Category: Uncategorized

Last Chance for Meaningful Use

Apr 16, 2015• 14

By ADRIAN GROPPER, MD

I mean: Last chance for patients as first-class citizens in Meaningful Use.

The ghetto is abuzz. As I write this #nomuwithoutme is just hitting Twitter. The reason the natives are restless in the patient ghetto is a recent proposal by our Federal regulators to downgrade a Meaningful Use (MU) requirement for Stage 3, in the final stage of a $30B + initiative to advance interoperable digital health records. The focus is on something called View / Download / Transmit (V/D/T) but the real issue and the Last Chance is broader and more important. The bad news is that MU may leave patients as beggars for own data. The good news is that the Office of the National Coordinator (ONC) and Congress are paying attention and patients still have a chance to shift the terms of the debate to what HIPAA calls “the patient’s right of access” and demand that it apply strictly to MU Stage 3 Appication Programming Interfaces (API).

To find the core of the downgrade, search the Notice of Proposed Rulemaking NPRM for the word “download”. To experience the ghetto first-hand, search the NPRM for “4 business days”. The issue is plain: patients are to get degraded, delayed information through a “portal” that forces us to take whatever the “providers” are willing to grant us.

Designing For Good: A Designer’s Hippocratic Oath

Apr 16, 2015• 2

By MAD*POW

The Designer’s Oath brings together designers from disparate disciplines and backgrounds to create collaborative Oaths that speak across design practices and organizations. The traditional boundaries of design are quickly expanding, and our code of ethics needs to be as flexible and easy to redefine as the process of design itself. The Designer’s Oath must become a tool that is applied to the process of design to ensure that the end result does good.

Surviving the Affordable Care Act Grace Period

Apr 16, 2015

By KATHY YOUNG

Since the first open enrollment in 2014 more than 11 million people have gotten coverage through the insurance exchanges established through the Affordable Care Act (ACA). While the plans offered through the exchanges are provided by the same insurers you deal with every day, there are some differences.

The biggest one is the 90-day grace period. As we near the end of the grace period for 2015, many practices are still struggling to manage the ins and outs to ensure they get paid. Here’s why.

When a person goes into the exchange to select a policy, they get a 90-day grace period to pay premiums. This grace period is between the insurance company and the policy holder. As with other coverage, when the patient makes an appointment and/or goes to the doctor, he or she shows the insurance card. When the practice verifies eligibility, it shows that the patient is covered. If the patient comes into the office during the grace period, the claim will go out as usual and get paid. However, if the patient did not pay their premium during this grace period, the insurance company will come back to the practice and ask for the money back. Then, the practice has to bill the patient directly. This is difficult for providers for many reasons, not the least of which is that the longer it takes to bill a patient, the lower the chances of getting paid.

As a provider you may feel a strong reaction to this 90-day grace period and want to wait to see patients until the grace period is past. This is probably not realistic. Patients need care, and you need to have a positive relationship with your patients. So, here are a few steps to help manage the grace period and ensure you get paid:

If the patient is in this grace period, ask them to bring proof of payment of their premium (cancelled check or receipt of some kind).
If the patient cannot provide this, have them pay at least 50% of the billed charges at the time of service.
Have patients sign a contract that states that they will pay the charges if the payer denies them or asks for the payment back after services are rendered.
Implement a credit card on file option. Patients provide a credit or debit card and sign a contract that it can be charged up to a specified amount (i.e., $150). If the payer denies the claim or asks for the payment back, the practice can charge the card and send a receipt to the patient.

Over 30% of physicians believe that the largest barrier to good healthcare is inadequate insurance coverage. So it is no wonder that over 40% of physicians also believe that the Affordable Care Act is mostly good and a similar number are accepting exchange plans. However, this doesn’t change the fact that the new plans come with challenges.

As a small business you can’t really afford to wait too long to get paid, or worse, have to return payments and then wait again. By implementing some simple steps now you can help reduce the headaches of exchanges plans in the years to come.

