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.

A Nut Too Tough to Crack?

One of the hardest problems in health IT is the effort to get data from different silos into a centralized database that can be searched as a single dataset. So, this is us announcing our new "linking and shrinking" technology, code named "Squirrel." What does it do?

Squirrel is a record-linkage and deflation system that pulls in data from multiple federal provider databases in various formats, makes them play nice together by linking everything up under providers' NPI numbers, preserves all the data but shrinks the file size down to about 9% of the original size, puts it in a format that can be managed in Microsoft Access or other garden variety database software, downloads it to our customers, and then does it all again fresh every month.

The technology is built on record-linkage methods developed over twenty years. Interesting trivia: The precursor to the current system was built in Microsoft Access 1.0 -- you remember it, the Introductory Package -- in 1992. While we don't share all the secrets, the basic trick involves pattern matching algorithms and a lot of processing time to handle more than 13 million rows of data, comparing each provider's records between all the sources. The end result is called CarePrecise Access.

We just sent out a press release about the whole thing.

Now you'll excuse us, as we have some more nuts to collect and crunch on.

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.)

Medicare Wins in Vegas Fraud Case

Rakesh Nathu, a Las Vegas oncologist, settled his fraud case with the Justice Department yesterday for $5.7 million plus interest. Dr. Nathu was accused of submitting false claims to Medicare, TRICARE and the Federal Employees Health Plan for various radiation oncology services, including intensity modulated radiation therapy, and double billing for services. We hope he did better at the craps table. The government has recovered more than $7.3 billion in False Claim Act cases since 2009.

Among CarePrecise clients are law enforcement agencies working on federal and private payer fraud investigations. As a result of work done for our clients, we developed a means of matching the federal fraud conviction list with providers' NPI records, and associating certain demographic data with practice locations to help visualize patterns. Late in 2010 we began including the fraud data in our CarePrecise Access Complete dataset, and the additional economic data in CarePrecise Gold products. Now included is a flag that indicates provider records whose data strongly suggest a match with the federal LEIE (List of Excluded Individuals/Entities) database. Other features help investigators track providers' licensing, credentials, specialty codes, enrollment in the PECOS database, and numerous other functions.

Read the Justice Department news release.

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.

Ryan Plan Dies in the Senate

"The Republican plan to kill Medicare is part of a plan to balance the budget on the backs of seniors," Senate Majority Leader Harry Reid said before yesterday's vote. That plan, originating in the House authored by Republican Paul Ryan, would have dismantled Medicare guarantees in favor of a private system that would force seniors to shop for health plans.

Republicans forced a vote on the Obama Administration's budget as a ploy to show the lack of support among Democrats for it. The 97-0 vote roundly defeated the President's budget.

Health Information Exchange Finance Study

Lately I've been asked by multiple people about the RHIO/HIE work we did a few years ago. With wider adoption of EHR and EMR, health information exchanges are finally beginning to be able to sink their teeth into data, and their value is being better understood. Still the most detailed analysis of HIE finance is the two-year study conducted while I was senior analyst at Healthcare IT Transition Group. The full 129-page study is now available online again.

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!

Got Teeth? Here Comes HIPAA Enforcement

Two-day workshops in April, May and June have been set to train state attorneys general in HIPAA enforcement. The economic stimulus law attached stronger penalties for HIPAA privacy and security violations, and perhaps more importantly, removed sole prosecutorial powers from the Office for Civil Rights at HHS (OCR) for enforcement of federal privacy and security provisions by granting dual enforcement authority to state attorneys general. Going further, the law also expanded application of HIPAA criminal provisions to any individual who obtains or discloses health information kept by a covered entity -- not just the covered entity itself -- which essentially reverses the Bush administration Justice Department, which held that only "covered entities" are eligible for prosecution. So, if that EHR software company has an oopsie with your medical records, your state attorney general can go after it. CHOMP! Read the Modern Healthcare article.

Patients Want Their Providers Online

The second-annual study from Intuit Health, the Health Care Check-Up Survey, found that 73% of Americans surveyed would use secure online tools to access lab results, request appointments, pay medical bills, and communicate with their doctor's office. CarePrecise began building web portals for healthcare providers a few years ago, and has seen a rise in interest from providers, who want to be able to point patients to written information in the controlled environment of their websites. Providers are also looking at adding scheduling applications, and some are participating in PHRs (patient health record portals). Read the Information Week article.

Good News, Docs and Vendors: No Medicut

According to the Associated Press, the Obama administration proposes $3.73 trillion for the next budget cycle, as part of its plan to shrink the federal deficit by $1.1 trillion over the coming decade. $62 billion of the savings would be used to avoid cuts in Medicare payments to physicians over the next two years. The full proposed budget is expected to be released later today.