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.

Artificial Intelligence In Healthcare

The healthcare industry is on the brink of major transformation, thanks to healthcare-related advances in artificial intelligence. Healthcare organizations around the world, and governments, are beginning to integrate AI into their systems and processes. With AI, healthcare providers are able to improve medical diagnostics accuracy and automate administrative tasks, while improving patient care. In this blog post, we will explore how healthcare will change and the potential impact of AI on healthcare.

Advances in Medical Diagnostics

AI has the potential to revolutionize healthcare by greatly improving medical diagnostics accuracy. AI-powered tools are being used to help healthcare professionals diagnose diseases more quickly and accurately, as well as identify healthcare trends that may have previously gone unnoticed. Furthermore, AI technology can be used to monitor patient vitals in real time and detect early warning signs of disease.

Automation of Administrative Processes

The healthcare industry is full of administrative tasks that take up a considerable amount of time and resources, from filing paperwork to scheduling appointments and managing patient records. AI can automate these processes in ways that may not occur to human workers, to free up the humans to provide more focused care on the most complex cases. AI can also provide healthcare organizations with better insights into patient care and help healthcare professionals make more informed decisions.

Improved Patient Care

AI has the potential to drastically improve healthcare outcomes by providing healthcare professionals with improved data about patients, allowing them to take preemptive action or provide targeted healthcare services. AI can also be used to track healthcare trends and identify areas where healthcare quality measures could be improved.

Improved Clinician Workplaces and Opportunities

Physician offices can be made far more efficient with AI in the picture. HCC risk management is one area where AI can be used to find missed opportunities, and to strengthen Medicare reimbursement profiles. AI can often see what humans can't, either because some details just are not apparent, or because clinicians and admin personnel are overburdened with just getting through the day. In the constant struggle to keep patients as the top priority over paperwork, AI-driven systems from companies like Hindsait and MDOps can take on a share of the workload.

Caveats

From the patient's perspective, will AI depersonalize medical services? If workflow streamlining cuts the wrong corners, who will suffer? Artificial intelligence, by its very nature, is a "black box." In many cases, advanced AI is very much like a person, in that it can be difficult or impossible to understand how its "thinking" works. AI needs to develop better "talk back" capability, so that human users can interrogate the system to correct errors - to ask how it is arriving at a given conclusion, and then to correct its "thinking," much as you would reshape a human employee's perceptions to obtain the most desirable outcomes. At present, such capabilities are not present, or are not being adequately utilized by the system's handlers in some environments. Busy practitioners haven't yet "merged" with these systems such that deliberate feedback is part of the clinical workflow. This will take time, and probably a few high profile mistakes. Progress here is a bit like the early progress of the medical profession. We're just now emerging from the blood-letting phase of AI, and we must hone strategies for better control of the new tools.

As HCOs begin to adopt AI-powered tools, healthcare processes, patient care and healthcare outcomes are set to improve significantly. AI will allow practitioners to diagnose diseases more accurately, automate administrative tasks, and gain insights into healthcare trends, enabling them to provide more informed and targeted care to their patients. At the end of the day, AI has the potential to revolutionize healthcare and significantly improve patient outcomes, while the cost of progress is bound to include some failure. All stakeholders, from patients to health systems to government, need to be informed as AI involvement increases, and become girded for the journey.

Why Do Some Physicians Dread Reading Their Email?

Imagine that you’re a somewhat to severely stressed-out doctor. Now you open your email program and you see this message: “I hope and expect that you will spend eternity in he**. You are an abusive, nasty, cheap person.” Now imagine that this happens a lot, relatively speaking; roughly 1 in every 20 email messages from patients are negative.

According to a new study from Journal of the American Medical Association (JAMA), 3% of messages received from patients were unflattering at best, and many contained words of violent or hostile intent. “F**k” was the most frequently used expletive, but words like “shoot” and “kill” were frequently used. 609 physicians responded to the survey, roughly equally split between women and men.

The study included examples of ugly wording, such as “What a disappointment in your office and the bullsh*t I was told. I’ll be switching plans because this is sh*t!”

