State Consumers Health Information and Policy Advisory ...

State Consumers Health Information and Policy Advisory Council Meeting

MINUTES

Date:

June 17, 2010

Start Time:

10:00 a.m.

Venue:

Agency for Health Care Administration, Tallahassee, FL

Members Present:

James McFaddin, proxy for Thomas Arnold, Agency Secretary; James Bracher, Florida Association of Health Plans; Susan Douglas, Florida Department of Education; Ebrahim Randeree, Ph.D., Florida State University; Michael Epstein, M.D., All Children's Hospital; Diane Godfrey, Florida Hospital; Meade Grigg, Florida Department of Health; Kate West proxy for Shachi Mankodi, Executive Office of the Governor; Charles Milsted, Florida State University; Gerry Smith, Office of Insurance Regulation; Harry Spring, Humana; Kim Streit, Florida Hospital Association; Karen van Caulil, Ph.D., Health Council of East Central Florida, Inc.; Craig Butler proxy for Michael Wasylik, M.D., Florida Medical Association.

Members Absent: Sally West, Florida Retail Federation

AHCA Staff Present:

Beth Eastman; Heidi Fox; Patrick Kennedy; Christopher Sullivan, Ph.D.; Carolyn Turner; Marsha Webb; Adrienne Henderson; Jennifer Green; Tiffany Vause; Patricia Norris; Courtney Duran; Fors Gregg and Nick Blake

Welcome, Introductions and Roll Call: Dr. Michael Epstein, Chair, called the meeting to order and welcomed the members, and staff. Dr. Epstein then called the roll.

Review and Approval of Minutes: Dr. Epstein called for the review and approval of the March 26, 2010, draft minutes. Mr. Harry Spring made a motion to approve the minutes. Ms. Diane Godfrey seconded the motion, and the March 26, 2010, draft minutes were approved unanimously.

Agency Update: Ms. Heidi Fox provided the update for the Agency and the Florida Center for Health Information and Policy Analysis.

The proposed legislation recommended by the Advisory Council, furthering coordination with the Regional Extension Centers and providing liability protection for entities that were entering into an agreement with the state level HIE to be the data source or the data user, did not pass. There was proviso language in the budget directing the Agency to issue an ITN by July 15, 2010, for a vendor to assist the Agency in establishing certain HIE functions and encourage the exchange of health information and electronic health record adoption. The budget also

State Consumers Health Information and Policy Advisory Council Meeting

authorized the spending required for planning for the Medicaid Electronic Health Record Incentive program and start-up funds for staff related to the state level health information exchange.

The Agency is currently working on 2011 legislative proposals and is interested in any ideas the Advisory Council may have about what the Agency should include in the proposals. The Advisory Council will be asked to review the legislative proposals as time allows.

A kick-off session was held June 4, 2010, for Health Information Exchange. This event was jointly sponsored by the Agency, and the FSU College of Communications. Ms. Fox expressed her gratitude to Dr. Randeree, whose extra efforts were instrumental in making this event happen. The Agency was pleased with the outcome and the large numbers of attendees staying for the all-day event. There were national speakers and the feedback from stakeholders was very positive. The slides and the documents from this event are posted on .

Ms. Fox mentioned that updates to the FloridaHealthFinder Web site will be made June 18, 2010, adding the data through September 2009.

In the HIE project, two contracts were awarded from the Medicaid EHR incentive program. The first contract was awarded to North Highland to assist with the planning process. The second contract was awarded to the WellFlorida Health Planning Council, who will be doing the environmental scan for the state. The Agency has entered into a Memorandum of Understanding with the Department of Health, which will be conducting the environmental scan of the County Health Departments and the health data repositories in the Department of Health.

The new data collection rules are in place regarding inpatient, outpatient and emergency departments in data collection. The new data layouts are posted on the FloridaHealthFinder Web Site. The Agency is working with facilities to make the transition as smooth as possible.

In the area of Health Care Reform the Agency is working on a contingency plan in order to meet deadlines required by the Act. Florida's Attorney General filed a lawsuit pertaining to certain provisions in the Act. The Agency is reviewing all other provisions of the Act to determine how these affect the Agency.

