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.

August 10, 2013

Physician Payment Data Is Coming

A Friday article in Modern Physician states that, despite vigorous protests from physician organizations against releasing physician-specific data on Medicare payments, "the dike appears to be crumbling."

Public release of payment information has been prohibited by a 1979 court injunction. But on March 31 the injunction was vacated by U.S. District Judge Marcia Morales Howard, and the way is now legally clear to release doctors' payment data. The challenge now is to settle on a method of dissemination that protects patient privacy.

CMS also plans to release physician quality data soon, as required by law - another action opposed by physician groups. In July, CarePrecise released new components that link the CarePrecise Access Complete U.S. healthcare provider database directly to the forthcoming physician payment and quality data, to facilitate value computation, healthcare delivery research, consumer advocacy and other applications. Hospital quality data is also linked through the new components, which comprise the Extended Professional, Group and Hospital (EPGH) dataset, including relational key crosswalks between all of the relevant datasets. CarePrecise specializes in bringing healthcare provider data from multiple silos together into a single dataset, and is the only source for these combined data at the present time.

July 31, 2013

Sunshine Thursday Morning

Open Payments, also known as the "Sunshine Act," relationship-data-collecting-period starts August 1, 2013, bright and early. Some of our customers are using CarePrecise data as the basis for the physician database underlying their Open Payments tracking process.

Starting August 1, manufacturers and suppliers have to start tracking payments and other transfers of value made to physicians and teaching hospitals, an certain ownership or investment interests held by physicians or their family members. Names, dates, values and other data must be captured, and will be required to be submitted to Centers for Medicare and Medicaid Services in early 2014. Submission files specifications are available for review.

July 25, 2013

Two New Beta Provider Data Releases

This summer has seen one spectacular new release of healthcare provider data from CarePrecise already, and a second is on the way. The first one, released just a week ago, is already finding its way into EMR pre-population, new web apps, OpenPayments and HIE applications.

The Extended Professional, Group & Hospital(TM) dataset extends CarePrecise's flagship master database, CarePrecise Access Complete (CPAC), with verified group practice data for physicians and other providers, their hospital affiliations, medical schools and graduation years. The EPGH's Extended Hospital table provides an unduplicated list of all U.S. acute care, VA, children's and critical access hospitals that bill Medicare (essentially all of these hospital types bill Medicare, so this list is nearly complete; link it to hospital data in the CPAC, and you've got everything -- a more complete, up-to-date and verified database of physicians than the American Medical Association's list at a small fraction of the cost... plus more than 3 million other healthcare providers not included in the AMA data.

The EPGH has only been released in beta so far, and in beta it is being distributed to all current CPAC subscribers free of charge through September 2013. The EPGH/CPAC bundle is the only commercially available merged database of NPPES, LEIE, PECOS, PhysicianCompare and HospitalCompare data, and it contains all of the "hooks" necessary to link to CMS hospital quality data and forthcoming physician quality data.

Coming next is the beta release of CP ProCase(TM), a proper-case version of the name, mailing address and practice address in CPAC, for all approximately 4 million records. Using CPAC data for marketing and other communications will be easier and more professional looking. As with the EPGH dataset, the ProCase add-on will be available bundled with CPAC, and not separately.

Planned beta release of CP ProCase will coincide with the August 2013 CPAC update release. As with EPGH, ProCase will be distributed as a free beta for evaluation to all current CPAC subscribers. (Betas are not available on single download purchasers.)

And, as if that weren't enough, our popular software, CP ListMaker, is undergoing a rebuild to add EPGH functionality. (Proper casing is already a feature of CP ListMaker.) The new version -- 4.01 -- will sport new output queries that include the new extended data linked to list outputs, completely configurable to use the new information. Release date for CP ListMaker v4.01 is scheduled to coincide with the August CPAC data release.

Questions about the new products? Call your CarePrecise sales representative at (877) 782-2294.

