April 12, 2016

Physician Quality Grading for Consumers

Columbia University Medical Center has just this week published a guide to the Physician Compare quality data. While the release of physician quality data has been delayed, expectations are that it will appear in 2017.

CMS will generate star ratings based on data drawn from the Consumer Assessment of Healthcare Providers and Systems (CAHPS), the Physician Quality Reporting System (PQRS), as well as Accountable Care Organization (ACO) and claims data. CMS will set benchmarks based on the Achievable Benchmark of Care (ABC) methodology.

The data will be made available with the intent to help consumers to make informed decisions and to encourage physicians to improve performance, leading to more efficient and healthful outcomes.

CarePrecise will continue to monitor the project, and will begin including physician quality data in an upcoming product, The Definitive Physician Database™, as it currently does with its product The Definitive Hospital database™. CarePrecise is a leading supplier of healthcare provider data used in consumer-facing web and mobile applications, through special licensing arrangements.

March 7, 2016

Medicare Fraud Steals $60 Billion a Year

Six months after a provider performs a particular medical procedure, they can bill it again. And, exactly six months to the day, the provider photocopies the original claim, changes the date, and sends the scammed claim it off to Medicare.

$60 billion worth of fraud is roughly 10% of the total amount Medicare pays out every year on healthcare for 54 million people. According to a March 7 WIRED article, "Since 2007 more than 2,300 providers have been charged with fleecing Medicare, and more than 1800 defendants have been convicted of felony offences, ranging from claiming phantom services to performing unnecessary surgeries."
Among CarePrecise Clients are the Federal Bureau of Investigation and state anti-fraud law enforcement bodies. CarePrecise provides comprehensive data on healthcare providers.
How will ever stop these scams? There are just too many of them for CMS' dedicated investigators to keep up. But the government is getting help from hundreds of citizens: whistle-blower lawsuits allow any medical office staff or other insider to sue their employer and collect 15% to 30% of the settlement. The number of bounty hunters is growing; in 2014 there were 469 such settlements resulting in $2.2 billion in fines.

Professional whistle-blower lawyers can help skittish employees to rat correctly, but they may not have the investigative chops. Now one clever business has begun to turn medical office whistle-blowing into a growth industry. National Healthcare Analysis Group may do more to help recover this money than has been possible in the past by organizing the process and "packaging" it. Read more about it...

February 16, 2016

COMING: Standard Quality Measures

The Obama administration, acting in concert with the health insurance trade group America's Health Insurance Plans (AHIP), announced today an agreement to develop a standardized set of healthcare quality measures for physicians. In particular, the new quality measurement system will track care given by accountable care organizations, patient-centered medical homes, primary care physicians, cardiologists, gastroenterologists, HIV and hepatitis C care providers, medical oncologists, orthopedists, obstetricians and gynecologists.

As physician's pay from insurance plans is more and more tied to quality outcomes - did the patient get well, or will there be additional claims down the road? - a system for measuring outcomes has become necessary. In recent years, government and private health plans have been working separately, and a confusing array of different measures for different companies has been growing. The CMS/AHIP agreement will seek to create a single standard system of measurement, relieving much of the burden caused by separate systems. In their news release, acting CMS administrator Andy Slavitt stated that "this agreement today will reduce unnecessary burdens for physicians and accelerate the country's movement to better quality." Representatives of the American Medical Association and the Americal Academy of Family Physicians praised the effort.

October 24, 2013

Out of the Silos: Combined Healthcare Provider Data

You always knew it was possible to get all of the rich federal data on healthcare providers together in one place, and in a form you could use on your PC. And you were simply ecstatic when CMS released the NPPES database! But then you downloaded it and learned that there is simply no normal desktop software that can make that data accessible to you. Rats!

Then CarePrecise created a version of that data -- our flagship product, CarePrecise Access Complete (CPAC), so you could use all 4 million provider records on your computer. Yay! But then you found that it was hard to get around in all that data. Rats! So CarePrecise released the CP ListMaker software that makes getting at the data you want a walk in the park. Excellent! And you wanted some way to know which providers were sanctioned, or that they were eligible to bill Medicare, so CarePrecise integrated data from the PECOS (Medicare) database and the LEIE (List of Excluded Individuals and Entities). Fantastic!

Then you wanted more than the single practice location and fuzzy practice group data that the NPPES gave you, so CarePrecise integrated all of the Physician Compare data with CPAC. Cool! And you wondered how would you ever tame all of that hospital data, so CarePrecise integrated a de-duplicated list of hospitals and the Hospital Compare data, and while we were at it, we included hooks into the hospital quality data and the upcoming physician quality data. And all of it -- the NPPES, PECOS, LEIE, Physician Compare, Hospital Compare (plus some really nice additional stuff like proper-cased name and address fields, provider service area wealth data, and urban/rural/suburban designations) -- all integrated into a single relational database, linked by the NPI number. And you though it couldn't be done.

