Again: Call for CMS to Release Tax Numbers

It's 2022 and still CMS fails to include healthcare organizations' tax numbers. Whether you call them TIN or EIN the numbers are not sensitive in any way, and the Centers for Medicare and Medicaid Services should release them. This is a repost of an article from 2010, more than 3 years after the first NPI Registry data was made public - except, of course, for those tax numbers:

____

The NPI Final Rule called for CMS to establish a system that would assign a National Provider Identifier (NPI) number to essentially every healthcare provider in the U.S. (HIPAA "covered entities"): now more than 3 million providers and growing. Great. But it was years before CMS released that data for the industry to use. CarePrecise personnel were at the forefront even back then, calling for CMS to release the data. If necessary, we were ready to fight for it, filing our own request under the Freedom of Information Act (FOIA). Federal agencies can't keep such kinds of data from the public. It's the law. CMS eventually looked at FOIA, and at their provider data, and decided that, sure enough, they were going to have to release it. We and our clients were ecstatic; now the industry would be able to produce the complex crosswalks necessary to actually achieve the efficiencies promised by the Final Rule.

Hurray... except CMS decided not to release one of the most useful data points of all. A provider's federal tax number is hardly a private number. Businesses have to give their tax number on every imaginable type of transaction. Employees see the employer's number on their W-2s. CMS's excuse was that sole proprietors and pretty much all individual practitioners would have to give their Social Security Number, or that busy doctors might type in the SSN in the wrong spot. Fair enough, but, as everyone who works with data knows, it's a piece of cake to parse a tax number field to determine if the number is a SSN or a business tax number. In fact, that's just exactly what CMS does in the Other ID fields of the NPPES (National Plan and Provider Enumeration System) database, replacing 000-00-0000 with a string of equals signs.

Instead of just redacting the SSNs, CMS decided it was best just to wipe clean the complete Employer Identification Number (EIN) field -- just in case some uppity docs got... uppity. Many of us have been hoping that CMS would revisit the issue of this gaping hole in the provider data, but it seems that the issue is to be ignored so that it will just go away.

So, here we are, once again, years into it, asking CMS to release non-SSN tax numbers/EINs so that we -- health systems and health plans large and small, clearinghouses, HIT vendors, medical billing and coding vendors -- can make this data do what it was intended to do for healthcare and for the taxpayers.

____

Check out the NPI information at CarePrecise.

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.

Healthcare Market Opportunities

The global healthcare market is growing at an unprecedented rate. Over the past decade, advances in technology and medical treatments have revolutionized the industry, allowing for the development of new treatments, therapies, and technologies. As a result, the global healthcare market is expected to grow to a staggering $4.95 trillion by 2026.

Growth Factors

This growth can be attributed to several factors, including increased access to healthcare services in emerging markets and an increasing focus on preventive care. In addition, advancements in digital health technology are also contributing to this growth, as they make it easier for providers to monitor patient data remotely and quickly respond to changes in their conditions or develop treatments that are tailored specifically to them.

Future Expansion

These developments will likely lead to further market expansion in the coming years. To capitalize on this opportunity, stakeholders must ensure that they are actively participating in innovation and leveraging existing trends such as artificial intelligence (AI) integration and big data analytics. As the U.S. population ages, needing more healthcare services, strong market opportunities are emerging for innovative companies, from creating "find a medical service" apps, to caregiver management and inter-organizational information exchange.

Leveraging Opportunities

Of course, companies need to continue investing in research and development efforts related to precision medicine, predictive diagnostics and personalized therapies that can provide better outcomes for patients while simultaneously driving industry growth. But at the same time, consumer-facing technologies, such as patient portals and "find a provider" services need to acquire and deploy accurate healthcare provider information, covering many tens of millions of rows of provider data that is updated constantly.

Companies that sell advanced products to hospitals, physician offices, clinics and other businesses also need provider information to infuse their campaigns with contact information and business intelligence. The U.S. healthcare industry is aggressively competitive, and business intelligence is jealously guarded. The job of finding the information is challenging, and companies like CarePrecise are dedicated to just that task.

Conclusion

To be successful, it is essential to have a comprehensive understanding of the market dynamics and leverage existing trends such as AI integration and big data analytics. Equally important is having accurate healthcare provider information - which can be effectively provided by companies like CarePrecise. Using these resources, businesses will be able to reach out to healthcare decision makers with their messages.

By engaging with these strategies now, stakeholders will be able to take full advantage of the rapidly expanding healthcare market – which is set to become one of the most lucrative industries of our time.

