living. When I researched the topic, I found that obesity creates a $147 billion per year price tag for the U.S. I then started to think about analytics and data. Obesity is a big problem and analytics can help. But, the question is where and when is big data needed. For example, you don't need big data to tell you that my body mass index (BMI) is high—you can get that from the last set of vital signs from my doctor. But, big data might help my providers and I understand types of behavior that are critical to address that high BMI (e.g., when I’m not getting in enough steps, blogging about unhealthy food, entering unhealthy foods in my food diary or more importantly not entering any at all).
All of this is great, but we need more. These insights are difficult to use until we combine them with human engagement and interaction. The human interpretation, collaboration and action are what make data truly intelligible; they are what make big data smart data. When researchers, sponsors and physicians can identify overweight patients by being able to analyze the right patient data, identify appropriate trials for those patients and how best to design these studies, research is smarter. When providers, patients and care managers can collaborate by appropriately sifting through data and identifying healthy interventions, clinical care is smarter.
There are now examples of collaboration in the industry to create tools and congregations of organizations interested in analyzing what works, what doesn’t and for whom in health care. My take is that these sorts of collaborations will help digest big data into smart data. We can then hope this will help organizations avoid the challenges of being bloated with data. And eventually, big data could help me stick to clinical trials and patient interventions that might be appropriate, helping me go from fat to “phat.”
P.S. – Deloitte Consulting LLP and Intermountain Healthcare forged an alliance earlier this year around big data and analytics to help accelerate the transformation of the U.S. health care system. To read more about the alliance, click here.
NOTE: There will be no Health Care Current issues on December 24 or December 31, 2013. Distribution will restart in the New Year with the first issue on January 7, 2014.
1 IDC, “ IDC Predictions 2012: Competing for 2020,” December 2011, http://cdn.idc.com/research/Predictions12/Main/downloads/IDCTOP10Predictions2012.pdf
2 IDC, “The Digital Universe Decade – Are You Ready?” May 2010, http://www.emc.com/collateral/analyst-reports/idc-digital-universe-are-you-ready.pdf
3 ESG Research, “North American Healthcare Provider Information Market Size & Forecast,” January 2010
Poll results from December 3 Health Care Current:
Last Friday, the Centers for Medicare and Medicaid Services (CMS) announced the implementation of Meaningful Use Stage 3 would be delayed a year, extending the timelines for Stage 2. The endpoint for Stage 2 will now extend into 2016 and Stage 3 will not begin until 2017 at the earliest: fiscal year (FY) 2017 for hospitals and calendar year (CY) 2017 for providers and other eligible professionals. In their statement about the delay, CMS indicated they had two goals:
- To allow CMS and the Office of the National Coordinator for Health Information Technology (ONC) to focus on enhancing patient engagement, interoperability and health information exchange (HIE) requirements involved in Stage 2
- To allow data collected during Stage 2 to inform policy decisions made for Stage 3
CMS expects to release proposed rulemaking for Stage 3 in the fall of 2014, with final rules that include all requirements for Stage 3 following in the first part of 2015. Read more about EHR adoption in the September 17, 2013 Health Care Current.
“This is likely to come as a relief to providers concerned with keeping up and a disappointment to those who feel this transformation is overdue. At the same time, there is heightened awareness that large scale information technology projects, particularly in healthcare, don’t always go smoothly or as planned.”—Harry Greenspun, Senior Advisor for Health Care Technology and Transformation, Deloitte Center for Health Solutions
“The desire to extend the duration between phases is something health care providers have been very vocal about. Many feel the workflow changes and associated adoption is complex in future stages and simply requires more time than CMS initially set between stages. The delay will provide additional time for the advisory committees and CMS to finalize the proposed and final rules for Stage 3, but it may do little to address struggles those attempting to meet Stage 2 in 2014 are facing.”—Eric Finocchiaro, Director, Deloitte Consulting LLP
A group of 102 leaders from more than 250 hospitals and health systems sent a letter to members of the Senate Finance and House Energy and Commerce Committees requesting that the cuts implemented to Medicaid disproportionate share hospital (DSH) payments cease. Thus far, DSH payments have been reduced by $500 million and more than $18 billion in cuts are slated to take effect between 2014 and 2020 as a result of provisions in the Affordable Care Act (ACA). DSH payments were created to compensate hospitals that provide care to a high proportion of the uninsured and underinsured population. DSH payment cuts were included in the ACA with the expectation that states would expand their Medicaid program, giving more people healthcare coverage and in turn, resulting in less uninsured and underinsured people seeking medical care. States that choose not to expand their Medicaid program are projected to have relatively the same uninsured and underinsured population, but less money to provide uncompensated and under-compensated care for them. In addition, because of technical glitches on Healthcare.gov, the number individuals signed up for insurance coverage is markedly lower than expected. The letter stated that more than $40 billion in uncompensated and under-compensated care is provided each year by hospitals around the country and drastically reducing DSH payments will force hospitals to cut vital services for patients.
