By David Shelton, chief executive officer, PatientMatters.
More than half of Americans have experienced the sick feeling that comes with opening a medical bill they assumed would be covered by insurance. Surprise medical bills are on the rise, often driven by services administered at an in-network facility using out-of-network providers.
A Journal of the American Medical Association(JAMA)analysis of privately insured patients showed that between 2010 and 2016, inpatient admissions with an out-of-network bill increased 16%, and emergency department (ED) admissions with out-of-network billing went up more than 10 percent.
As alarming as the number of surprise bills is the impact on patients’ pocketbooks. In the same timeframe, potential patient liability skyrocketed from $804 to $2,040 for inpatient services and from $220 to $628 for ED visits.
Price transparency and accurate estimates are critical to preventing surprise bills and giving patients more control over their healthcare spending. Many providers are experiencing increases in self-pay patients, often because patients have a high-deductible plan that requires significant out-of-pocket before coverage kicks in. As such, patients need the ability to compare prices across providers and get accurate estimates of what they’ll owe before making healthcare decisions.
Why healthcare bill estimates are so difficult
Many factors contribute to the historical absence of bill estimates, but it starts with healthcare payment system fundamentals. Unlike other industries where transactions involve a buyer and a seller, healthcare brings in a third party, the payer, who is typically reluctant to reveal publicly what they pay various providers for services. Contracts, discounts, coding and other variables make it inherently difficult to achieve price transparency.
Price transparency progress
A step toward more price transparency came when the Centers for Medicare & Medicaid Services (CMS) required hospitals to publish their chargemasters online, starting January 1, 2019. Unfortunately, neither consumers nor many hospital employees could translate the data into usable, patient-specific bill estimates. In fact, more than half of hospitals in a 2019 survey said the move created further confusion.
In June 2019, President Trump issued an Executive Order to improve healthcare price and quality transparency. CMS later issued a final rule expanding current requirements for hospitals. These include providing a machine-readable file containing negotiated rates for all items and services annually and a consumer-friendly display of gross and negotiated rates for 300 “shoppable” items and services, including 70 defined by CMS. Insurers would also be required to provide members personalized out-of-pocket costs for all covered services in advance. These new rules are planned to take effect Jan. 1, 2021.
By Carl Kunkleman, senior vice president and co-founder, ClearDATA.
Carl Kunkleman
Working in the world of healthcare security and compliance, I find one of the biggest dangers organizations face is having a false sense of security that their PHI is adequately protected. I’ve done hundreds of security risk assessments, and I have yet to find one single organization that did not have a security gap they were unaware they had in one or more of their administrative, technical or physical safeguards.
Add to this, the complicated current state of healthcare battling COVID-19, and we are likely to see administrative systems that have gaps in off-boarding or off-boarding employees, technical infrastructures that didn’t have time or resources for patch management, and physical scenarios in makeshift triage units with compromised physical safeguards that simply cannot be addressed in the current haste to stop the spread of the virus.
Sadly, this sense of chaos creates the ideal conditions for the hackers of the world looking to infiltrate via phishing, malware and ransomware and more. Once this spread is arrested and we all get a moment to catch our breath and assess business practices, a good move would be to conduct a security risk assessment known as an SRA. Your internal teams and resources are stressed, overworked and possibly burned out and an SRA can identify security gaps that will inevitably arise and present an actionable plan to remediate. This will help reduce risks while protecting your organization’s finances and reputation while we all find out what “getting back to normal” will mean.
Right now, we are all doing everything we can. And the Department of Health and Human Services recognized that with their decision last week to waive penalties for providers that are serving patients through everyday communications technologies during the COVID-19 public health emergency. A security risk assessment this summer will help you put the compliance health of your organization back in order. In addition to the HIPAA requirement that you have an SRA on file annually, it helps unite your team in a strategic path forward by articulating what your highest and lowest risks are, before a hacker uncovers them.
Because an SRA covers administrative, technical and security safeguards, your entire organization will benefit from the process. I continue to find organizations who think their PHI is protected because they have password protected their computers and mobile devices. Our penetration testing has revealed that passwords are relatively easy to defeat. We continue to find gaps in encryption, patch management and even with PHI inventories. If you don’t know where all of your PHI resides, how can you protect it?