Hospital Affiliations for U.S. Clinicians

Just a couple of months ago you could get relatively good data on physician and other clinician hospital affiliations on the Physician Compare website. Well, then CMS went and changed the data! They removed the hospital name, address, phone and all other hospital data except for the CCN number (CCN stands for "CMS Certification Number," and it is the unique identifier used to link clinicians to the hospitals they are affiliated with). 

Take back your hospital data

CMS dropping the hospital data means that you can't just download the physician downloadable file anymore, and get the associated hospital info. There's a solution. You can download a whole bunch of other files from across the CMS online universe, and piece together some CCN-to-hospital data. (The Hospital Compare general hospital information data is woefully incomplete.) This takes a LOT of work. CarePrecise has long been accessing these resources and "knows where the bodies are buried," as they say. We do the work of locating and aggregating millions of rows of data every month, including tens of thousands of rows of specifically hospital data, gleaning all sorts of valuable information for our customers to gain the business insights they seek. Our CarePrecise Advanced contains the links between the physicians and other clinicians with their practice groups, clinics, hospital affiliations, and much more. 

More facilities than just hospitals

In fact, instead of just the links with 7,000+ hospitals, we now include linkage with nearly 40,000 facilities of all sorts, including dialysis centers, outpatient hospital services, clinics, long-term care facilities, rehab facilities, as well as the inpatient hospitals we've included in the past. The information includes the facility name, type, physical address, phone, and much more. Depending on the CarePrecise data package you choose, you can even view the facility's contact person, title, an NPI rollup (NPI-to-CCN crosswalk), quality measures, outpatient procedure volumes, MSA/CBSA, precise geocoding (latitude and longitude), and the new Placekey for integrating our data with other POI ("Point of Interes") data available across dozens of data suppliers.

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.

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.

Medicare Fraud Steals $60 Billion a Year

Six months after a provider performs a particular medical procedure, they can bill it again. And, exactly six months to the day, the provider photocopies the original claim, changes the date, and sends the scammed claim it off to Medicare.

$60 billion worth of fraud is roughly 10% of the total amount Medicare pays out every year on healthcare for 54 million people. According to a March 7 WIRED article, "Since 2007 more than 2,300 providers have been charged with fleecing Medicare, and more than 1800 defendants have been convicted of felony offences, ranging from claiming phantom services to performing unnecessary surgeries."

Among CarePrecise Clients are the Federal Bureau of Investigation and state anti-fraud law enforcement bodies. CarePrecise provides comprehensive data on healthcare providers.

How will ever stop these scams? There are just too many of them for CMS' dedicated investigators to keep up. But the government is getting help from hundreds of citizens: whistle-blower lawsuits allow any medical office staff or other insider to sue their employer and collect 15% to 30% of the settlement. The number of bounty hunters is growing; in 2014 there were 469 such settlements resulting in $2.2 billion in fines.

Professional whistle-blower lawyers can help skittish employees to rat correctly, but they may not have the investigative chops. Now one clever business has begun to turn medical office whistle-blowing into a growth industry. National Healthcare Analysis Group may do more to help recover this money than has been possible in the past by organizing the process and "packaging" it. Read more about it...

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.

Out of the Silos: Combined Healthcare Provider Data

You always knew it was possible to get all of the rich federal data on healthcare providers together in one place, and in a form you could use on your PC. And you were simply ecstatic when CMS released the NPPES database! But then you downloaded it and learned that there is simply no normal desktop software that can make that data accessible to you. Rats!

Then CarePrecise created a version of that data -- our flagship product, CarePrecise Access Complete (CPAC), so you could use all 4 million provider records on your computer. Yay! But then you found that it was hard to get around in all that data. Rats! So CarePrecise released the CP ListMaker software that makes getting at the data you want a walk in the park. Excellent! And you wanted some way to know which providers were sanctioned, or that they were eligible to bill Medicare, so CarePrecise integrated data from the PECOS (Medicare) database and the LEIE (List of Excluded Individuals and Entities). Fantastic!

Then you wanted more than the single practice location and fuzzy practice group data that the NPPES gave you, so CarePrecise integrated all of the Physician Compare data with CPAC. Cool! And you wondered how would you ever tame all of that hospital data, so CarePrecise integrated a de-duplicated list of hospitals and the Hospital Compare data, and while we were at it, we included hooks into the hospital quality data and the upcoming physician quality data. And all of it -- the NPPES, PECOS, LEIE, Physician Compare, Hospital Compare (plus some really nice additional stuff like proper-cased name and address fields, provider service area wealth data, and urban/rural/suburban designations) -- all integrated into a single relational database, linked by the NPI number. And you though it couldn't be done.

