3D Views of Healthcare Locations

Google Maps has just released a fascinating new capability. Their new 3D Area Explorer offers the ability to create immersive, interactive views of any point of interest. Like a 2D map, locations are pinned, and the view can be rotated on various axes to explore the locations. This would be useful in applications like "find a provider" apps that would be able now to show the user around an unfamiliar building or facility compound, making it easier to find their destination and building entrance.

Combined with data from CarePrecise, such as HealthGeo, which contains latitude and longitude for U.S. providers, these clinicians and facilities, or a cluster of them, such as medical offices around a hospital, can be viewed as an interactive 3D map.

Google's new 3D Area Explorer application. 

Using the Google Maps Platform API along with other tools from Google and CarePrecise datasets, such as CarePrecise Platinum extended healthcare provider data, it's possible to visualize information, such as:

• All of one doctor's practice locations and the hospitals they're affiliated with, and to zoom around and identify travel routes
• The locations of all medical facilities, or specific types of facilities, in a city or neighborhood
• All of the practice locations of physicians with particular specialties, or who perform particular procedures
• Locations of physicians who have opted out of Medicare, versus those who accept Medicare

We expect these tools to find uses in identifying areas that are underserved or overserved, offering improved revenue opportunities for providers. Overlaid with POI (Point of Interest) data from other vendors, heat maps can be created to indicate volumes of patients per location.  From retail to investment to insurance, innumerable scenarios scenarios make use of geospatial data. With 3D visualization, these complex data can be better understood and communicated with team members, stakeholders, and consumers.

CCN and PAC ID to NPI: Crosswalk between the NPI Registry and Hospital and Group Records

The federal Centers for Medicare and Medicaid Services (CMS) publishes a wide range of information on U.S. hospitals, which all carry the unique identifier, the CCN number (CMS Certification Number)*. On the other hand (which often seems to not know what its counterpart is doing), CMS also publishes the frequently updated NPPES database (National Plan and Provider Enumeration System), commonly known as the NPI Registry, which uses the NPI number (National Provider Identifier) as its unique identifier. While hospitals and other medical organizations will have only one CCN Number, they are required to have at least one NPI number, and they're permitted to have as many as they like (and they do seem to like quite a few). 

And, between these two ID systems, the CCN and the NPI, ne'er the twain shall meet.

CarePrecise has developed a sophisticated system to "roll up" an organization's NPI-numbered records with its CCN number (and with the PAC ID for practice groups, which stands for "PECOS Associate Control ID"). This mighty trick produces some eye-opening data, such as contact names and titles, license information, specializations, market data added by CarePrecise to NPI records, and the ability to crossmatch groups to their members and hospital affiliations, directly from their NPI numbers. It also permits integration across the complete line of CarePrecise provider data packages, and all of the information that CarePrecise collects or creates and then merges to the NPI records.

Currently, these CarePrecise rollups (or "crosswalks" if you prefer) are the only available such thing in a relatively comprehensive dataset. The full rollup of all medical facility NPI numbers is available for hospitals, and a single "priority" NPI number is currently available for practice groups, with a full rollup of all PAC ID-to-NPI linkages in development with a tentative release date in May 2023.

The hospital CCN-to-NPI crosswalk is part of the Authoritative Hospital Database (APD), and the Group PAC ID-to-NPI link is part of the Authoritative Physician Database (APD) and CarePrecise Platinum.

The "rolling up" is made possible by several CarePrecise innovations, starting with the CoLoCode (co-location code) affixed to almost every provider in the 7 million+ record CarePrecise master reference database. To fill in additional linkages, The CarePrecise HealthGeo geocode dataset, containing latitude and longitude for all 8.5 million+ provider records, which can readily be used to link data between data suppliers for a variety of purposes.

* The CMS Certification Number has replaced the term Medicare Provider Number, Medicare Identification Number or OSCAR Number. The CCN is used to verify Medicare/Medicaid providers for survey and certification, assessment-related activities and communications. Note that CarePrecise includes the old OSCAR Number in its CarePrecise Complete and CarePrecise Advanced/Platinum datasets, if reported by the provider in their NPI record(s) or available through third-parties, but this is a small fraction of records, and the OSCAR numbers have changed, hence the need for a CCN-to-NPI crosswalk.