Last Tuesday, the National Association of Health Underwriters (NAHU) wrote a letter to President Barack Obama to express its concern over back-end technical barriers that are causing problems for health insurance agents and brokers assisting consumers trying to enroll in the health insurance marketplace (HIX). The group is asking for immediate action to fix technical obstacles to ensure that their 70,000 agent and broker members who have obtained certification have a better experience. NAHU provided several recommendations to the Administration including:
- Add agent and broker contact information on the website search feature
- Make application submission outside of the website clearer through a call-center line, mailing location or both
- Create an online portal for brokers and agents to facilitate enrollment on behalf of clients
- Establish capacity on Healthcare.gov to add brokers to cases and allow them to edit records
- Create a customer-support line for agents and brokers
- Include agents and brokers as an assistance option in public communications
- Prioritize technology efforts to allow agents and consumers to access direct enrollment portals
- Increase consumer protections by changing the marketplace coverage application to add recording capabilities for interactions between agents/brokers and clients
According to results from a Gallup poll conducted between November 20 and December 2, most Americans (63 percent) that are currently uninsured are likely to meet the ACA individual mandate requirement to obtain health insurance coverage. However, about 28 percent plan to opt out health coverage and pay the penalty (the greater of $95 or 1 percent of their annual income). According to Gallup’s analysis of the survey results, of the 17 percent of Americans without health insurance, 5 percent would remain uninsured in 2014. Familiarity with the law and political party affiliation had some influence in individuals’ decisions to purchase health insurance:
- 62 percent of those aware of the insurance requirement indicated they would get insurance, as compared to the 30 percent who intend to pay the fine
- 80 percent of Democrats, 58 percent of Independents and 46 percent of Republicans intend to purchase insurance
According to a report released by CMS, Medicaid and the Children’s Health Insurance Program (CHIP) applications increased by 8.6 percent in October, with 55 percent of applicants qualifying for coverage. More than 2.5 million individuals applied through state agencies while about 171,000 applied through state-based HIXs. States expanding their Medicaid programs had a higher application rate than states that opted out of expansion; 13.2 percent as compared to 4.1 percent. A total of 29 states saw an increase in enrollment, 15 states showed a decrease and data was incomplete for the remaining states. Of the 2.5 million Medicaid and CHIP applicants in October, 1.4 million were determined eligible for coverage. The report noted that it is unclear why a large number of individuals who are ineligible for Medicaid are applying to the program, but called the increase in applicants “encouraging.”
Last Wednesday, the Senate Finance and House Ways and Means Committees released an updated Sustainable Growth Rate (SGR) replacement draft bill. Both committees expect to mark up the draft this week, making it unlikely that they would be able to combine and vote on a final draft before Congress goes on recess for the holidays. Without an approved bill to repeal the current formula, Congress is expected to again pass a short-term fix to avoid the scheduled 23 percent reduction in Medicare physician reimbursement rates set to take place on January 1, 2014. The short-term fix is expected to last for approximately three months, allowing time to negotiate policies to permanently replace the SGR payment formula by next spring. The updated draft includes several changes that physician groups requested in recent meetings with lawmakers. Notable draft changes:
- Removes the 10 percent payment reduction penalty to doctors for failing to submit cost data
- Reduces the Value Based Payment (VBP) program penalty from 8 percent to 4 percent and gives credit for improvement even if the target measure is not met
- Adds exceptions in the VBP for participating in alternative payment models and funding increases to help small physician practices transition to alternative pay models
Last week, the U.S. Food and Drug Administration (FDA) outlined the reporting, registration and enforcement policies contained in the recently passed drug compounding legislation, the Drug Quality and Security Act (DQSA). DQSA was signed into law on November 27, 2014 as a response to the 64 deaths resulting from tainted steroid injections produced in a compounding center in Massachusetts last year. DQSA gives compounding pharmacies the option to register with the FDA as “outsourcers,” requiring them to comply with quality standards, provide product information and partake in regular facility inspections. Compounding pharmacies who do not register as an outsourcing facility with the FDA will be exempt from these regulations, but will still be subjected to oversight and regulation by state boards of pharmacy. Outsourcing compounding facilities:
- Must comply with current good manufacturing practices requirements
- Are subject to FDA inspections according to a risk-based schedule
- Must meet certain other conditions such as reporting adverse events and providing FDA with certain information about the products they compound
Commissioner Margaret Hamburg publicly urged health care providers to only purchase compounded drugs from facilities that are registered with the FDA.
