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More widespread implementation of gaps in care programs is essential to realizing the value of population health management, according to a new report from the Workgroup for Electronic Data Interchange. In its study, "Closing Gaps in Care through Health Data Exchange," WEDI defines those gaps as the discrepancy between evidence-based best practices and the care that's actually delivered to the patient. At too many providers, that chasm is still too wide, according to the report. Better IT infrastructure – enabling more robust exchange health data, automating identification of information gaps and streamlining care coordination – is needed to bridge it. Toward that end, WEDI offers five key takeaways: 1. Education and communication are essential to making providers aware of the value of identifying and closing gaps in care. "Providers appear to lag behind health plans in implementing gaps in care programs," according to the report. "Challenges include the lack of sufficient resources or education about how to maximize workflow changes and effectively close gaps in care." 2. Gaps in care can adversely affect provider performance. "Surveyed providers are significantly more concerned than health plans that gaps in care pose a threat to their organization by affecting clinical performance, financial performance and the ability to retain patients," according to WEDI. 3. Programs to address gaps in care offer a high return on investment. "Improvements were observed in quality outcomes such as access to behavioral healthcare, pediatric and adolescent check-ups and medication adherence," according to the report. "Reductions in utilization of ambulatory care, hospital admission and hospital readmission were also observed." 4. Better consensus is needed to develop and standardize quality measures and methodologies for data exchange among payers, providers and patients. "The terminology, standardization and scope of gaps in care measures need more clear definition and alignment between health plans and providers before actionable data harmonization can occur," WEDI researchers say. "Best practices need to be disseminated that illustrate stakeholder roles, automation of workflow and quality improvement. The report also points to other barriers such as the "provenance, quality, completeness, timeliness, transparency and accuracy of data." More widespread use of open API and element - based exchange could help address these 5. Fixing care gaps will only grow in importance as value-based models evolve and access to care and coverage expands. "As newly eligible consumers continue to enter the health insurance marketplace and access healthcare, it will be essential for stakeholders to develop effective healthcare communication, prevention and education and intervention strategies to improve the quality of patient-centered care," the report says. "As we increasingly grow fee-for-value arrangements in our nation, it is critical that we look to methods  automate gaps-in-care – to not only ensure that data moves seamlessly between clinical systems and payment systems but that the information is useful and actionable for clinicians and patients," WEDI founder and former HHS Secretary Louis W. Sullivan, MD, said in a statement. Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com Like Healthcare IT News on Facebook and LinkedIn

The Act to Prevent Opiate Abuse by Strengthening the Controlled Substance Prescription Monitoring Program also sets a cap on number of days for opioid prescriptions and requires doctors to undergo addiction treatment every two years.

New York's Mount Sinai Health System is joining other high-profile health systems across the nation in embracing OpenNotes, an initiative that gives patients access to their care provider's notes in their medical records. The notes are available for the first time in the health system's online electronic health record portal, called MyMountSinaiChart. Users can now read details of their office visit from the convenience of their personal computer, tablet or smartphone. MyMountSinaiChart, launched in 2012, also enables patients to communicate with their doctor, access test results, request prescription refills and manage appointments. The goal of OpenNotes is to improve transparency, communication and trust between patients and physicians – and it's working, Mount Sinai officials say. [Also: OpenNotes: 'This is not a software package, this is a movement'] "When patients can access their physicians' notes, they can better understand their medical issues and treatment plan as active partners in their care," said Sandra Myerson, chief patient experience officer at the Joseph F. Cullman, Jr. Institute for Patient Experience at Mount Sinai. "This can ultimately lead to improved patient engagement, patient empowerment, and communication between patient and physician." "Patients expect and deserve to have full access to their medical records and the Mount Sinai Health System is committed to meeting this expectation," Jeremy Boal, MD, chief medical officer at Mount Sinai Health Systems, said in a statement. Four Mount Sinai physicians in various clinical practices conducted the initial OpenNotes pilot beginning in December 2015. Twitter: @Bernie_HITN Email the writer: bernie.monegain@himssmedia.com Like Healthcare IT News on Facebook and LinkedIn

