June 20, 2013

Doctors: Will Patients Misread Sunshine Info?

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

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

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

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

May 21, 2013

Health Information Exchange Saves Moore Hospital Records

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

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

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

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

Healthcare IT Spending Optimism

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

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

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

Free Webinar on Sunshine Law

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

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

Topics include:

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

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


February 11, 2013

Healthcare Fraud Recovery $4.2B for 2012

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

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

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

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

February 8, 2013

Exchange and Medicaid IT Contract Tracker

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

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

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

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


February 1, 2013

15 Types of Medical Billing Fraud & Abuse

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

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

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

Data Security: An Online Hacking Primer

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

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



January 31, 2013

Patients Resist Digital Doctoring

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

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

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

January 18, 2013

Surprise: You May Now Be Liable Under HIPAA


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

No more.

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

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

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

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

January 9, 2013

$1.25 Billion in December EHR Incentives


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

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

September 17, 2012

HIPAA Grows Teeth II

You could be forgiven for thinking that the seminal law underpinning U.S. healthcare reform has been aggressively enforced. Alas, most within the healthcare industry have wondered when the federal government would begin taking HIPAA's most blatent offenders to the woodshed. If ever. But action this week by the HHS Office for Civil Rights suggests that the government may begin pursuing violations in earnest.

HHS has announced that Massachusetts Eye and Ear Infirmary (MEEI) and its physician group, Massachusetts Eye and Ear Associates, agreed to pay $1.5 million to settle HIPAA security-rule violations. The case involves the theft of a laptop computer storing 3,621 patient records, and HHS' allegation that MEEI and the physicians not only failed to secure data on the laptop but also failed to comply with other HIPAA security requirements. According to the Office for Civil Rights brief, MEEI failed to execute “thorough analysis of the risk to the confidentiality” of provate patient information stored on the laptop and had not adopted and implemented "policies and procedures to restrict access to ePHI [electronic protected health information] to authorized users of portable devices.”

The initial installment of $500,000 is set to be paid to the government on October 15, with two subsequent payments scheduled through 2014. The offenders will also have to submit to independent monitoring of a "corrective action plan" twice a year for three years. Read the Resolution Agreement here.

Time to lock down that patient data, folks. And maybe download free open source encryption software for those laptops while you're thinking about it.