Physician and Nurse Burnout 2023

Beyond the increased patient loads due to the pandemic, and the increasing number of older Americans, other burnout-igniting factors are significant, if not as easily spotted. Data collection, which relies almost entirely on what clinicians record manually, has doubled in volume in the last decade. The increasing workload has had a dramatic effect on workflow efficiency and accuracy. This has caused both physicians and nurses to experience burnout as they struggle to attend to patient care needs while complying with burdensome regulations.

Many clinicians have had enough, and they're leaving the profession, or taking some time off. This has the effect of causing additional stress in the workplace as duties shift and workloads increase. Stressed administrators, who must deal with the costs and frustrations of staffing open positions, has risen along with frontline burnout. It's a vicious circle.

The causes of burnout

Burnout is a state of severe mental, emotional, and physical exhaustion typically experienced by those working in high stress environments. It can manifest itself due to an increase in workload, insufficient pay for workload, long hours and lack of rest or breaks, taking on an unmanageable patient load, or excessive amounts of mandated paperwork. All these factors can lead to feelings of extreme fatigue, cynicism about the job and its outcomes, and difficulty concentrating on tasks. If left unchecked and unaddressed, burnout can worsen over time and lead to depression or other health issues. Identifying the underlying causes behind burnout is essential in order to find ways of resolving them and reducing the negative externalities associated with this phenomenon.

The effects of burnout on patients and healthcare providers

Burnout among healthcare providers has a cascading effect on patients, leading to missed diagnoses or inadequate care. This is especially relevant in today’s world, where there is often a lack of physicians and significant nurse shortages. These issues can further compound patients’ suffering since they lead to long waits in waiting rooms with longer wait times for appointments. Burnout presents physical and psychological signs that require attention from both patients and healthcare providers; however, without sufficient numbers of providers and funding, burnout will continue to be a problem for the foreseeable future.

Steps that can be taken to prevent or reduce burnout

It's important for medical organizations to recognize these issues and take steps to reduce demands on frontline workers. Ultimately, we must find new ways to strike balance between improved workloads, accurate data usage, and the safety of patients.

To combat the effects of burnout, companies should take proactive measures to reduce stress among employees. Improved workflow can help by ensuring that processes are efficient and simple, so employees don't have to complete unnecessary tasks. Better equipment, such as faster computers with a quick response time can help employees work faster and with more confidence.

If a shorter work week is possible, consider allowing workers to come in for fewer hours, giving them a break from the hectic day-to-day schedule and allowing them to spend more time on leisure activities that can help to reduce overall stress levels. Finally, providing regular breaks throughout the day also helps reset focus and boost energy levels.

Staff up! Medical staffing is an art best practiced with the help of professional staffing companies, and offloading this part of the work can relieve some of the pressure on administrators, who keep their frontline staff informed about the staffing effort. This communication can relieve some of the concerns that the bosses aren't listening.

Coping with the burnout you feel right now

When you're already feeling the toll of burnout, it can be hard to take a step back. Self-care should be the first priority when it comes to handling burnout. Start by talking to your co-workers about how they are dealing with their workloads. Do not hesitate to ask for help and take some extra time for yourself during the day. Schedule some activities outside of work that allow you to re-energize and connect with others like social events or exercise classes. If possible, formally demand better equipment and systems so that everyone can manage their workloads more easily without sacrificing their well-being in the process. Self-care is essential when it comes to coping with burnout before it takes an even stronger hold on your life and job performance.

CarePrecise is interested in hearing from companies whose products or services can help alleviate burnout in the medical profession. Please contact us!

References

• Zhang, J., Grobler, L., & Saayman, A. (2017). Burnout: An Occupational Hazard in the Health Care Sector? Frontiers in Psychology, 8.

• Yirmiya-Rimmerman, N., & Yerushalmi Bar-Lavie, E. (2018). Conditions for preventing burnout among healthcare workers. International Journal of Nursing Studies, 84, 40-50.

• Harrison, C., Lobo, M., & Lambert, T. (2018). Staffing Strategies to Reduce Burnout and Increase Job Satisfaction among Healthcare Professionals: A Review of the Literature. Administration and Policy in Mental Health and Mental Health Services Research, 45(6), 867–876.