Revenue cycle management has gone from being a "back office" function to an "end-to-end" system that begins at patient intake or even before, claims specialists say. Advanced technologies, in tandem with improved workflows and better data have resulted in RCM systems that encompass the entire healthcare enterprise. With the right automation tools and revenue cycle support, experts say healthcare providers should be able to improve their cash flows by collecting patient payments up front, determining precise eligibilities and filing clean claims to payers. With the fee-for-service business model changing to prospective payment and value-based care, healthcare organizations are undergoing a cultural shift that dramatically alters their approaches to patient intake, eligibility verification and claims processing. These are issues that providers will have to understand and adjust to accordingly, says Jose' Rivera, vice president of physician solutions development at Santa Rosa, Calif.-based Visiquate. "Fee-for-service is going away and bundled payments will come to fruition," he said. "We will see a resurgence of capitation because it puts the risk back on the provider. Organizations were able to overcome ICD-10, but as the model moves toward quality I think we'll see another resurgence of value proposition payer mixes." As a result, Rivera believes it will be a lot more difficult to get paid. Meeting the challenge means physicians must become educated on tracking quality metrics and reporting them to payers, he says. "This is a formidable task because different payers with different contracts all want slightly different quality metrics," Rivera said. "It's a big question mark in the back of my mind." Emphasizing intake RCM specialists agree that patient intake is a critical part of the revenue cycle process and that if they aren't emphasizing it, they need to do so immediately. Collecting patient deductibles, co-payments and eligibility authorizations is paramount for boosting the organization's cash flow as well as for ensuring clean claims, Rivera said. "That is the front line – they need to capture that information correctly and guide it to the right places," he said. "When it comes to authorizations, we are still in a prehistoric environment where a payer has to be called on the phone and it's a half-hour wait to get the authorization. This process definitely needs to be upgraded." Patient registration is undergoing dramatic change, with intake clerks "being asked to do more and more," says Colleen Wood, vice president for the Eastern U.S. at Jacksonville, Fla.-based Availity. RCM technology at the point of intake should be leveraging technology for patient data capture as well as having credit and debit card readers for upfront payments, she said. And while some providers – especially physicians – have been reluctant to ask for payment upfront, collecting deductibles and co-payments at intake fosters cash flow while informing patients of their obligations. "As patients, they should want to know how much it will cost," she said. "This is an opportunity for them to ask about costs and manage their dollars, which they couldn't do previously." Receiving deductibles and co-payments not only improves cash flow, it also creates a more comprehensive patient profile, Wood said. "It goes deeper than just getting deductibles and co-insurance," she said. "It is the total dollar for the patient and provider experience. Deductibles are part of the equation, but the challenge is that there is a ton of data about patients being eligible for services, but also the benefit level each payer covers and how it is going to be covered. Providers need to realize they need to get the total dollar and understanding of the benefit level for every patient, whether it is in the physician or hospital setting." Illuminating the buckets Although the emphasis is on intake, the back end of the revenue cycle continues to be as vital as always and clean claims remain the key to prompt payment. Still, there are stumbling blocks in the claims filing system, says Jay Deady, CEO of Greenwood Village, Colo.-based Recondo. "On the back end, we need to identify the buckets and reasons why claims aren't adjudicated cleanly," he said. "When we illuminate those buckets, patient ineligibility and lack of authorization are still the main reasons for denials." Electronic data interchange transactions with payers is still the standard for eligibility and authorization data, but Deady's research shows that the information can be wrong up to 25 percent of the time. On the whole, however, the process has improved immensely in the past few years, he said. "We're getting more information earlier, getting more information cleared earlier and more is being done earlier," he said. Many moving parts While the end-to-end revenue cycle system has become more automated, there are "still a lot of moving parts" within the process, noted Mike Nissenbaum, CEO of Dallas-based billing contractor Aprima. "There are so many changes just on what is covered and how much will be paid," he said. "There are constant changes in plans and the payers can modify formularies and delay them up to six months. That is very stressful. If we don't pay attention to all these rules changes, our clients suffer." Twitter: @HealthITNews Like Healthcare IT News on Facebook and LinkedIn

More than 100 million records reportedly were compromised in 2015 in healthcare, which now is the top industry for cyberattacks, according to new IBM research.

