Each month, the Executive Corner provides prominent WEDI leaders an opportunity to share their perspectives on a variety of topics impacting healthcare – from legislative matters and industry events to the headline-grabbing issues of the day.

Dear Members of WEDI,

This past month, WEDI held a Summer Forum with an agenda focused on tackling problems the healthcare industry faces with Prior Authorization workflows. The forum provided a wonderful opportunity for all stakeholders to share the pain points that are preventing the industry from moving forward with automating the process of authorization for healthcare services. The sharing of information throughout the Forum allowed all parties to understand each other’s concerns and to work on identifying ‘best practices’. During one of the Forum’s sessions, the WEDI subworkgroup for Prior Authorizations presented work they’ve accomplished over the past several months along with providing some key questions for attendees to delve into. The valuable information gathered from those working sessions will be used by the subworkgroup to develop future white papers and presentations.

As a named advisor to Health and Human Services in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), we take this role very seriously. Our workgroups constantly scan the healthcare industry for areas of concern and the difficult challenges in meeting regulations as well as ways to improve current and future processes. In fact, we refocused our workgroup efforts this year to take on the business challenges our members face implementing the standards and operating rules named in HIPAA and the Affordable Care Act (ACA) as well as the security and privacy concerns as we move to cloud based computing all while surveying the industry to better understand the impact of proposed regulations.

White papers, issue briefs, webinars and surveys are all part of the workgroup toolkit for providing education and best practices to our members. The WEDI Conferences have added a new approach to getting more input from attendees through workshops and face-to-face meetings of the workgroup members. This cross-stakeholder participation in these workgroups helps us get a well-rounded view of the issues and challenges from all stakeholder perspectives.

As we look ahead, the dedicated members of our workgroups are busy planning webinars and white papers on important topics impacting our healthcare arena including: the impact of MACRA and economic reforms; prior authorization challenges and best practices; barriers to moving forward with the adoption of the remittance advice and fund transfer standards; and a ‘how-to’ guide to implementing electronic attachments for claims and prior authorizations. Our Property and Casualty subworkgroup is working on a survey covering all 50 States to determine the readiness for electronic medical bills.

 

We have some of the best minds in the industry working together to provide insight and education to the healthcare industry, but we need more people to be involved. We need to look to the future for better methods of exchanging information in both the administrative and clinical areas as well as consider new payment models and the impact to current workflows and revenue cycles along with the proper, secured use of the data moving forward. Are you up to the challenge? If so, I hope we can connect to see how your voice can be heard!

— Deborah Meisner, WEDI Board of Directors, Vice Chair of Programs & Services

Vice President of Regulatory Strategy, Change Healthcare

Earlier this month, WEDI held its 2017 Summer Forum which featured keynote addresses by Donald W. Rucker, MD, head of the Office of the National Coordinator for Health Information Technology (ONC/HHS) and Madhu Annadata, director, Division of National Standards, Centers for Medicare & Medicaid Services (CMS). Speaking before a gathering of provider, payer, vendor and government sector decision-makers in Chicago, Dr. Rucker and Mr. Annadata highlighted a successful two days of high-level discussions focused not just on the burdens prior authorization and other transaction policies pose, but, more importantly, potential solutions the industry can implement to address these hurdles.

After giving a brief overview of HHS and the two recent laws that have impacted the health IT landscape, the 21st Century Cures Act and MIPS/MACRA law, Dr. Rucker shared with attendees how the ONC is focused on two complex tasks as related to electronic health records (EHR) – burden of usability and interoperability.

 

On the topic of burden of usability or provider burden reduction, Dr. Rucker told Forum attendees that most issues stem from how EMRs are designed as software, how they are installed as software, and policy issues such as prior authorization saying “purchase for value seems entirely reasonable but somehow collectively as a country what we’re implementing in software, we’re missing some of the opportunity here and generating another layer of costs to massage and capture and curate this data which we ultimately pay for as a taxpayer.”

Turning towards the theme of interoperability, Dr. Rucker explained how “ONC is charged with effectively coming up with definitions for interoperability, for information blocking and for open APIs” as mandated by Congress through the 21st Century Cures Act. According to Dr. Rucker, the ONC approach to tackling interoperability issues is by looking at three use cases. The first, how patients can get their records electronically if it was generated electronically; the second, institutional accountability, an area where Dr. Rucker feels “many healthcare markets providers have merged and aren’t competing on price anymore. They’re simply not. There needs to be institutional accountability.” The final use case according to Dr. Rucker focuses on the question of what is an open API? “What does an open API look like if I’m a small provider, small practice or chain of hospital?” he asked attendees.

