Healthcare Compliance, Patient Access to Information Prove Costly
Healthcare compliance and patient access to services and information prove costly to one of the nation’s leading payers.
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By - Today’s roundup includes HIPAA violations, telehealth trends, and efforts to ensure equitable access to care.
UnitedHealthcare Settles HIPAA Right of Access Case for $80K
UnitedHealthcare settled a potential HIPAA right of access violation case with the Office for Civil Rights (OCR) by paying an $80,000 fine. This marks the 45th case settled under OCR's HIPAA Right of Access Initiative, which ensures patients' timely access to their medical records.
The case stemmed from a complaint in March 2021, alleging UnitedHealthcare hadn't promptly provided a requested medical record. The individual received it in July 2021 after OCR's investigation started. As part of the settlement, UnitedHealthcare agreed to implement corrective measures, update policies, provide privacy training, and ensure access to protected health information.
The settlement underscores that all HIPAA-covered entities must adhere to right of access provisions or face consequences. READ MORE
Medicare Shared Savings Program Achieves $1.8B Savings in 2022
In 2022, the Medicare Shared Savings Program (MSSP) saved Medicare $1.8 billion, with 63% of accountable care organizations (ACOs) receiving payments for their performance. This marks the program's sixth consecutive year of generating savings and high-quality results.
ACOs performed well on quality measures related to various health aspects, including diabetes control, cancer screenings, and depression follow-up. Coordinated care by ACOs aligns with the Biden Administration's goals for better behavioral healthcare services and cancer prevention. ACOs with low revenue saw higher net savings per capita compared to high-revenue ACOs, emphasizing the role of primary care in MSSP success.
CMS has proposed changes to encourage participation and health equity improvements in underserved areas. As of January 2023, over 573,000 clinicians serving almost 11 million Medicare beneficiaries were part of MSSP ACOs. READ MORE
11% of Telehealth Visits Lead to In-Person Follow-Ups
Around 11% of telehealth visits result in subsequent in-person follow-ups for the same clinical reasons within one week. Behavioral health and chronic conditions are the main reasons for such follow-ups.
This information comes from an analysis of telehealth data conducted by market research firm Trilliant Health. The study suggests that while telehealth is increasingly used for chronic conditions and behavioral health issues, it may lead to fragmented care due to limitations in maintaining ongoing relationships and comprehensive monitoring.
However, other research, including studies by Epic Research, indicates that telehealth generally does not drive duplicative care and that most specialty and primary care-related telehealth visits do not require subsequent in-person follow-ups. READ MORE
Procedural Reasons Drive 74% of Medicaid Disenrollments, Affecting Millions
A substantial number of Medicaid enrollees, approximately 74%, have been disenrolled from the program during the redetermination process, primarily due to procedural reasons.
As of August 23, 2023, over 5.36 million Americans were disenrolled from Medicaid, with about 37% of individuals who completed the renewal process being disenrolled. This figure might be higher, as not all states included total disenrollment counts in public data. Procedural disenrollments are often linked to paperwork-related issues rather than ineligibility for Medicaid coverage. States like Texas had high disenrollment rates, primarily due to targeting specific populations during renewal efforts.
Despite disenrollments, over 94.2 million people remained enrolled in Medicaid or CHIP as of April 2023, showing a steady increase since the pandemic's onset. READ MORE
NLP Tool Enables Extracting of Social Determinants of Health Data
Researchers from Indiana University Fairbanks School of Public Health and Regenstrief Institute have validated a natural language processing (NLP) model's effectiveness in extracting social determinants of health (SDOH) data from clinical notes.
The NLP tool demonstrated high accuracy, portability, and generalizability across two different health systems, specifically focusing on factors like financial insecurity and housing instability. The study highlighted the importance of adapting NLP models to institution-specific templates and clinical terminology when extracting SDOH data.
The tool's success suggests the potential to enhance patient care by efficiently identifying and addressing SDOH needs, ultimately leading to more proactive interventions. READ MORE
Epic EHR Education Boosts Clinician Satisfaction, Efficiency
Participation in Epic EHR education programs, such as the Physician Power User and Physician Builders initiatives, is associated with higher clinician satisfaction, as revealed by a KLAS Arch Collaborative report.
Clinicians engaged in these programs reported better Net EHR Experience Scores (NEES), which measure EHR efficiency, functionality, and care impact. However, some providers who received extra EHR training felt unable to share best practices with peers due to limited opportunities or system access. The report emphasized the need for improved EHR efficiency to tackle clinician burnout and staff turnover, linking it closely to burnout causes.
Epic offers modules like Brain, Hey Epic!, Rover, and Secure Chat to enhance efficiency and EHR experience, leading to increased satisfaction among providers. READ MORE