• Gill, T., Lippel, K., & Gallagher, D. (2018). Work-Life Balance for Healthcare Professionals: A Systematic Review and Meta-Analysis of Interventions for Burnout Prevention. International Journal of Environmental Research and Public Health, 15(3), 466.

• Nasrin Shokrpour, Leila Bazrafkan,1 and Marzieh Talebi (2021) The relationship between empowerment and job burnout in auxiliary health workers in 2019.

Remarkable U.S. Healthcare Market Growth

The U.S. healthcare market has grown dramatically, and not just as a result of the 2019-2022+ pandemic. Health insurance has grown to a $1.1 trillion market [source: IBISWorld], representing a decade of growth between 2012 and 2021 of 44.7%.

$100b in one year

In just 2021, the hospitals facilities market grew $100 billion, from $1.1 trillion to $1.3trillion. As a result of numerous factors, hospital growth is expected to accelerate through 2030, to over $2 trillion [source: Grand View Research]

More healthcare professionals every month

Despite the reported numbers of front-line healthcare workers leaving the profession due to burn-out and the search for better pay, the number of healthcare providers overall in the U.S. has continued to grow essentially every month since 2005, to more than 7.3 million HIPAA-covered HCP/HCO records currently reported as active in the National Identifier Number registry. 

As the market value has grown, the accuracy of U.S. healthcare data continues to improve. An article explains that several factors are at play in the growth in accuracy of healthcare provider data. These include the migration of solo- and small-practice- practitioners to larger practices, where personnel are in place to assist in maintaining federal records with the most recent information. Another factor is providers' growing savvy about keeping their federal records in sync with the information they report on health insurance claims, with some payers using a mismatch as reason to delay payment of claims.

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.

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.

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.

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.

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.

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).

$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.

Population Healthcare Is Health Reform

Michael Christopher
Chief Chigger, CarePrecise Technology

We have heard many people say that the Affordable Care Act is not health reform, but an attempt at health insurance reform. But a broad shift in the focus and delivery of healthcare has begun, shaped in part by the ACA, and poised to bring significant change to American healthcare. At the heart of that change is population-based healthcare.

"With the Supreme Court upholding the ACA, we all now understand that population healthcare is what we're all going to be doing going forward," says Dr. Steven Davidson, senior vice president and chief medical informatics officer for New York's Maimonides Medical Center in a June 28 Modern Healthcare article. What is "population healthcare," what does it have to do with the Affordable Care Act, and what does it mean to industry vendors?

The term refers to "the ability to assess the health needs of a specific population; implement and evaluate interventions to improve the health of that population; and provide care for individual patients in the context of the culture, health status, and health needs of the populations" according to the Association of American Medical Colleges. Population healthcare is a broadening of focus to see beyond the individual patient to the broad context of that patient's health issues, and to understand the issues of the patient's population to better serve both the individual patient and broader communities of patients.

This perspective becomes ever more critical when cost efficiencies are taken seriously into account, as they must be in an "affordable care" paradigm. In a Tufts Managed Care Institute's white paper on population health, we find

"Population-based care involves a new way of seeing the masses of individuals seeking health care. It is a way of looking at patients not just as individuals but as members of groups with shared health care needs. This approach does not detract from individuality but rather adds another dimension, as individuals benefit from the guidelines developed for the populations to which they belong.* Members with a particular disease must be prioritized so that disease management interventions are targeted toward those members most likely to  cost-effectively benefit.**"

The Affordable Care Act package as it now stands places the emphasis on results, rather than on specific means to obtain results. Despite what has been said by opponents, providers are given wide freedom in achieving improved quality and reach of care, and are provided with new resources, such as advanced electronic health records, paid for in part by the taxpayer. Population healthcare is a strategy for deploying these resources and creative latitudes, in a package of practical tactics and achievable objectives, and at scale.

When viewed through the lens of health reform's quality focus, public health data collection and bringing the technologies that enable collection to every point of care, population healthcare is seen as a key - if not the key - strategy for both implementing the provider side of health reform, and rewiring its financial backbone of health insurance.