CarePrecise has noted recent tightening of spam filters in physician group email systems, and we have identified one of the reasons as resulting from unprecedented pandemic-related spam from PPE hawkers. The pandemic has ratcheted up stress levels for people from all walks of like; none more than physicians and other clinicians. The study’s researchers suggested that “Health systems should be proactive in ensuring that the inbasket does not become a venue for physician abuse and cyberbullying. Posting reminders in EHR patient portals to use kind language when sending messages, applying filters for expletives or threatening words…” We can expect many providers’ walls to be raised just a bit higher if high levels of abuse from patients continues.

Physician Quality Grading for Consumers

Update March 2023: Physician Compare data is available as part of a rich physician database compiled from Physician Compare and numerous other sources. All reported physician/facility affiliations are included, with more than 50,000 medical facilities covered. 

Columbia University Medical Center has just this week [week of 4/12/2016] 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 Authoritative Physician Database™, as it currently does with its product The Authoritative Hospital database™. CarePrecise is a leading supplier of healthcare provider data used in consumer-facing web and mobile applications, through special licensing arrangements.

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.

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.

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.

$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.

Hurry Up, Sunshine

Senators Chuck Grassly (R-IA) and Herb Kohl (D-WI), authors of the Physician Payments Sunshine Act, are pushing for CMS to get its final implementation rule out the door. Once the rule is published, the process of collecting data on financial transactions between doctors and industry vendors can start. Six months after CMS missed the October 1, 2011 statutory deadline, the senators expressed their displeasure with the agency's slow movement.

After missing the implementation date, CMS again missed a March 31, 2012 start date for the 1,150+ drug, device, biologics and medical supplies manufacturers to report all "transfers of value" given to physicians and teaching hospitals.

The Sunshine Act, as it is nicknamed, is designed to bring transparency to physician interactions with revenue sources that may unduly influence decisions regarding patient care. While such sources as manufacturers' payments for research are vital to healthcare technology development, patients should know when (and what for) large sums of money are attached to their doctors' treatment decisions.

Proposed implementation, published December 19, is available online.

5,000th Application Milestone

In April, 2012, CarePrecise will celebrate having built and released our 5,000th database application and version release! Actually, we will have released 5,049 (and maybe more) separate software applications, including state-by-state NPIdentify Desktop apps, CarePrecise Access sets, customized CarePrecise Select sets, CP ListMaker version upgrades, custom applications, and specialized MEDICAlistings marketing lists. In all, we will have distributed software and datasets representing nearly a terabyte of data and code since 2008. We're a privately held company and we don't release financials or our exact number of users, but we can say that it's between 500 and 1,000. And we love every single one!

Five Steps to EHR: A .Gov Primer

Now that electronic health record software is a virtual necessity for a productive practice, HealthIT.gov offers a common-sensical five-step plan for implementing EHR in a practice. A number of years ago, we worked with the national Blue Cross and Blue Shield Association to create a case-based analysis of the EHR scenario. That publication outlined the efforts of many practices to incorporate EHR into multi-physician practcies. Check out the current wisdom at HealthIT.gov.

Phone Messaging: New Channel to Physicians

It's wildly hit-and-miss -- much like email spam -- but marketers are increasingly using bulk text messaging to penetrate the armor cladding of physician offices. And it's a wide open opportunity; physician office phone numbers are openly published, unlike email addresses. Fax numbers are available too (CarePrecise provider data includes both phone and fax numbers, up to four numbers per record, and we know that it is widely used for marketing to physicians), but "faxpam" doesn't have the same high-tech glamor. Unlike a fax broadcast, text messaging allows marketers to embed a live link to a web landing page, as well as an instantly accessible means for recipients to opt out, making bulk SMS marketing just a little bit more respectable. (Ever tried to get a faxpammer to stop? Ha!)

So what's the difference between bulk SMS cold-calling and plain old spam? Not much, except that it's newer and less fraught with sleaze. And here's something more: It's not free, so spammers can't just set up a computer and start sending 100 million spam messages a day at essentially no cost. Text messaging to phones requires that you have an SMS gateway, or an account with a service provider who has one. These are available to bulk senders, but at a price. Okay, it's not exactly postage, but it's at least a price.