Ms. Christina Nye resigned and is taking a job in Washington D.C. with the National Opinion Research Center. She has enjoyed working with the council and apologizes for not being able to attend today's meeting. Her last day with the Agency is June 25, 2010.

Ms. Kim Streit asked Ms. Fox if the Agency is planning to make comments on the Health Care Reform Act especially as it relates to data collecting and reporting requirements. Ms. Fox stated the Agency is using project management techniques to perform a section by section analysis of the Act as it pertains to the Agency. Teams are determining what the Agency needs to do and when and what coordination needs to occur with other agencies. Ms. Streit asked if this analysis will come back to this committee. Mr. James McFaddin stated he had not participated in this committee before so he did not have a definitive answer. He stated the Agency is coordinating its efforts with Department of Children and Families (DCF), Department of Health (DOH),

State Consumers Health Information and Policy Advisory Council Meeting

Office of Insurance Regulation (OIR), Agency for Persons with Disabilities (APD), and Department of Education (DOE). The Governor's office is working with the Agency as well.

Mr. Patrick Kennedy mentioned that Office of Insurance Regulation (OIR) has contacted the Agency about the availability of assisting with a grant for putting together some type of claims database activity. The grant defines them as a medical reimbursement database. The Agency has had discussions with OIR since it appears funding is available for this type of activity. Gerry Smith stated that the grant they are working on states no more than $50,000 would be available for Medical Reimbursement Centers.

Mr. McFaddin stated there are also other local grants available or that will become available down the road and the Agency is determining which grants it will pursue so the Agency can position itself to take advantage of those opportunities.

Mr. Spring mentioned that the OIR is having a series of meetings in Orlando called the Health Insurance Advisory Board. OIR is using these meetings as a forum for all stakeholders to discuss what is coming, ask questions and make comments. He recommended the Agency look at replicating that activity through one of the Agency's boards. Dr. Epstein concurred with Mr. Spring and requested an update be given at the next meeting in September.

Dr. Epstein announced that Dr. Karen van Caulil has taken a new job and is no longer with the Health Council of East Central Florida, Inc. Since her position on the board represented health councils she has resigned from the board and can no longer serve the board as Vice Chair. Dr. Epstein asked for nominations from existing board members to replace her as Vice Chair. Dr. Epstein stated he had one nomination; Ms. Diane Godfrey. He asked if she accepted the nomination and she replied affirmatively. He called for any other nominations, hearing none he closed the nominations. Upon reconvening, after lunch, Ms. Godfrey was elected to Vice Chair by unanimous decision.

Data Standards and Transparency (DST) Committee Meeting Update: Ms. Beth Eastman gave an update on the DST committee meeting held in Orlando on June 3, 2010. Ms. Eastman mentioned there are now two Public Relations (PR) openings on the committee; Ms. Deborah Fleming, representing Florida Libraries, and Dr. Karen van Caulil. Ms. Eastman stated the committee membership consists of two hospital representatives, two physician representatives, two health plan representatives and two PR representatives.

Ms. Eastman reviewed the three areas covered at the June 3 meeting. The areas were improving , promoting , and a physician pilot project focused on physician volume in relation to hip replacements.

At the DST Committee meeting, Ms. Tiffany Vause, the Agency Press Secretary gave a presentation on visits to the Web site and how to work together to promote the Web site. It was recommended the Agency review the Communications Plan previously developed and other work previously done by the PR workgroup. The team will go back and reevaluate these work products. It was also recommended that press conferences would be a good way to get the word out about .

State Consumers Health Information and Policy Advisory Council Meeting

Ms. Streit suggested that it might be possible to use the Health Reform Legislation environment of transparency and information sharing to promote the Web site. It could be a way to promote the fact that Florida has been out in front of Health Care Reform on the issue of transparency and sharing information. Ms. Eastman stated she will take this suggestion back to the Outreach and Communications team.

In regards to improving the Web site, Ms. Eastman stated the committee was provided with a listing of over 150 conditions and procedures already on the Web site for adults, pediatrics, etc. Most recently AHRQ pediatric measures and pediatric readmission rates have been added to the Web site. To continue to improve the Web site the committee decided to review what CMS has on their site and follow their lead whenever feasible.