* Boland P., editor. Redesigning Heath Care
Delivery. Boland Health Care, Berkeley,
1996. pp. 159-163.
** Zeich R. Patient identification as a key to
population health management. New
Medicine. 1998;2:109-116.

Now We Know: Time to implement the Affordable Care Act

As the Tennessee Medical Association puts it, there is now a "certain finality" to the Affordable Care Act following the Supreme Court decision upholding the law. A huge win for the Obama administration, the decision yesterday was like kicking a hornet's nest among conservatives. The Christian Medical Association said the decision "sounds an alarm across the country to people with faith-based and pro-life convictions" and called on Congress to repeal the law.

An article in Modern Physician characterizes the response among physicians as "mixed," but the vast majority of our MD, DO, PA and RN contacts have come down strongly in favor of the law, in one case saying "The government did something right... 50 million healthier Americans is going to look pretty good here in a few years."

Whichever political side one is on, it is now clear that work can move forward on implementing the law. The Tennessee Medical Association's statement concluded "Today's decision allows us to make more definitive plans regarding reforms to our healthcare system in Tennessee." The sentiment seems to be fairly widespread through the provider side of the industry.

Some states - among them our own Oklahoma - elected to refuse federal funding ($54 million in Oklahoma's case) to establish health insurance exchanges. The decision, taken on the part of Governor Mary Fallin, appears to have been politically motivated, but Oklahoma is, in fact, developing an exchange, without the federal dollars. An agency head, speaking with an Oklahoma radio station, said "It would have been good to have the money, so we could have a more user friendly and effective system, but we'll have something, anyway."

The justices struck down provisions in the law that would empower the federal government to force states to comply with the planned Medicaid expansion or lose all of their Medicaid funding. Now states will be eligible for basic Medicare funding even if they choose not to accept the additional dollars to provide expanded care. Numerous states have sworn to refuse expanded Medicaid funding, but it remains to be seen whether any will ultimately deny this added coverage for hundreds of thousands of their citizens. The federal dollars are being offered with no required match for three years. Medicaid is often one of the biggest lines in states' budgets, and that share is growing as healthcare costs continue to rise.

Medical Data Breaches Unnecessary

The problem of breaches involving healthcare data is getting worse, not better. As more medical information is stored electronically, the risk of unauthorized access grows. But a significant portion of the risk could be reduced to near zero if the primary users of the data - practitioners, healthcare information technology staff and contractors, administrative staff - would take one simple step. One simple and completely free step. Really; it costs nothing, and places nearly zero burden on the user.

We made this same recommendation about six years ago, when reports of stolen laptops first began coming in. But it seems as though no one in the industry has applied our simple fix. In January of 2012, a contractor copied the records of 34,000 patients of Howard University Hospital, containing SSNs, birthdates, and diagnosis-related information, onto a laptop. The data was not encrypted; the laptop, of course, was stolen from the contractor's car. This same scenario has been reported numerous times. Data, laptop, car, repeat.

Last month, federal prosecutors charged a worker at the same hospital with selling hospital data. She's set for a plea hearing on June 12. Clearly, this is a different situation, and would not have been mitigated by encrypting the data, since the worker was entrusted with full access. But you can be sure that Howard University Hospital wishes that the stolen laptop had not preceded this incident. Patients and regulators are rightly outraged.

Simply put, had the data been stored on an encrypted drive partition on those laptops, it would have been safe from prying eyes. How difficult is it to do that? If a free, open source program like TrueCrypt is installed on the computer, it's as easy as typing in a password to open the protected drive, copying the data onto it, and using the data just as though it were on any ordinary drive. After so many minutes of idleness, or when the computer sleeps, hibernates or is shut down, the program can be set to close the protected drive, rendering its contents completely unusable until the password is given again.

Along with encryption, passwords must be strong, which means hard to guess. But they don't have to be hard to remember and type. A good rule is to have 20 or more characters, but a simple phrase can be easy to remember. Stop thinking pass word, and think pass phrase instead. Here's an extremely strong password: Theylike2bheld/theseKitties ("they like to be held, these kitties"). Easy to remember and type, but it has upper and lower case letters, a numeral and a punctuation character, and totals 27 characters in all. That's one strong password. It works in TrueCrypt and virtually all other encryption programs. And it even has kittens!