Among the numerous offerings for bulk SMS gateway and software services are Mobomix and TXTwire. Both offer essentially unlimited sending with premium accounts, but both enforce opt-in requirements. That is, you can't just upload a database of phone numbers, such as the 5 million or so in the CarePrecise database, and start texting. Instead, these services require that you are sending only to your own customers or others who have explicitly said, "Yeah, okay, text me spam."

Of course, there's always a workaround. Another company, SMScountry, offers an Excel plug in that lets you send personalized text messages. While they have a similar anti-spam policy, the way the system works would make it difficult to police. As with all bulk SMS systems, it isn't particularly easy for a recipient to contact the carrier to complain. The carrier backbone for SMS is a bit primitive compared with that of email, and there are fewer hooks for filtering messages by the carriers, should they ever want to do what ISPs are doing about email spam. It's pretty much up to the owner of the gateway.

In the war between marketers and physicians, both sides escalate as new weapons or defenses arise. A fax isn't likely to ever see a doctor's spectacles, but that same unreachable physician isn't really that unreachable if you can get his email address or phone number. Naturally, it helps to have her mobile number rather than just the office phone, for obvious reasons. But if you've got a product to sell to docs, any opening is a huge gaping hole, and, even if the text message gets converted to a computer-voiced voice mail message, and, even if only the smallest percentage reach a bona fide phyz, maybe paying $60 a month for a bulk gateway account with few limits sounds good to you. And a good many of those published numbers are cell phones, some portion of them presumably reaching right into a doctor's pocket.

Bulk SMS has its Whitehat side, of course. Services that allow you to enter your customers' account info and send text billing notices, patient appointment reminders, among a host of other applications, are opening up the commercial use of phone messaging. I opted in for a J.C. Penney's coupon texting service, and I use it.

But let's say you've got a nice big customer list, folks who freely gave you their phone numbers (long before the advent of SMSpam, but still...). Can you send em all a coupon, or a new product announcement, or an offer of a free EHR assessment? I want to say no, but we send these same customers more-or-less "unsolicited" email, at least in the sense that they never explicitely said "Send me your coupons," but something more like "Send me product update notices via your monthly newsletter." That phone number was optional, right? Houston, we have achieved opt-in.

Certain advantages of smartphones, such as the ability to blacklist messagers, are a helpful control. The barriers to entry are currently very high for an SMSpammer who wants to set up his own unrestricted gateway, so he'll be using these third party services and, perhaps, have to behave himself. But look for text marketing to grow wildly in the near future.

Check out our page on Marketing to Healthcare Providers.

Nifty Licensing Agency Contact Resource

Want to know who the various healthcare provider licensing entities are for a given state? Palmetto GBA has made that a piece of cake now. Their new database of licensing requirements (primarily for use by DME suppliers) includes the licensing bodies for each state. For example, here's what they show for New York:

1)	New York State Board of Pharmacy Phone: 518-474-3817 extension 130 extension 130 Web: http://www.op.nysed.gov/prof/pharm/ - Registered Pharmacy Establishment Certificate
2)	New York State Board of Pharmacy, Office of the Professions Phone: 518-474-3817 extension 250 extension 250 Web: http://www.op.nysed.gov/prof/od/ - Ophthalmic Dispenser License
3)	New York State Board of Respiratory Therapy Phone: 518-474-3817 extension 120 extension 120 Web: http://www.op.nysed.gov/prof/rt/ - Respiratory Therapist
4)	New York State Education Department, Office of the Professions Phone: 518-474-3817 extension 591 extension 591 Web: http://www.op.nysed.gov/prof/ - Optometrist License - Physician License
5)	New York Department of Health Phone: 518-402-1016 Web: http://www.nyhealth.gov/ - Ambulatory Surgical Center - Home Health License - Hospital License - Nursing Home Administrator License - Nursing Home License

Another table shows the type of provider with a link to the number (as listed above), and still another nifty feature lets you choose a healthcare product or service from a dropdown, and jumps you to a listing of the various licensing requirements. Kudos!