Healthcare interoperability and enhanced information sharing continued to improve healthcare quality, safety and cost for U.S. patients and providers, according to the Surescripts 2019 National Progress Report. The nationwide health information network processed 19.15 billion secure transactions in 2019, while connecting 1.78 million healthcare professionals and organizations with actionable patient data for 95% of the U.S. population.
“With the COVID-19 pandemic impacting patients and providers across the globe, a trusted nationwide health information network has never been more critical,” said Tom Skelton, chief executive officer of Surescripts. “In 2019, doctors, nurses, pharmacists and others across the Surescripts Network Alliance made remarkable progress transforming interactions with patients and driving significant improvements in care quality, safety and costs.”
In 2019, healthcare professionals saw the benefits of leveraging actionable patient information to enhance the prescribing process with greater automation, improved workflows, and increased price transparency. For example:
In 2019, prescriber enablement for e-prescribing reached 79%, with 1.79 billion e-prescriptions filled, bringing the rate of e-prescribing to 80% of all prescriptions.
The number of e-prescriptions filled for controlled substances reached 134.2 million, representing 38% of controlled substance prescriptions—up 12% from the year prior, with 49% of prescribers enabled for the technology.
The volume of real-time benefit checks at the point of care increased by 336% with more than 250,000 prescribers using the service (a 233% increase).
Electronic prior authorizations increased by 132%, driven by a 58% increase in provider adoption of the tool.
Further, clinicians accessed actionable patient insights to obtain a more complete picture of their patients’ care histories and make more informed care decisions. For example:
Surescripts delivered 2.18 billion medication histories, a 19% increase, while use of Medication History for Populations increased nearly 200%.
Record Locator & Exchange delivered 333.8 million links to clinical document locations and 143.2 million documents listing where patients had previously received care. Nearly 136,000 clinicians used the service—a 28% increase in 2019.
In 2019, more than 648,000 individuals and organizations sent 37.7 million Clinical Direct Messages (a nearly 20% increase from 2018).
In the midst of this significant progress, Surescripts maintained network-wide uptime of approximately 99.999%, maintained HITRUST CSF Certified status for privacy, security and risk management practices, improved the networkwide Quality Index Score for e-prescription accuracy by 10%, and helped migrate most of the network to the National Council for Prescription Drug Programs’ (NCPDP) new e-prescribing standard (SCRIPT Standard Version 2017071).
Current Health announced that it has launched a collaboration with Mayo Clinic to develop remote monitoring solutions that accelerate the identification of COVID-19-positive patients and predict symptom and disease severity in patients, healthcare workers and other at-risk individuals in critical service sectors.
Using digital biomarkers collected by Current Health’s FDA-cleared remote monitoring sensors and platform, experts from Mayo Clinic and Current Health will also be able to expedite identification and assessment of treatment efficacy and improve care for patients with or at risk of COVID-19 infection. Through this collaboration, Current Health and Mayo Clinic aim to improve patient outcomes while preserving and optimizing health system capacity worldwide.
Today, more than 40 hospital systems around the globe use Current Health’s remote patient monitoring platform to monitor and manage patient health. These systems are now increasingly using Current Health to monitor and manage patients infected with COVID-19 at home and in the hospital. The next stage is to use digital biomarkers collected by the Current Health solutions, such as temperature, heart rate, oxygen saturation, activity and posture, to develop AI-based algorithms that can detect and predict symptom and disease severity to enable proactive treatment.
This collaboration will leverage Current Health’s existing patient database – which already includes anonymized vital sign data and raw physiological sensor data from hundreds of patients infected with COVID-19 and thousands of uninfected patients – as well as algorithms developed by Mayo Clinic, which will be used to provide individualized care to patients with complex and critical medical conditions. By working together, Current Health and Mayo Clinic hope to scale data analytics, add to Mayo Clinic’s major advancements in accelerating COVID-19 detection and diagnosis, and further efforts to understand and treat this disease.
“Our collective ability to save lives hinges on our ability to understand this virus quickly. COVID-19 has presented in many ways across different people, which has made it very challenging to understand the virus and how it develops,” said Chris McCann, CEO and Co-Founder, Current Health. “By combining our platform with the deep medical and scientific expertise that exists at Mayo Clinic, we seek to explore both known and novel biomarkers, as well as how they manifest in entirely diverse populations. This will be critical to determining how we define, and enable effective treatment of, this disease.”
“Combatting the COVID-19 pandemic is our number one priority,” said Jordan D. Miller, Ph.D., who directs the Center for Surgical Excellence and leads the investigative team at Mayo Clinic.