July 19, 2013

New data on Physicians, Groups and Hospitals

We are delighted to announce that our new Extended Physician, Group and Hospital (EPGH) dataset is in beta release, and is available for CarePrecise subscribers to download. The new data adds rich physician information, including verified hospital and group affiliations and education data, to the popular CarePrecise Access Complete database of U.S. healthcare providers.

Practice groups and hospitals, as well as physicians and other professionals are all inter-linked within the vast relational database representing nearly 4 million healthcare providers in all. But the data is made accessible by CarePrecise's unique compression and record-linkage processing, so that it can be used in popular desktop database software, such as Microsoft Access and FileMaker.

The combined CPAC/EPGH database offers a 360-degree view of U.S. healthcare providers' data, and assimilates in a single database the information contained in the federal NPI database (NPPES), the Medicare database (PECOS), the federal excluded provider database (LEIE), Hospital Compare and Physician Compare databases. It is the only comprehensive source of this data in a single database environment, and it can be used on ordinary laptop and desktop computers with ordinary office database software.

The new EPGH dataset is not available separately, but as an add-on to the CarePrecise Access Complete (CPAC) database of all HIPAA-covered U.S. healthcare providers. Currently in beta release, the EPGH add-on is now available only to current quarterly and monthly subscribers to the CPAC product, pending the full release scheduled for this fall.

To review the fields in the new dataset, see the field list table on the CarePrecise Access Complete documentation page. Standard pricing of CarePrecise data products provides a single-user license; multi-user licenses and derivative product (limited publication) licenses are also available. Contact CarePrecise Sales at (877) 782-2294.

June 20, 2013

Doctors: Will Patients Misread Sunshine Info?

The Centers for Medicare and Medicaid Services (CMS) is reassuring physicians about Physician Payment Sunshine Act reporting, saying that reporting efforts involving connections between physicians and vendors will fall largely on the shoulders of the vendors, rather than on physicians. But that's not the only issue that worries docs. Once the Sunshine data becomes public, they are concerned that it may be incorrectly interpreted by consumers and the media, leading to unwarranted witch hunts. At the AMA's House of Delegates meeting in Chicago, pediatrician Lynda Young said "The media can really sensationalize this," worrying that when information goes public, "the media jumps on it."

The Sunshine Act (Section 6002 of the Patient Protection and Affordable Care Act) is being rebranded by CMS as the "Open Payment Program," according to a June 20 article in Modern Healthcare. Quoting Dr. Shantanu Agrawal, director of the CMS data-sharing and partnership group, the agency wants to create a national transparency program for payments to physicians and teaching hospitals by drug and medical-device manufacturers and group purchasing organizations. According to Agrawal, pharmaceutical companies spent $15.7 billion in 2011 on face-to-face sales and promotional activities. But companies like Pfizer and GlaxoSmithKline have reported reductions in spending to attract doctors.

The law kicks in August 1, requiring drug and device companies to start tracking transfers of anything valued at more than $10. Physicians will be able to see what has been reported about them in the second quarter of 2014, and reports will become public on Septenver 30 of that year.

CarePrecise.com supplies accurate physician databases used by drug and device manufacturers in their Sunshine Act tracking programs.

May 21, 2013

Health Information Exchange Saves Moore Hospital Records

"Worst tornado in history" devastates
Moore, OK, Moore Medical Center,
and two elementary schools.
The "worst tornado in world history" tore the roof off of Moore Medical Center in Moore, Oklahoma on May 20, 2013, visiting horrific damage on life and property, but medical records were essentially undamaged. MMC is a member of their local RHIO, SMRTnet. The Regional Healthcare Information Organization (RHIO, or HIE if you prefer), saves a backup of essentially the hospital's complete medical records database.

SMRTnet performs these services for 26 hospitals, 99 clinics, and many more individual providers. 1,400 registered provider users' data represents approximately 2.4 million patient records.

This is a far cry from the 2005 devastation in New Orleans by Hurricane Katrina, where waterlogged hospital medical records were sent blowing around the streets, or were pinned to patients' chests; with the exception of the VA hospital, where electronic records were preserved.

Moore Medical Center is located about two and a half hours southwest of Tulsa, Oklahoma, home of CarePrecise Technology.