In regard to the physician volume pilot project, Ms. Eastman the data on hip replacements was presented in different ways to the workgroup. The Agency looked at the number of physicians with very small numbers, which was questionable whether these could potentially be coding errors. The workgroup also went over the feedback from hospitals. The majority of the errors in the data were some form of coding errors by the facilities.

Ms. Godfrey commented that although the data may have been incorrect when sent to the Agency, the data in the hospital is correct. She stated the problem is in the medical staff databases where staff is keying in the medical license number. The errors are more than likely data entry errors. Dr. Epstein commented that the important thing is to identify something that does not make any sense and take the opportunity to correct those errors.

Ms. Eastman stated the workgroup reviewed what other states have done such as Pennsylvania, Massachusetts and Virginia. The workgroup preferred the Pennsylvania model and based its recommendation on it. Also, the workgroup felt it was important to get the physicians, facilities and consumers engaged in using the Web site as an educational tool as well as using all the educational information available through A.D.A.M.

Mr. Kennedy was asked about the status of the volume exemption from data reporting for Ambulatory Surgery Centers having fewer than 200 visits in one quarter. Mr. Kennedy was reminded of the council's recommendation that Florida Center staff pursue the deletion of this provision with all deliberate speed. Mr. Kennedy indicated that a rule change to remove the exemption was being initiated with the target date for the elimination to go into effect being Jan 1, 2012. Mr. Bracher indicated his dissatisfaction with such a long wait for the exemption to be eliminated. He indicated his desire for the provision to take effect immediately. Mr. Kennedy indicated that he felt it was wise to give such small facilities a long run-up period to get comfortable with such technical reporting requirements. Mr. Spring proposed a compromise effective date of Jul 1, 2011.

Ms. Streit reminded Mr. Kennedy that the National Uniform Billing Committee had eliminated the "07" point of origin code and that starting July 1 of 2010 facilities would no longer be able to submit codes indicating inpatient admissions from their ERs. Ms. Streit felt that since a rule change would likely be necessary to designate replacement code for the "07," Florida Center

State Consumers Health Information and Policy Advisory Council Meeting

staff could expedite a rule that addressed both the ER point of origin code and the ASC volume exemption deletion. Mr. Kennedy indicated his support for such an approach.

Advisory Council Motion: Ms. Eastman presented the recommendations from the DST workgroup for presenting hip/knee replacements data on site and the Advisory Council approved the motion. For more information , visit

The AC Motion included the DST recommendation to display physician volume data on total hip and knee replacements by provider as well as by facility.

Dr. Epstein suggested a hot button be added to the disclaimer page for consumers to switch to the research discussing surgical volumes and the relationship to patient outcomes. Mr. Spring stated he admired the way a consumer can move back and forth through the Pennsylvania Web site and he was happy to see the Agency move in that direction. He asked what numbers are used to suppress hospital data.

Ms. Eastman explained this was a first step in getting physician information out and perhaps down the road including other quality indicator type information should be considered. Dr. Epstein asked how the Agency would get information about this out to the medical professionals. Ms. Eastman replied that this is where the Agency really needs help promoting the Web site and getting information to the physicians and brochures in their waiting rooms. It was suggested to ask Dr. Wasylik to take it back to the Florida Medical Association (FMA) as well as approach the medical schools and other medical specialty associations.

The motion to accept the proposal in the first three slides as presented by Ms. Eastman was made by Ms. Streit and seconded by Mr. Spring.

Health Information Exchange Update: Dr. Ebrahim Randeree, Ph.D. gave an update on the HIECC kick-off where there were approximately 300 attendants. At the kick-off, Dr. David Blumenthal, M.D. presented an overview of where HIE is headed from a nationwide perspective and offered insights into federal programs available to support the efforts of states to implement statewide health information exchange initiatives.

Dr. Randeree discussed hosting an Electronic Medical Record symposium in the Fall with vendors who would showcase their products. There are also university programs that focus on HIT programs, and after discussing with various educators from the meetings it is proposed that a symposium be held to create a standard for HIT. At this time, there is no way to know the similarities between different programs. UCF has volunteered their facilities to host this event.

At the HIECCC meeting in May there were multiple subjects discussed: How we would adjust the Health Information Organization contract, secure messaging, secure look up, incentives to have organizations to send in data, and which models to use in terms of the governance structure.

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