“Real-world, continuous data – from patients infected and not infected with the disease – is essential to understanding and predicting how the disease presents and evolves,” says Abinash Virk, M.D., an infectious disease expert at Mayo Clinic. “If we are successful in accomplishing our goals, we believe we will improve how patients with COVID-19 are identified, monitored, managed, and ultimately help with their recovery.”
Mayo Clinic will also become an investor in Current Health as part of this collaboration.
United States Senators Lamar Alexander (R-Tenn.) and Mark Warner (D-Va.) introduced legislation that will ensure rural hospitals can keep up with the cost of providing care and curb the trend of hospital closures by boosting their Medicare payments.
“Last year, the Trump Administration updated the formula that determines how much Medicare will reimburse hospitals for patient care, taking into account, among other things, the cost of labor in that geographic area – called the Medicare Area Wage Index. And because of this change, Alan Levine, who leads Ballad, announced a $10 million investment in pay increases to nurses. However, these changes are temporary and will expire in three years, and many hospitals are concerned that hospital reimbursements could revert to the lower rates,” Alexander said.
“Given COVID-19 impacts on rural hospitals, any changes that lower reimbursement would have significant impact. Tennessee has the second highest rate of hospitals closures in the country, with 13 hospitals having closed since 2010, and this is, in large part, due to lower reimbursements. This legislation will help keep up with the cost of providing care and help curb the trend of Tennessee rural hospital closures by setting an appropriate national minimum for the Medicare Area Wage Index.”
“The current payment policy has long placed some of Virginia’s most rural hospitals at a disadvantage and made it more difficult to provide quality care in communities that need it most,” Warner said. “The COVID-19 public health emergency has made it more important than ever to do everything we can to support our rural hospitals and this legislation is absolutely critical in doing that.”
The legislation the senators introduced today, along with Senators John Cornyn (R-Texas), Doug Jones (D-Ala.), Marsha Blackburn (R-Tenn.), Tim Kaine (D-Va.), David Perdue (R-Ga.) and Richard Shelby (R-Ala.) would:
Establish an appropriate national minimum (0.85) for the Medicare Area Wage Index (AWI)
Ensure rural hospitals are paid for the care they provide while preserving the existing reimbursements for urban hospitals
Ensure fairness in reimbursements for hospitals across the country, including many hospitals that are facing closure in rural areas
Fix severe and disproportionate disadvantages that unfairly penalize hundreds of communities and hospitals across the United States
The Medicare Area Wage Index, which is a formula Medicare uses to reimburse hospitals, is much lower for states like Tennessee and Virginia because the formula is based labor costs, which vary across the country. Medicare accounts for about 43% of reimbursements for hospitals nationally, according to the American Hospital Association.
The Microsoft MS-202 exam is targeted at those IT professionals who are pursuing the Microsoft 365 Certified: Messaging Administrator Associate certification and have already taken and passed Microsoft 70-345.
The MS-202 test is actually a transition exam, which is intended for the specific candidates. The messaging administrators targeted by Microsoft MS-202 are those who are involved in troubleshooting, configuring, managing, and monitoring public folds, mail flow, mail protection, recipients, and permissions in the Cloud and on-premises enterprise environment.
These IT specialists are typically responsible for managing hygiene, migration, high availability, hybrid configuration, client access, disaster recovery, messaging, and infrastructure. They also partner and work in collaboration with the security administrators and Microsoft 365 Enterprise administrators to carry out a very secure hybrid topology, which performs business requirements of the modern organizations.
The message experts who want to take the Microsoft MS-202 test are supposed to have the relevant knowledge of authentication types licensing with M365 applications and integration to attempt this exam successfully.
NIX, a leading organization in the development of custom software solutions, announces that it is embarking on a partnership with Fortify 24×7, award-winning cybersecurity, and IT services company, to offer managed services that serve the evolving cybersecurity needs of NIX’s customers.
NIX will provide custom software development services for joint projects, as well as new opportunities co-developed by the partners, while Fortify 24×7 will offer its award-winning cybersecurity services to enhance NIX’s cybersecurity capabilities.
NIX is well-known in the custom software industry for helping its clients to become industry leaders. Fortify 24×7 brings its award-winning managed cybersecurity solutions, US-based 24x7x365 security operations center (SOC), military-grade tools, and deep expertise in cybersecurity to the partnership and NIX’s clients.