Healthcare IT Spending Optimism

As federal support for EHR implementation ebbs, other HIT projects are crowding in to keep spending strong. Aging financial management systems will need to be replaced as pay-for-performance ramps up as a result of the Patient Protection and Affordable Care Act. The mandated switch to the ICD-10 diagnostic and procedural code set, requiring updates in IT systems, as well as more advanced coding systems to handle the vastly increased code granularity, not to mention the new technical complexities felt by state Medicaids and CMS itself, is already making good business for firms like Cognosante, a brain trust of some of the most talented healthcare IT people in the country.

BCC Research recently predicted that total spending on clinical health IT would soar to $26.1 billion a year in five years, up from $9.5 billion in 2011 and $11.2 billion in 2012. CarePrecise builds provider databases targeting various applications within the healthcare industry, including EHR, HIE, HIX and Sunshine Law (Open Payments) applications.

Joseph Conn has an excellent article in Modern Healthcare will more details.

Free Webinar on Sunshine Law

The federal National Physician Payment Transparency Program, variously know as NPPTP, Open Payments, and Sunshine Law, requires collection of information by the healthcare industry as of August 1, 2013. Getting ready for that yet? How about some help?

A free webinar is being offered by the Centers for Medicare and Medicaid Services (CMS) on Wednesday, May 22, 2013 titled "National Provider Call: National Physician Payment Transparency Program (OPEN PAYMENTS) - What You Need To Know."

Topics include:

  • Overview of final rule
  • Review key program dates
  • Your role
  • Resources available to you

Speakers will be Dr. Shantanu Agrawal, Director, Data Sharing & Partnership Group, and Anita Griner, Deputy Director, Data Sharing & Partnership Group.

February 11, 2013

Healthcare Fraud Recovery $4.2B for 2012

Attorney General Eric Holder and HHS Secretary Kathleen Sebelius released a report today indicating that for every $1 spent on healthcare fraud and abuse recovery, $7.90 has been returned to the treasury over the past three years. With the Obama administration making recovery a top priority, this is the highest level of return in the 16-year history of the program.

Health Care Fraud Prevention and Enforcement Action Team (HEAT) was created in 2009 to reduce fraud, waste and abuse in the Medicare and Medicaid programs and to crack down on individuals and organizations that are bleeding the system. Last year, the Justice Department opened 1,131 new criminal fraud investigations involving as many as 2,148 defendants. Convictions have been achieved on 826 defendants in fraud-related crimes during the year. In the same year, the department opened 885 new civil investigations.

In 2012, CMS began screening all 1.5 million Medicare-enrolled providers through the new Automated Provider Screening system. APS fingers ineligible and potentially fraudulent providers and suppliers prior to enrollment or revalidation. Nearly 150,000 ineligible providers have been eliminated from Medicare’s billing system so far. 

CarePrecise's standard database of healthcare providers includes a field that indicates providers who may still be active, but have been added to the federal List of Excluded Individuals and Entities, tying excluded providers to their NPI numbers.

February 8, 2013

Exchange and Medicaid IT Contract Tracker

State Refor(u)m has created a chart that tracks states' choices of firms to build health insurance exchanges and Medicaid systems, with details on technical roles performed by vendors and on some of the software components vendors will use. The chart was produced by the Office of Health Policy and Technology at the University of Massachusetts Medical School. States can help State Refor(u)m keep the tool updated by using the page's comments section to post information about similar contracts awarded in their states.

CarePrecise provides healthcare provider information to state insurance exchanges, health information exchanges, Sunshine Act programs, healthcare fraud investigations and other state and federal healthcare projects.

Visit the Exchange and Medicaid Systems Contracts Chart to see who's doing what on whose project, and to add your own.

CarePrecise is a sponsor of Big Data for Healthcare Forum, April 29 - May 1, 2013. Join us there!

February 1, 2013

15 Types of Medical Billing Fraud & Abuse

Estimates of U.S. medical fraud and abuse go as high as $80 billion. It contributes significantly to rising healthcare and insurance costs.  The complexity and fragmentation of the American healthcare billing landscape is frequently a culprit makes fraud and abuse easier to commit and more difficult to detect.