Kathleen Young is the CEO and co-founder of Resolutions Billing & Consulting, Inc., which was founded in 2003. Kathleen is also the owner of Healthcare Chart Audits, which offers auditing to physicians and attorneys. Kathleen has been in healthcare since 1989 and has worked for physicians, large corporations and three billing companies. Kathleen is a CPC and a CPMA with the American Academy of Professional Coders and speaks to many groups on coding, billing, and auditing.

The Big Fix. Medicare Doc Pay Enters a New Era

Apr 15, 2015• 6

By STEVEN FINDLAY

It’s done. Congress on April 14 passed and the president signed into law a bill that terminates one of the most egregious and silliest examples of dysfunctional government in recent years—the so-called “sustainable growth rate” (SGR) formula for doctors’ fees under Medicare.

A previous blog explained the background and protracted lead-up to this moment.

Now what?

First, a round of applause for bipartisan agreement—however obvious it was that had to happen in this case. The vote in the house was 392-37. In the Senate, it was 92-8.

Praise is also in order for enacting two more years of funding for the Children’s Health Insurance Program and $7.2 billion in new funding over two years for community health centers, a program that was expanded under the Affordable Care Act and serves low-income families. There’s also welcome help for low-income Medicare beneficiaries and rural hospitals.

But the main thrust of the law is to kill one (failed) program that adjusted doctors’ fees under Medicare and create a new and hopefully better one.

Time For a Stand Against Misinformation

Apr 15, 2015• 3

By SUSANNAH FOX

Two years ago, I interrupted a speaker at a big health/tech conference, right in the middle of his presentation. I still blush at the memory. But the speaker was citing data — my data—incorrectly and I couldn’t let it pass.

Brian Dolan recently wrote about how he wished he’d spoken up when he heard someone spreading misinformation at a conference:

Unfortunately, about 80 people sitting in the room either accepted this as new information or failed to stand up to correct the speaker. I wish I had pulled a Susannah Fox and done the latter.

He linked to my 2012 post about what happened at Stanford Medicine X.

In that post I asked:

What style of conference is the right one for the health/tech field? The TED-style “sage on stage” who does not take questions? Or the scientific-meeting style of engaged debate? Or is there a place for both?
Do different rules apply to start-ups? Is it OK to fudge a little bit to make a good point, as one might do in a pitch? Personally, I do not think people are entitled to their own facts. There’s too much at stake.

We can’t let misinformation—or worse—go by without comment.

I think it’s time for more people to speak up in health care.

More pediatricians should express their measles outrage.

More people should chronicle the reality of living with chronic conditions.

More people wearing medical devices should demand access to the data being collected.

More people should speak up about medical errors before—and after—they happen.

Continue reading…

The Anecdote-Innovation Cycle

Apr 15, 2015

By SAURABH JHA, MD

“Drinking single malt has stopped me from developing flu” – Anecdote (& Business Opportunity)

“Everyone should drink single malt based on my experience. It stops flu” – Advice

“You are talking baloney” – Paternalism

“Everyone is entitled to opine what saves them from flu” – Freedom and Choice

“We need science to determine efficacy of single malt “- Elitism

“Burden of proof is on he who asserts the benefit of single malt” – Epistemology

“We need evidence before third parties can pay for single malt” – Value-based healthcare

The 3 S’s of Smartphone Shopping

Apr 15, 2015

By TREY LAUDERDALE SPONSORED CONTENT

What a difference a few years makes. It wasn’t long ago that healthcare CIOs declared they would never use smartphones for caregiver communication. Now, with smartphones proliferating throughout the nation’s hospitals as an effective clinical communication solution, many vendors are adding smartphone options to their product lines. If you’re attending HIMSS15 in Chicago this week, you will undoubtedly see traditional communication vendors touting the benefits of their brand-new smartphone offerings.

The good news: It’s fairly easy to build a smartphone app using current development technologies. The bad news: It’s not so easy to build a solid smartphone platform that’s reliable in the healthcare environment and scalable enterprise-wide.

While vendors may present their smartphone solutions as tried and true, many have only a portion of their advertised functionality deployed in a real healthcare environment. And many of those deployments are small, one-unit pilot projects that haven’t been tested site-wide. As you assess the mobile communication solutions presented at HIMSS, take the time to ask probing questions to determine which vendor, products and services are right for your facility.