Claiming that it was "startled" by VA officials' recent testimony, the committee put strict conditions on full funding that a Senate committee already approved.

CISOs and security analysts from top-tier firms offer highly effective advice and tactics for rooting out and getting rid of malicious code.

National Coordinator Karen DeSalvo, MD, is stepping away from the co-chair role on the ONC Health IT Policy Committee. Kathleen Blake, MD, vice president of performance improvement at the American Medical Association, will replace DeSalvo, according to Politico, which reported the announcement was made Tuesday at the joint meeting of the Health IT Policy and Standards Committees. Blake will serve alongside DeSalvo's current co-chair, Paul Tang, MD, chief innovation and technology officer at the Palo Alto Medical Foundation. Tang is also the head of ONC's meaningful use workgroup.  [Also: How satisfied are you with your EHR? Satisfaction Survey results]  DeSalvo currently serves as both National Coordinator for Health IT and Acting Assistant Secretary of Health and Human Services. She's been with ONC since January 2014. Health and Human Services Secretary Sylvia Burwell brought DeSalvo to HHS in October 2014 to help coordinate the federal government respond to the Ebola outbreak – touting her public health qualifications after having served as New Orleans Health Commissioner in the wake of Hurricane Katrina. In May 2015, President Barack Obama appointed DeSalvo HHS Acting Assistant Secretary for Health. If she gets a Senate confirmation hearing and is approved, she would step down from the National Coordinator post at ONC.   Twitter: SullyHIT Email the writer: tom.sullivan@himssmedia.com Like Healthcare IT News on Facebook and LinkedIn

Theranos, the embattled blood testing startup, is now under investigation by the U.S. Securities and Exchange Commission, as well as the U.S. Attorney's Office for the Northern District of California, according to Bloomberg. The investigation is the latest in a series of hardships for the once-vaunted company, coming on the heels of a recommendation by the Centers for Medicare and Medicaid Services that founder Elizabeth Holmes be banned from the blood testing business for a two-year period. In March, a study in the Journal of Clinical Investigation found that cholesterol test results obtained through Theranos – which are drawn from small finger pricks – were much different than those from large laboratory companies, implying that doctors' medical decisions could be thrown off by results acquired through Theranos technology. [Also: Theranos results differed from Quest, LabCorp enough to impact care decisions, study finds] In all, Theranos' results for total cholesterol were found to be an average 9.3 percent lower than those obtained through clinical laboratories Quest and LabCorp, according to the March study. This has lead researchers to surmise that in some instances, doctors may inappropriately begin, or fail to begin, statin therapy, a drug-based regimen that aims to prevent heart disease. The investigation by the SEC, which ensures companies give accurate information to investors, was one of several described in a memo from Theranos (once valued at $9 billion) obtained by Bloomberg. The memo was originally furnished to Theranos' partners including Walgreen's, which has reportedly been looking to cut ties with the startup. "The company continues to work closely with regulators and is cooperating fully with all investigations," Theranos officials said. Before the federal investigations were announced Monday, Holmes appeared on NBC's Today show to say she was "devastated" that her lab did not discover its deficiencies. Holmes also said Theranos would rebuild its lab from scratch to avoid future problems. In addition to suggesting that Holmes be temporarily banned from the industry, CMS has proposed a number of other sanctions, including revocation of Theranos' Clinical Laboratory Improvement Amendments of 1988 certificate – or, alternatively, a civil monetary penalty of $10,000 per day for each day of non-compliance. Theranos could delay the effective date of the sanctions by filing an appeal. Twitter: @JELagasse Like Healthcare IT News on Facebook and LinkedIn

Recent cyberattacks on healthcare have been highly disruptive and publicly embarrassing for the industry. Take part in the 2016 HIMSS Cybersecurity Survey to help identify how organizations are mitigating the risk of being the next victim.