One of our long-time clients, PayerFusion, has just published an article on its blog highlighting fifteen different forms of fraud and abuse, including upcoding, cloning, phantom billing, and a dozen more. Read the article for useful and timely information on this important subject.

CarePrecise provides software, data and services employed by law enforcement, including the Federal Bureau of Investigation, in ongoing investigations. To report fraud or abuse, go to http://oig.hhs.gov/fraud/hotline/
CarePrecise encourages you to attend the Big Data for Healthcare Forum, April 29 - May 1, 2013.

Data Security: An Online Hacking Primer

Medical records security has been rising to the top of mind among the healthcare IT community. As HIPAA now has some teeth and has been extended to contractors, it is wise to remember that three in four Americans have fallen or will fall victim to cyber crime as a result of having been hacked. Among the systems that have infamously leaked personal information are those of universities and hospitals. The following infographic offers an overview of the personal information leakage going on out there. Thanks, Allison!

Infographic courtesy OnlineCollegeCourses.com.
CarePrecise encourages you to attend the Big Data for Healthcare Forum, April 29 - May 1, 2013.

January 31, 2013

Patients Resist Digital Doctoring

Modern Physician reports that "The pull-down menus, alerts and point-of-care information contained in computerized clinical decision-support systems [CDSS] can distract physicians from their face-to-face encounters and leave patients feeling ignored and dissatisfied with their care." This comes from a study at the University of Missouri at Columbia that evaluated patient perceptions of doctors using digital diagnostic tools.

"Get over it!" is the first thing that comes to mind. Would you begrudge your mechanic hooking up your car to the diagnostic computer and scrutinizing the bars and gauges and charts on the screen? The physician has to use tools, just like everyone else, to achieve peak performance in treating patients. Personally, I'd rather see the back of his head researching my complaint to take advantage of every inspiration and precaution, than to look at a smiling face telling me "Shucks, I don't know, let's try some drugs!"

The time has come for us as patients to embrace the new technology, just as we insist that our doctors do the best job possible in our behalf, and to get used to some changes in the doctor-patient relationship.

January 18, 2013

Surprise: You May Now Be Liable Under HIPAA

When the HIPAA privacy rule first went into effect, business associates of hospitals, physicians, etc. didn't have to worry about getting in trouble for releasing data in ways that violate patients' privacy.

No more.

In light of several years of clumsy handling of patient data by contractors and employees, it's perhaps not surprising that HHS is changing the rules to extend the strict HIPAA privacy rules -- and penalties for violations -- to external vendors and IT communities.

If you work in any way with patients' medical data -- whether as a data processor, consultant, IT contractor, EHR installer, whatever -- you'd better get familiar with the new rule that goes into effect March 26. It clarifies when breaches need to be reported to the Office for Civil Rights, scraps the old standards for the use of patient-identifiable data for marketing and fundraising purposes, and expands direct liability under the law to so-called “business associates” of HIPAA-covered entities.

Perhaps equally interesting is that patients once again will have the right to limit release of treatment records to insurance companies if they paid out-of-pocket on that treatment. Look out for problems and potential fines related to goof-ups related to granting access to the wrong business partners on the wrong data. Greatly increased penalties for privacy and security violations under the ARRA are explained in the new ruling.

Read the HHS news release.
Read the rule in the federal register (you've still got time to comment).

January 9, 2013

$1.25 Billion in December EHR Incentives

The Centers for Medicare and Medicaid Services announced that a record $1.25 billion was paid in December to hospitals, physicians and other professionals in electronic health-record (EHR) incentive payments. The program awards healthcare providers for adopting electronic health records systems.

The December pay out is three times the size of the previous largest one-month awards total. Medicare and Medicaid awarded $255 million to physicians and other professionals, and $1 billion to hospitals. So far, EHR incentive programs have paid out $10.3 billion to improve the quality of US healthcare information technology, which for decades has lagged behind other industries.