Some encryption software, including TrueCrypt, offer an additional important feature.  Let's say you are carrying extremely valuable data, being mugged, and are forced to enter your password to start the computer. Let's go so far as to say that the mugger is savvy enough to search the computer for an encrypted file, and finds it. TrueCrypt actually lets you use a different password when you mount the protected drive, which opens a phony data trove on which you've stored some bogus data. Plausible deniability saves you and your data.

There is simply no reason not to require all staff members and contractors to use encryption for all medical and other personal data. Essentially zero ownership cost, and it doesn't slow anybody down. No excuses.

Encryption and strong passwords. Take these two pills and sleep better tonight.

TrueCrypt is a free open source project, available at http://www.truecrypt.org/

ICD-10 Selling Coding Systems

Are those coders in the basement about to see their pink slips? Maybe so, within the coming two years, as roughly half of inpatient providers say they expect to buy automated coding solutions over the next one to two years.

According to a new report released by KLAS Research, many healthcare providers are seriously considering purchases of inpatient computer-assisted coding (CAC) systems during the coming 24 months, despite the ICD-10 deadline delay to a recently proposed date of October 1, 2014.

Providers say that encoder/grouper integration is particularly important. 73% of providers reported that they are considering 3M, which currently holds a 50% market share and three quarters of the inpatient encoder market.  OptumInsight and Dolbey have also generated strong interest among providers.

Interest in CAC is being driven by concerns about the productivity impact that ICD-10 will have on providers' practices in both outpatient and inpatient settings. The transition to ICD-10 cranks up the number of diagnostic codes to 68,000 from 13,000 in the ICD-9 code set. Codes for inpatient procedures will shoot from 11,000 to 87,000 codes.

Hospital Spending To Grow

A new survey conducted by L.E.K. Consulting indicates a predicted rise in spending and aggressive supplier negotiations by hospitals during 2012. The study, which surveyed 200+ hospital executives, found that 61% expect budgets to grow through the year, in such areas as healthcare I.T. (57%), facilities and major medical devices (35%), and many expect growth in infection-fighting disposables. In fact, budgets are expected to rise through the coming five year period.

But the study also revealed that hospitals can be expected to drive ever harder bargains for their purchasing. Eighty percent stated that they will continue or step up pressure on suppliers to cut costs, while the number that anticipate greater use of purchasing organizations grew from 52% to 62% over last year.

The investigators cited the Affordable Care Act as a driver for the increase in hospital spending. CarePrecise healthcare provider data contains 31,270 hospital records as of February 29, 2012, representing 5,755 hospitals with 942,000 beds and total 2011 expenditures of $751 billion.

Health IT Talent at a Premium, or Take 2 Aspirin and Call Me a Headhunter

It's hardly news that the pool of qualified healthcare information technology professionals is drying up as providers and vendors race to meet tech deadlines associated with federal HIT funding programs. For HIT folk like us, this rocks! Except, of course, when we're trying to flesh out project staff and we learn that the talent is beginning to know what it's worth.

At stake is the $25 billion allocated in 2009 by the American Recovery and Reinvestment Act for EHR and other health IT outlays. Providers can be compensated for costs if they jump through the hoops by certain dates, with several important deadlines coming through the next several months. July 3 is the last day for hospitals to begin the 90-day reporting period in which they must demonstrate Meaningful Use for the Medicare EHR incentive program for federal FY 2011.

Oct. 3, 2011 is the last day for physicians to begin their Meaningful Use reporting period for EHR, and November 30 the curtain drops on general and critical access hospitals registering for payments. And that's just a handful of the headaches.

In addition to all of this activity, ICD-10 and 5010 implementations are also looming. If you're in HIT and you haven't asked for a raise, as my daddy used to say, "What's wrong, cat got your tongue?" (Apologies to our CIO friends.)

New Way to Market to Healthcare Providers

The international PR firm Ogilvy has just released a study prescribing a shift in healthcare marketing from the exploitation of clinical breakthroughs to something Ogilvy calls "sustainability." They're not talking about the sort of sustainability we in healthcare usually mean, such as the sustainability of a health information exchange's business model. Instead, they're suggesting that we start selling green.

