The Sunshine List

As lawmakers continue to push CMS to implement the Physician Payments Sunshine Act, and CMS mildly demurs out of concern that drug and equipment manufacturers won't be able to comply any time soon, CarePrecise has been busy getting prepared for a run on the databank.

As most of the players are beginning to realize, an accurate and up-to-date source of provider information will be a necessity in reporting payments properly. The CarePrecise master provider list contains all the hooks required to positively identify specific providers, and connects provider licensing and NPI numbers to such pertinent information as PECOS enrollment, Medicare billing eligibility, and the Office of Inspector General's excluded providers database. The current version of the CarePrecise Access Complete database identifies multiple providers practicing at a single location, using super-conformed location coding.

Sunshine Incoming

CarePrecise can process incoming lists of payments to providers using the advanced record-linking technology we use to build our master databases. Whether companies have NPI numbers or not, our system can use other data to identify payees.

CarePrecise data is already in use is installations where states have various types of Sunshine laws in place, and where organizations are preparing for the federal act to take effect. When we can all finally see who's paying what to whom (to whatever extent that will be truly possible), CarePrecise data will be part of this vital next step in controlling healthcare costs and abuses of influence.

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.

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!

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.

Practice Group Data Now Part of CP ListMaker

Jan. 29, 2012 -- CarePrecise announces a major upgrade of its  CP ListMaker software that puts all 3.5 million U.S. healthcare provider records – including almost one million physicians – in reach for marketers. Now includes practice group data to help qualify sales leads.

Today we announced a new version of our popular CP ListMaker software, our desktop system that puts all of the 3.5 million healthcare provider records – including approximately one million physicians and tens of thousands of hospitals and ambulatory care facilities – at the fingertips of researchers and marketers. CP ListMaker allows users to pull tightly targeted lists of physicians and other providers based on criteria such as specialty, subspecialty, facility types for organizations, provider gender, wealth/poverty of service area, Medicare enrollment, and many more. The new version, CP ListMaker 3.5, unveils new practice group data, and does it in an interesting way.

Until now, it has been difficult to find data indicating provider’s practice groups. With new data now obtained from Centers for Medicare and Medicaid Services (CMS), combined with CarePrecise’s advanced record linkage system, CP ListMaker identifies practice groups, and can list all of the providers working at each practice location. 

The “Co-location codes” attached to each record make it possible to further qualify potential prospects for companies marketing to the medical community. Not only physician practices, but dental groups, behavioral services groups, and all other HIPAA-covered healthcare providers are co-location coded. The new CP ListMaker offers tools for using the new data. For example, to export a list of obstetric/gynecology group practices of between 3 and 20 members.

CarePrecise’s record correlation processes also make it possible to link providers’ PECOS and LEIE records with their NPI (National Provider Identifier) records ( http://www.careprecise.com/pecos-npi ), providing a rich master record ( http://www.careprecise.com/provider-data-linkage.htm ) that can be used to enrich or update customers’ existing databases. The PECOS data (indicating which providers are enrolled to be able to bill Medicare) has recently been redacted by CMS, now providing only a partial NPI number; however, our system restores the full NPI number. The federal List of Excluded Individuals/Entities (LEIE) database, which lists providers who have been barred from billing federal programs due to fraud convictions or other infractions, also has no unique identifier as distributed; however, CarePrecise links the LEIE data to the NPI data with each monthly update.

With or without a unique identifier, such as an NPI, EIN, UPIN or OSCAR -- or even a telephone number -- the CarePrecise master data management system, known as QoRelate® (http://www.careprecise.com/provider-data-linkage.htm ), can pull provider data together into a master record database from diverse sources. The company offers boutique record linkage services that can be used to merge data acquired during mergers and acquisitions, through cooperatives such as Health Information Exchanges, or from multiple in-house systems.

CP ListMaker is available as part of the CarePrecise Gold bundle, which includes CP ListMaker and the full U.S. healthcare provider database, or separately for customers who already subscribe to the CarePrecise data. The tool runs in Microsoft Access 2003, 2007 and 2010, and is provided open source, making all of the Access tools available to users.