Now we call that sweet package of data heaven by a weird name: The CarePrecise Total Bundle. And as we integrate upcoming federal data releases, will we be tucking them in there too? You betcha. That's what CarePrecise is all about: healthcare provider data integration and application.

It's brand new and available now: The only 360 degree view of U.S. healthcare provider data. Total Bundle pricing is just $689. That's less than 2/100ths of a penny per record for the most complete physician database / hospital database / dentist database... available anywhere.

You're welcome!

Healthcare Reform Brews Startup Gold

As state and federal insurance exchanges struggle to open their portals to millions of new insureds, the Affordable Care Act is spawning myriad opportunities for startup entrepreneurs in the healthcare IT space.

The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 handed physicians generous incentives to invest in healthcare information technology. Unprecedented investment has been finding its way to to electronic medical record (EMR) vendors. Use of these systems has exploded, roughly doubling since 2012.

That other familiar new legislation, the Affordable Care Act, affectionately dubbed "Obamacare," seems to be awakening the sleeping giant of American capital investment, as the largest growth in the history of healthcare insurance is being launched this month. Private exchanges have offered one such opportunity, but many more are on the horizon, as healthcare providers turn to technology to cope with increases in patient services, and as new providers hang out their shingles to capture the burgeoning patient market. Coupled with the aging of the Baby Boom generation, healthcare industry fortunes have never looked so good.

Remote patient monitoring tools, including wearable sensor/transmitters, represents one of the early forays for startups. Mobile devices will monitor patients and report bio data to patients' healthcare provider teams. As the ACA changes the game from the existing volume-based model to a value-based revenue system, physicians will no longer have an incentive to order a flurry of expensive tests, but to maintain a 360-degree view of patients' health, catching threats while intervention is relatively less costly, and to prevent hospital re-admissions by remote monitoring of biometrics during at-home recovery and on an ongoing basis. Federal incentives to treat patients under outpatient conditions will be an initial major driver. A recent estimate by Rock Health pegs recent investment in this technology at $102 million.

MedTronic, a manufacturer of mobile insulin delivery technologies, recently announced FDA approval of its new "artificial pancreas," a mobile device that combines automated constant glucose testing with insulin delivery. The device, already in use in Europe, collects and can report patient blood glucose levels and insulin pump interventions on a minute-to-minute basis, and will be rolling out in the U.S. over the next year. The device does not yet transmit data, but must be downloaded.

Fitness-tracking devices are among the new direct-to-consumer devices finding acceptance in the market. Some see this development as helping to bring down the cost of mobile biometrics, and providing the data stream needed to feed the emerging preventive care and early intervention movement. The presence of such technology in the consumer market could ease consumer acceptance of more clinically-oriented mobile technologies related to population health management, a potentially enormous new segment in the industry.

Population health management encompasses tools and expertise to capture and analyze vast streams of biometric data and broader patient health information in order to identify trends that threaten particular populations. Hospitals are the current market for these tools, but new markets can be imagined among outpatient services providers of many types, in supply chain management, pharmaceuticals and medical devices, as well as government-based public health entities.

New ways of delivering primary and specialty care represent another area of growth. Concierge clinics, and clinics that cater to niche patient populations make heavy use of technology in acquiring and keeping patients, frequently commanding higher fees than broader-based clinics.

The emerging "maker community" also represents a new force in the healthcare technology and medical device development markets. New technologies that democratize the prototyping of new technologies, utilizing $35 computers, smart phones and inexpensive 3D printing, are attracting record numbers of individual inventors to the once-stodgy healthcare industry dominated by huge conglomerates like GE and 3M. What healthcare will look like after the coming boom is anyone's guess, but it will almost certainly involve more people applying more intelligence and effort to our health, and, as their achievements emerge, so may vast new wealth.

CarePrecise provides data products to the healthcare IT market, and marketing tools to vendors of health IT, medical devices, pharmaceuticals, including numerous startups.

Patient Portal Segment to Soar

Driven by federal Stage 2 Meaningful Use requirements, patient portal use is taking off across the United States. Healthcare IT News wrote last week that "the patient portal market is poised to absolutely boom." The article refers to a Frost and Sullivan report that has the market soaring towards $900 million in about three years - a spike of 221%. CarePrecise provides marketing tools to patient portal vendors and other healthcare IT companies.