Following Dr. Rucker’s keynote, Madhu Annadata’s presentation shared how CMS is focused on maintaining relationships with the industry, enhancing communications and improving the quality as well as the volume of those communications – especially with stakeholders. His remarks also included news on the implementation of a new complaint and enforcement system, one that will make it more usable and nimble as well as the goal to implement a viable audit program later this year to increase overall enforcement efforts. Future collaboration with the National Committee on Vital and Health Statistics (NCVHS) on their signature project, the predictability roadmap – focused on standards update and adoption process – is also on the horizon for CMS.

We’ve certainly set the bar high for next year’s event following this year’s successful Summer Forum! 

WEDI’s outstanding programming continues this December with WEDI-Con 2017. Taking place at the Hyatt Regency Reston in Reston, Va. from December 4-6, 2017, WEDI-Con will convene hundreds of healthcare leaders looking to network and collaborate with a diverse cross-section of the industry including payers, providers, government regulators and industry vendors. Lead by a host of industry thought leaders, WEDI-Con sessions will touch upon important issues impacting the healthcare arena including privacy and security; data exchange topics such as prior authorization, attachments, eligibility and transactions; risk management and data security; a primer on blockchain technology and more.

So don’t delay, register today so your voice can be heard at WEDI-Con 2017! 

The following feature article appeared as the lead story in the August issue of Population Health News:

The Time Is Ripe for Prior Authorization Reform

Charles Stellar, August 2017

Ask any physician about the biggest time waster in their practice, and they likely would say prior authorization (PA). Three-quarters of 1,000 practicing physicians surveyed by the American Medical Association (AMA) late last year said the prior authorization burden is “high or extremely high.” Each individual physician fielded nearly 37 PA requests in the week before taking the survey, and answering those requests consumed nearly 17 hours of physician and staff time.

Any way one slices it, that’s too much time deferred from direct patient care. Payers are simply doing their jobs to satisfy requirements that insurance is being used properly. The same challenges of PA vary little from those in the 1970s, when the process was first introduced.

One would think by now that insurers would have settled on the information required to approve a certain drug, test, device or procedure; however, time and again physicians express exasperation at being thrown curveball questions that require more research or additional information. Despite the rise of utilization management vendors, software and more standardized forms, the issue hasn’t abated. If anything, it appears to be growing worse if physicians surveyed are to be believed.

To read the full Population Health News article, click here.

Join our webinar on Thursday, September 21 from 2:00 p.m.- 3:00 p.m. EDT which will explore Cherokee Health Systems’ Use of Telehealth!

Cherokee Health Systems (CHS) in Eastern Tennessee has been using telehealth for nearly 20 years to better serve the needs of their community. They provide a broad range of telehealth services including psychiatric care, medication counseling, consultations in public schools, and crisis care. During the webinar, participants will hear from CHS leadership as they talk about the lessons learned and successes of CHS’ use of telehealth including how they deliver services to best meet the needs of their patients. 

For more information on how to register for this webinar, contact Samantha Holvey at sholvey@wedi.org

This month's highlighted Vimeo channel video features Mark Martin, Director, Payer Solutions, Provider Data Management for Availity, who shares details of his WEDI Conference 2017 presentation Provider Data Directories: How Clinical Information Gets Transferred.

Visit the new WEDI Vimeo Channel to view all of our latest videos!

All of our workgroups have special projects and activities underway, here’s just a brief highlight of a few:

Health Plans/Insurers

Not-for-Profits/Government

Technology Solutions/Vendors

Providers

If you are a WEDI Corporate Member organization and would like to have your press releases included in a future edition of the WEDI Monthly Newsletter, please email with a link to your press release to t om@andersoni.com.

The Workgroup for Electronic Data Interchange (WEDI) is the leading authority on the use of health IT to improve healthcare information exchange in order to enhance the quality of care, improve efficiency and to reduce costs of the American healthcare system. Formed in 1991 by the Secretary of Health and Human Services (HHS), WEDI was named in the 1996 HIPAA legislation as an advisor to HHS and continues to fulfill that role today.