RESOURCES:

CP ListMaker healthcare provider research and market targeting tools:
http://www.careprecise.com/cplistmaker

 

QoRelateMaster Data Management & Record-Linkage:
http://www.careprecise.com/provider-data-linkage.htm  

CarePrecise Gold (complete U.S. healthcare provider database with marketing and research tools):
http://www.careprecise.com/gold

 

Contact CarePrecise:
http://www.careprecise.com/contact

Sorting Out Practice Group Data

Starting with the November 2011 distribution, CMS began including 15 new fields in the NPPES database related to practice groups. These are actually taxonomy codes; the taxonomy code set includes two group codes: 193200000X Multi-Specialty Group and 193400000X Single Specialty Group. The definition of the single specialty code is "A business group of one or more individual practitioners, all of who [sic] practice with the same area of specialization." That should clear it all up, right? Oh, no.

So these are not necessarily physician groups. That's fine, but additional questions remain, like Why aren't these taxonomy codes reported in the taxonomy codes section of the NPPES? The documentation from CMS is mum. And why is it that individual (Type 1) practitioners can call themselves a "group" when the NPI regulation says that a Type 1 provider is a single human being ? There are more than 1,000 of these in the data. So, a group can be physicians or not, or a mix, and a group can be one guy. And these two taxonomy codes aren't in the providers' taxonomy code data. Oh, and providers can report these same two codes up to 15 times (presumably having some relation to the up to 15 taxonomy codes in that other section of the data?) And, given 15 fields to play with, they can report being both a single specialty group and a multi-specialty group.

Hrrmph.

And there just happens to be many more group practices out there than are reported via these codes.

Using the new group codes data to actually identify groups, then, is somewhat less than doable. So we've taken a different tack.

Many of our clients need to know the group status of an individual practitioner. Let's take some really common examples. Let's say you are putting together a clinical trial for a new drug, or a marketing campaign for a new device. By phone, fax, and/or mail, you plan to contact a few thousand physicians in this state, a few thousand in that state, etc. You don't want to deluge a practice with 50 letters or phone calls all at once (and some practice locations are that big and bigger), so you need to know the practice group for the physicians on your list, so you can stagger your communications. Or, let's say, you just want to reach the CEO or medical director for a given group. Well, as it happens, the CEOs isn't always the record that indicates a group practice; it's sometimes the office manager, credentialing coordinator, or just a young doc who can pilot the laptop. How do you sort all this out? Well, frankly, you couldn't, until now.

Beginning this month the CarePrecise Access dataset contains a new feature called a "CoLoCode" (co-location code). The CoLoCode is derived from deeply conformed practice location data, and each provider record gets one. Look up a group (using the CMS Group codes or by looking for a number of physicians co-located at the same practice address), then plunk that CoLoCode into a query to show you all the providers practicing at that location. Voila!

To make it even easier, we are releasing a new version of our CP ListMaker software, with new group features that take full advantage of the CoLoCodes and new CMS group data.

CMS Redacts NPI in PECOS File: Solution

The PECOS Ordering and Referring Report has been a tremendous resource for those of us who have to know whether a business partner is eligible to bill Medicare. A great example is the DME supplier who needs to know that the physician who orders a patient's medical equipment is authorized to do that; could cost him money when the claim is rejected. Well, that report has just gotten a mite less useful.

(UPDATE: Here's a press release we just sent on this issue, and a page on our website with details.)

Starting with the current release, CMS has blocked out the first 6 digits of the NPI number. It looks like ******1234. Utterly useless if you want to incorporate that file into your business systems. We have a solution!

CarePrecise specializes in healthcare record linkage projects. We collect data files from many sources and, using our QoRelate record "linking and shrinking" system, match them into our NPI database. The PECOS Ordering and Referring Report and the pending enrollment files are no exception. Our system can still tell you which providers are enrolled to bill Medicare or have a pending enrollment -- with their NPI number and a lot of additional information the PECOS reports never offered.

In fact, we not only match up NPI numbers with PECOS enrollment, we also do it with the federal List of Excluded Providers (LEIE), the now deprecated but still useful UPIN registry, state license numbers, phone and fax numbers, both mailing and practice addresses, economic data from the US Dept of Commerce, and much more. Now we can even tell you how many providers practice at the same location, and give you the providers who report as a multi-specialty or single specialty practice group.

It's all in CarePrecise Gold (and everything except the economic data is in our basic dataset, CarePrecise Access), for 3.5 U.S. healthcare million providers.

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.

Wall Street In Ruins

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!