The Louisiana Department of Health and Hospitals (DHH) Bureau of Health Services Financing released an emergency rule that aims to penalize any physician that inappropriately persuades a patient into enrolling in certain Medicaid managed-care (MMC) plans. The emergency rule went into effect on December 1 2014 and applies to physicians who treat the 888,000 beneficiaries in Bayou Health, the state’s MMC program. Physicians will face fines of up to $5,000 for non-compliance. Patients participating in Bayou Health have the freedom to choose between five health care plans; however, DHH has received reports of physicians steering patients into plans favored by physicians. Officials speculate that incentives or preferred administrative processes offered by plans may sometimes influence physicians to direct patients toward or away from various plans. The Louisiana State Medical Society contests that the rule and penalties are “draconian,” and that the rule will prevent physicians from giving needed guidance about selecting the best MMC plan for their patients.
MetroChicago Health Information Exchange (HIE), one of the largest secure patient data exchange systems in the country, is slated to launch early next year and will combine health information of 34 Chicago area hospitals. The MetroChicago HIE will use an online portal system providing health professionals with real-time patient information such as lab tests, imaging and diagnosis and treatment information. Officials with the HIE stated the collaboration was designed to prevent errors in diagnosis and treatment, improve the coordination of care for patients and save on medical costs. An additional 20-30 Chicago area hospitals are expected to join MetroChicago HIE by summer 2014 and officials hope to eventually include skilled nursing and long-term care facilities.
Friday, the Pennsylvania Department of Public Welfare Office of Medical Assistance Programs posted a notice outlining a formal plan for expansion of their Medicaid program. According to the plan, federal funds for the expansion will be used to buy private insurance for the newly eligible Medicaid applicants via the state’s federally-run HIX. Under the plan, monthly premium costs for individuals and families are as follows:
- Earning 0-50 percent of the federal poverty line (FPL): no premiums
- Earning 50-100 percent of FPL: premiums will cost at least $13
- Earning 100-133 percent of FPL: premiums will cost at least $25
Additionally, adults who are deemed “able-bodied” and who are working less than 20 hours per week will be required to enroll in JobGateway, an online system designed to help participants engage in “work search-related activities” in order to maintain their Medicaid eligibility. The expansion is estimated to cover roughly 500,000 low-income residents. Before sending the plan into CMS for approval, Pennsylvania is scheduled to hold several public meetings and will accept public comments over the next 30 days.
Researchers at the University of Pittsburgh have developed a digital database tracking infectious disease cases as far back as the late 1880s through a compilation of disease surveillance reports and Centers for Disease Control and Prevention (CDC) data. The database provides a detailed depiction of the time, number and fatalities involved in infectious disease cases, providing a landscape to understand the magnitude of diseases and intervention strategies that have worked. For instance, when comparing the timeframe of polio, smallpox and disease outbreaks to the time vaccines were used, researches are now able to analyze more precisely the role that life-saving drugs and interventions may have had. The goal of the database is not only to depict a historical reference of infectious diseases, but to provide useful tools to track interventions that have worked or not worked to better manage outbreaks in the future.
The database is available at www.tycho.pitt.edu and will soon be accessible at www.healthdata.gov, a site managed by the U.S. Department of Health and Human Services (DHHS).
Researchers at the Australian Research Council Centre of Excellence for Electromaterials Science (ACES) have developed a hand-held BioPen, which enables surgeons to deliver living cells and growth factors directly to the site of damaged and diseased bone marrow. The BioPen is designed to give surgeons more control, reduce surgery time and speed regeneration of functional bone and cartilage. The BioPen delivers biologic material via a biopolymer, which is protected by an outer layer of gel material. The material is placed on the pen head and “drawn” onto the bone site where damage has occurred. The pen has a low-powered ultra-violet light attached to it that allows for the inks to be cured during the dispensing process, giving the surgeon the opportunity to construct layers of the biologic material in the wound site. The biologic material is non-toxic and is designed to biodegrade as the cells multiply and fill in the wound. In addition, growth factors or other drugs can be added to the biologic material to assist in recovery and a polymer core can be added for structural strength. The BioPen will be used at St. Vincent’s Hospital Melbourne for clinical projects that will be carried out at the proposed Aikenhead Centre for Medical Discovery.
Last Wednesday, the Congress of Neurological Surgeons (CNS) hosted the Innovation and Technology Symposium at their annual meeting in San Francisco, which brought together inventors, neurosurgeons, researchers, venture capitalists and the like, to discuss cutting-edge technologies around spine, cerebrovascular, endovascular and brain tumor procedures. Thought leaders presented new ideas, research and technologies that are furthering the development of neurosurgery, including:
- Google Glass for imaging, patient management and communication
- Biological replacements for discs
- Coil treatments for aneurysms
- Endoscope for blood clot removal in the brain
- Intra-operative MRI technology
- Fluorescent peptides for surgery
- Technology to retrieve floating genetic material from tumor sites
- New laser technologies to
- Reach and treat tumors previously deemed inoperable
- Replace traditional sutures used for bypass vessels