91 Charged With $295 Million Medicare Fraud

Ninety-one doctors, nurses and others were charged in a blockbuster sting operation, with arrests unfolding over three weeks and culminating in 70 arrests last week. In 2007, a strike force was set up between the Department of Justice and the Department of Health and Human Services to identify and build federal fraud cases to fight criminal abuse of federal healthcare programs. U.S. Attorney General Eric Holder said that arrests were made in eight US cities involving more than $295 million in stolen funds.

Almost half of those charged were part of a Florida ring that recruited healthcare providers to refer patients to a mental health center, in some cases threatening residents of a halfway house with eviction if they refused the unnecessary care. Another case involved $3.4 million in unnecessary physical therapy by two Brooklyn physicians.

On September 1, officials in Detroit charged 18 physicians, nurses, clinic owners and other medical professionals for submitting $28 million in false claims to Medicare. Just one day earlier, the owner of a Houston, Texas durable medical equipment business was sentenced to 97 months in prison for his role in a Medicare fraud scheme.

In all, the strike force, known as Health Care Fraud Prevention and Enforcement Action Team (HEAT), has charged 1,140 defendants who collectively have falsely billed the Medicare program for more than $2.9 billion.

When providers have been convicted of fraud and certain other infractions and delinquencies, their names are placed on the List of Excluded Individuals/Entities (LEIE) database. CarePrecise compiles this data into its comprehensive database of U.S. healthcare providers, identifying excluded providers' NPI numbers, phone and fax numbers.

Read the full story on the HHS website.

U.S. Doctors Earn Big, Drive Up Costs

According to a new study published in Health Affairs, America's approximately 1.1 million physicians are paid dramatically higher fees than those in all of the other more than 230 Organisation for Economic Co-Operation and Development countries. Per capita, our physicians are paid $1,599; other countries averaged significantly less than that -- about 81% less -- or about $310. The difference, nearly $1,300, is a major factor in driving up U.S. healthcare costs, and, according to the report, is the the main cause of higher overall spending in America on physicians' services.

The disparity comes into stark focus in the area of specialists' fees. While U.S. primary care docs earned significantly higher than their foreign counterparts -- averaging $186,582 annually -- orthopedic physicians earned $442,450. As an example, the study compared physicians’ fees paid by public and private payers for hip replacements in Australia, Canada, France, Germany, the United Kingdom, and the United States, finding that much higher fees were paid to U.S. orthopedic physicians for hip replacements (70 percent more for public payers, 120 percent more for private payers) than public and private payers paid these specialitsts in other countries. The study concludes that "the higher fees, rather than factors such as higher practice costs, volume of services, or tuition expenses, were the main drivers of higher U.S. spending, particularly in orthopedics."

According to August, 2011 CarePrecise data, of the approximately 1.1 million U.S. physicians, about 35,500 practice as orthopedists and orthopedic surgeons, with another 378,000 specialists practicing in the high fee taxonomies. Only about 160,000 U.S. physicians serve in family practice.

And They Were So Close to Canada!

Looks like some Medicare patients will go to any lengths to escape the high cost of U.S. prescription drugs. Even if only through opium-induced euphoria.

Michigan: Twenty-six persons have been charged by Federal investigators in a Medicare fraud scam that took in more than $58 million in fraudulent billings and illegally acquired more than 6 million doses of pricy medications. Drugs were used to entice Medicare patients to play along.

The brains of the gang, one Babubhai Patel, ran a network of 26 Michigan pharmacies that bribed physicians to write the prescriptions, many of them opiates and other frequently-abused pharmaceuticals. Physicians recruited grandmas as mules. Medicare patients would knowingly fill the illicit prescriptions, keeping the drugs and handing over their Medicare and Medicaid billing information to the conspirators. Four doctors and ten pharmacists, as well as some of the patients and others, were indicted in the federal grand jury action.

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.)