Companies with strong environmental competencies will rule the market in the coming years, say the investigators, Jeff Chertack and Monique da Silva. In an op-ed by Chertack, he says that "[the new] value will be delivered by new healthcare products and delivery systems that help society adapt to and thrive in changing climate and disease patterns."

CarePrecise Technology made a move in the past year toward eliminating a large part of its carbon footprint by shifting even our largest file deliveries from physical (DVD disks) to virtual. All new product sales are now 100% virtual, and as subscribers renew, their deliveries will be virtual as well. Not only has the shift reduced fuel and materials consumption, but products are now delivered in less than half the time. In a business where the freshness of data is crucial, every hour counts. CarePrecise's NPI directory unit, NPIdentify, has produced state NPI directories in electronic form only since 2007.

CarePrecise's data center is a shared environment, utilizing hyper-efficient cloud computing resources. Except for certain mission-critical operations performed on in-building platforms, all front-end operations and many back-office computing tasks have been moved to the cloud, dramatically reducing office space utilization and fuel consumption.

Whether the healthcare industry in specific, and the broader business community in general, will effectively turn environmental competencies into profits is still an open question. Certainly, entities like hospitals make huge impacts and consume enormous resources (think about all those disposables and all those sheets washed after 30 minutes of use, pillows, trays and pitchers discarded after each patient...), and spectacular improvements could be made. Vendors who help these organizations green up are offering a new way to compete for patients. The competitive advantage offered by corporate carbon consciousness could be tomorrow's marketing edge for providers and their vendors.

Flaw in CMS Logic Causes Cost

When the NPI Final Rule (and all of its after-final rules) created the National Plan and Provider Enumeration System, there were many unknowns: Which datapoints would be released for the industry to use? loomed large. But another issue has come home to roost.

Organizations (Type 2 providers under the rule) were permitted to have as many NPI numbers as they liked, and they could structure their assignment of NPIs any which way. For instance, one hospital might get separate NPI numbers for each of its business units, while another got and NPI for each of its physical locations, another for each of the cluster of corporations, while some clever hospitals got an NPI for each reimbursement channel. And then of course, some hospitals got just one.

No problem with that -- the various business optimization strategies are interesting to observe, and surely make sense in their various contexts. The problem is that there is no primary NPI number per hospital or health system. That is to say, there is no way to know from the NPPES records which if any of the NPI records is a parent, and which is a child. Oh, of course, an army of human analysts can pore over the records and find 37 hospital NPI records each identifying, say, Mayonaise Health System as its parent. But a computer finds that task a bit difficult, since it will find many variations in the records, e.g.,

• Mayonaise Hospital
• Mayonaise Health System
• Mayo Hospital
• Mayo Hospitals
• Mayonaise Hospitals
• Miracle Whip Health
• and on an on

Thus, it becomes essentially impossible to say how many hospitals there are, even though we are looking at the complete set of federal records on hospitals. Had there been a primary or master NPI required for each General acute care hospital -- regardless of how many business units and other NPIs are involved, it would be possible to perform much more significant research on hospital service areas, densities, availability of care, duplication of services, and much more. (We've just started putting state-by-state physician and hospital counts on our home page at CarePrecise.com, but for now, we are able only to show the total of all hospital records -- 29,946 at present -- which is far more than the roughly 5,000 actual hospitals to whom all those records belong.)

The coyness built into the NPPES was more or less deliberate. American hospitals are a contentious lot, engaging in constant competition, and they did not want any more known about them than absolutely necessary. Coy data costs everyone money, and adds opacity to the healthcare system. Still, with the HospitalCompare project and our subsequent mining of all of these data sources, much can be learned, and the reach of each hospital organization can ultimately be published. Stay tuned.

New Hospital Admin Education Website

Hannah Anderson's goal was to compile an unbiased and updated list of every school that offers a hospital administration degree in the US.  She felt that the existing lists were not comprehensive, easy to find, and many websites have outdated information and links. www.HospitalAdministration.org is a valuable new resource for hospital administration students, and for seasoned administrators when we're asked to make recommendations. All the schools are listed on the front page and lead directly to each program, and can be viewed state-by-state. Thanks, Hannah!