Emerging Healthcare Innovation Space Needs Serious Investors, Herd Thinning

Apr 15, 2015• 6

By TOM RODGERS

Just a few years ago, you would have had to scour the show floor to find a startup exhibiting at the HIMSS Annual Conference. But, for the first time this year, they will have a major presence at this show that gathers more than 37,000 health IT professionals and innovators who are developing next-generation technologies. In fact, more than 200 startups will be on the floor at the inaugural Hx360 event taking place at the conference in Chicago– demonstrating the perceived ripening of the industry for disruption and the rising expectations of entrepreneurs and the investors supporting their efforts.

Drawing these innovators like the Sirens from the Odyssey is the newly empowered and often under informed consumer with their high deductible and array of chronic diseases. Healthcare provider organizations, payers and pharmacies must adapt to them and view them as actual customers not untapped wells overflowing with potential CPT codes. Now, more than ever, the industry needs to focus on quality experiences and good clinical outcomes for patients – and many startups are developing new approaches and technologies to tackle these issues. In order to make these new approaches a reality sooner rather than later, larger industry players need to understand the dynamic landscape, and work with and invest in these emerging companies. Incumbents with their large feet planted squarely on the traditional solid ground are sensing some seismic rumblings and how well they are leveraging and embracing these emerging companies to help maintain their balance may determine whether they can sustain themselves moving forward.Continue reading…

HIMSS 2015: Medicomp’s Dave Lareau

Apr 15, 2015

By MICHELLE RONAN NOTEBOOM

Michelle Noteboom: Give me a bit of background on Medicomp and what Medicomp does.

Dave Lareau:Medicomp was founded by Peter Goltra in 1978 and the main mission since its founding was to present relevant clinical information to the physician at the point-of-care so they can document and treat the patient. That’s really the core of what we do. We work with 15 to 20 physicians, most of them board certified in internal medicine, as well their specialty. We have a fairly expansive knowledge editing system, where the physicians work with our knowledge engineers.

So, if you’re thinking about asthma, what are the relevant symptoms, history, physical exam, test, diagnosis, and therapies? If somebody presents with left upper quadrant abdominal pain and nausea and vomiting, what would you be thinking of, and what would you want to document, what kind of test do you want order, what’s your presumptive diagnosis? At the point-of-care we can present the relevant information for documentation given the clinician’s thought process so that we don’t slow them down, we don’t get in their way, let them see more patients. They get all their documentation done and it’s all coded to all the standards. The ICD-9 or 10, as well as LOINC, RxNorm, etc. is in the background, but they’re dealing with something that is fast and familiar. That’s what we do.Continue reading…

An EHR Attestation Report Card and Data Set

Apr 14, 2015

by FRED TROTTER and ASHISH PATEL

DocGraph will release an initial dataset will become available on the last full day at HIMSS, and the crowdfund will continue until Datapalooza. This post discusses our underlying motivation for creating a new dataset, as well as some of our goals with its release.

I enjoy and appreciate many aspects of the annual HIMSS conference: the people who run it, the attendees, educational sessions, and keynotes. Further, I find that regional and local HIMSS events are well worth attending. However, I am not a fan of the “big” HIMSS tradeshow floor. The parallels between walking down the “main aisle” at HIMSS and walking down the strip at Vegas creates are striking. The opulence of the Vegas strip and the excess in the HIMSS tradeshow floor both stir a sense of unease and bring up the same questions: “Who is paying for all of this? Is someone getting fleeced? Is it me? If it is not me, would that make the fleecing OK?”

The HIMSS tradeshow floor is a necessary evil because we have, in Health IT, no better way to make decisions about what products we buy. As it stands, figuring out which vendors have the biggest booths at HIMSS is probably not the worst way to make decisions about EHR systems.

The alternative is to hire someone to tell us which EHR vendor fits us best. Probably the most famous provider in this space is the “Best in Klas” service. However, Klas is famous for being payed by both sides of the industry. Klas is paid both by potential EHR purchasers and by those who sell EHR system. Like HIMSS, Klas creates a space for buyers and sellers to meet. I think Klas and HIMSS both do an admirable job trying to maintain fairness and objectivity, given the massive financial biases under which both organizations operate.