”We really appreciate this partnership and are looking forward to working with Fortify 24×7 further to enhance NIX’s cybersecurity capabilities,” said Vladimir Kuzmenko, senior vice president of sales and business development at NIX. “The team at NIX stands ready to support Fortify 24×7 and its clients in with world-class software development resources. We really appreciate this partnership and are looking forward to working with Fortify 24×7 further, setting more advanced goals and reaching new heights together. There is nothing we cannot do, with such reliable partners by our side.”
”Fortify 24×7 is thrilled to partner with NIX; we have been evaluating potential software development partners for a firm like Vladimir’s for over a year,” said Jeremy Murtishaw, CTO of Fortify 24×7. “We expect our partnership will yield outstanding benefits for our mutual clients, and position our combined resources in a way that other competitors cannot match.”
NIX, founded in 1994, is a team of more than 2,000 specialists across the globe, delivering custom software solutions for its clients. NIX resources put its expertise and skills at the service of client businesses to pave their way to their leadership in industries from financial services, healthcare, pharma, and countless others.
Fortify 24×7 is an IT services company founded in 2015, recently listed in the top 20 ofCHANNELe2e’s 2019 top 100 MSP’s and fourth in the healthcare vertical. Fortify24x7 helps organizations address evolving security threats through Cybersecurity Managed, a US-based 24x7x365 security operations center (SOC) with military-grade tools and expertise. Fortify 24×7 leverages the most advanced threat detection and protection technology in the industry, and their global reach supports customers as IT and security needs scale as a business grows.
Technology has always been at the forefront of improving our understanding of diseases, but the rise of big data has taken this to new heights. Big data in healthcare isn’t new, but it is worth discussing over and over again because it has not yet reached its full potential. No one even knows what its full potential looks like yet.
Even still, the application of big data in healthcare has now reached a point where it’s producing meaningful results not only for researchers but also for clinicians and patients.
Big data has provided changes to the way people in healthcare and research work, but what about the changes it’s provided to specific treatments? These changes are already here, and they’re indicative of both what’s to come and what’s possible for both individuals and patient populations.
What is Big Data in the Healthcare Context?
Big data is a broad concept with applications in a wide swath of fields. In the healthcare context, big data refers to the practice of collecting, analyzing, and using data from many different sources, including patient data, clinical data, consumer data, and physical data. In the past, it was possible to collect only a few types of data in smaller volumes because the tools needed to process and apply it were unavailable.
In this way, big data goes hand-in-hand with other technological developments, like machine learning and artificial intelligence (AI). Before machine learning, both clinical studies and applications were massively limited in terms of their scope: you could only handle a certain volume of data or a set variety. Veracity was also a problem with big data sets, which impacted the validity of studies.
Today, big data is a huge part of healthcare. You can find it in the creation of electronic health records (EHRs), pharmaceutical research, medical devices, medical imaging, and genomic sequencing. It differs from previous advances because it encompasses what data scientists call the 3Vs of Big Data: volume, velocity, and variety.
Big Data Reintroduces Old Treatments
Evidence-based medicine is at the core of modern practice. From diagnosis to treatment, physicians and specialists rely on an extensive foundation of research before making decisions. Medical big data has the ability to impact predictive modeling, clinical decisions, research, and public health. But it does so with greater precision: big data uses temporal stability of association. It leaves causal relationships and probability distributions behind.
Hypertension represents an ideal case study of the impact of big data on medicine. Despite the various effective medicines, including beta-blockers, the rates of uncontrolled hypertension in the general population are still very high. Scientists are using big data and machine learning to identify other drugs that may be working against beta-blockers to prevent the patient from gaining control of their blood pressure. One study identified proton pump inhibitors (PPIs) and HMG CO-A reductase inhibitors as drugs that weren’t previously considered to be antihypertensive but that actually improved success rates in hypertension treatment.
Without big data, it would be both time-consuming and expensive to rerun studies on these kinds of drugs. Moreover, there simply wouldn’t be enough data available to do it.
More than half of Americans have experienced the sick feeling that comes with opening a medical bill they assumed would be covered by insurance. Surprise medical bills are on the rise, often driven by services administered at an in-network facility using out-of-network providers.
NIX, a leading organization in the development of custom software solutions, announces that it is embarking on a partnership with Fortify 24×7, award-winning cybersecurity, and IT services company, to offer managed services that serve the evolving cybersecurity needs of NIX’s customers.