Now we call that sweet package of data heaven by a weird name: The CarePrecise Total Bundle. And as we integrate upcoming federal data releases, will we be tucking them in there too? You betcha. That's what CarePrecise is all about: healthcare provider data integration and application.

It's brand new and available now: The only 360 degree view of U.S. healthcare provider data. Total Bundle pricing is just $689. That's less than 2/100ths of a penny per record for the most complete physician database / hospital database / dentist database... available anywhere.

You're welcome!

October 11, 2013

Healthcare Reform Brews Startup Gold

As state and federal insurance exchanges struggle to open their portals to millions of new insureds, the Affordable Care Act is spawning myriad opportunities for startup entrepreneurs in the healthcare IT space.

The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 handed physicians generous incentives to invest in healthcare information technology. Unprecedented investment has been finding its way to to electronic medical record (EMR) vendors. Use of these systems has exploded, roughly doubling since 2012.

That other familiar new legislation, the Affordable Care Act, affectionately dubbed "Obamacare," seems to be awakening the sleeping giant of American capital investment, as the largest growth in the history of healthcare insurance is being launched this month. Private exchanges have offered one such opportunity, but many more are on the horizon, as healthcare providers turn to technology to cope with increases in patient services, and as new providers hang out their shingles to capture the burgeoning patient market. Coupled with the aging of the Baby Boom generation, healthcare industry fortunes have never looked so good.

Remote patient monitoring tools, including wearable sensor/transmitters, represents one of the early forays for startups. Mobile devices will monitor patients and report bio data to patients' healthcare provider teams. As the ACA changes the game from the existing volume-based model to a value-based revenue system, physicians will no longer have an incentive to order a flurry of expensive tests, but to maintain a 360-degree view of patients' health, catching threats while intervention is relatively less costly, and to prevent hospital re-admissions by remote monitoring of biometrics during at-home recovery and on an ongoing basis. Federal incentives to treat patients under outpatient conditions will be an initial major driver. A recent estimate by Rock Health pegs recent investment in this technology at $102 million.

MedTronic, a manufacturer of mobile insulin delivery technologies, recently announced FDA approval of its new "artificial pancreas," a mobile device that combines automated constant glucose testing with insulin delivery. The device, already in use in Europe, collects and can report patient blood glucose levels and insulin pump interventions on a minute-to-minute basis, and will be rolling out in the U.S. over the next year. The device does not yet transmit data, but must be downloaded.

Fitness-tracking devices are among the new direct-to-consumer devices finding acceptance in the market. Some see this development as helping to bring down the cost of mobile biometrics, and providing the data stream needed to feed the emerging preventive care and early intervention movement. The presence of such technology in the consumer market could ease consumer acceptance of more clinically-oriented mobile technologies related to population health management, a potentially enormous new segment in the industry.

Population health management encompasses tools and expertise to capture and analyze vast streams of biometric data and broader patient health information in order to identify trends that threaten particular populations. Hospitals are the current market for these tools, but new markets can be imagined among outpatient services providers of many types, in supply chain management, pharmaceuticals and medical devices, as well as government-based public health entities.

New ways of delivering primary and specialty care represent another area of growth. Concierge clinics, and clinics that cater to niche patient populations make heavy use of technology in acquiring and keeping patients, frequently commanding higher fees than broader-based clinics.

The emerging "maker community" also represents a new force in the healthcare technology and medical device development markets. New technologies that democratize the prototyping of new technologies, utilizing $35 computers, smart phones and inexpensive 3D printing, are attracting record numbers of individual inventors to the once-stodgy healthcare industry dominated by huge conglomerates like GE and 3M. What healthcare will look like after the coming boom is anyone's guess, but it will almost certainly involve more people applying more intelligence and effort to our health, and, as their achievements emerge, so may vast new wealth.

CarePrecise provides data products to the healthcare IT market, and marketing tools to vendors of health IT, medical devices, pharmaceuticals, including numerous startups.

Patient Portal Segment to Soar

Driven by federal Stage 2 Meaningful Use requirements, patient portal use is taking off across the United States. Healthcare IT News wrote last week that "the patient portal market is poised to absolutely boom." The article refers to a Frost and Sullivan report that has the market soaring towards $900 million in about three years - a spike of 221%. CarePrecise provides marketing tools to patient portal vendors and other healthcare IT companies.

August 15, 2013

HIPAA-Covered Providers Top 4 million

With the August, 2013 data release, a new milestone has been reached in the U.S. healthcare industry. There are now 4,021,049 healthcare providers covered under HIPAA, of which 900,126 are physicians.

Over 1 million entities, mostly physicians and physician groups, are enrolled to bill Medicare, according to the PECOS Ordering and Referring report.

Added just this month were 30,578 new NPI records. Over the past 60 days, changes were made by healthcare providers on 127,972 NPI records.

The CarePrecise Access Complete dataset includes all of these records.