CHIME and HIMSS are in the news again, and this time you’ve got to love that they are — for sticking up for what they, as organizations, believe in. Their flexing of a little muscle is for telling ONC that its leadership and its current efforts just are not good enough; referring to the announcement that Dr. Karen DeSalvo, current national coordinator for health information technology, is splitting here duties between ONC and HHA, where she’s battling Ebola.
CHIME, especially, is known for its bravado, one of the reasons I find it such an intriguing organization to watch. Its messages are always loud and clear, and unadulterated; just what we need in an overly PC public where “the folks” are supposed to take what’s given to them.
CHIME and HIMSS’ letter is more about the overall leadership changes taking place at ONC and the organizations’ apparent difficulty keeping leadership in place; DeSalvo has led the organization for less than a year. “We are concerned with leadership transitions currently occurring within the Office of the National Coordinator for Health Information Technology (ONC); changes which could have a detrimental effect on ONC’s role in HHS’ charge to positively transform our nation’s health system,” CHIME and HIMSS’ letter to ONC states.
“Health IT is a dynamic field; to successfully address the needs of patients, providers and developers, ONC’s leadership team must be in place over the next two years. Such constancy will pay huge dividends in navigating all the changes that must occur for positive transformation.”
CHIME and HIMSS point out the obvious in their missive: That ONC faces a public that perceives its leadership as not wanting to be at the organization, much in the same vein as what’s going on at the White House amid reports that a disengaged Obama is counting down his last days as President.
As ONC’s leadership publically takes a willy-nilly approach, CHIME, HIMSS and others are done looking on wondering what’s up and are starting to demand some action. A half-hearted approach to leadership is not going to work, not now, not after so many of its programs that ONC lobbied for and put in place while practices and health systems looked on wondering how to deal with the swarm of new mandates and regulations.
Being adiehard Kennedy fan, this is what I’d normally quote to someone purchasing the latest commodity, or acquiring the latest service that everyone is flocking to stores to get – Conformity is the jailer of freedom and the enemy of growth. However, outsourcing medical billing is a different ballgame altogether.
I’m often confronted by worried physicians who are already overwhelmed by a recent deployment of an electronic health record (EHR) system at their practice when they hear that the clinic next door is outsourcing medical billing. With an expression that could easily pass off as ICD-9 code number 564.0 (a person suffering from constipation), the hesitantly ask me this: “Why is everyone outsourcing medical billing; and even if they are, why should I?”
In response to all those people and all the physicians out there having similar questions, here’s why:
1. It costs significantly lesser
Medical billing companies charge rates as low as three percent of your monthly collections to handle this process for you. Compare this with the costs of a dedicated medical billing department at your practice, and the difference will be significantly lower.
The salaries of the staff won’t be the only cost there, as they’ll need a room or office space to work in, desks and chairs to work on, dedicated equipment (computers, fax machines, printers), and miscellaneous expenses, such as stationary in addition to utility costs. Now when you accumulate all of this with the insurance packages of these staff personnel and the maintenance of this equipment, you’ll realize that the percentage of collections work out a lot cheaper.
2. A large staff base
Each practice assigns a specific budget for billing according to which many small and medium sized practices are able to employ one or two billers who handle all of the practice’s billing related tasks.
More often than not, these understaffed and overworked personnel come across situations whereby they have to decide between negotiating over denied and underpaid claims, or moving on to the numerous pending cases. Given their constraints, they choose to move on, settling for lower (sometimes zero) payments on such claims.
The large staff base of a medical billing company will rid you of this problem as they’ll have different personnel to handle different processes, resulting in the maximization of reimbursements.
Guest post by Ken Perez, vice president of healthcare policy, Omnicell.
In the wake of the U.S. 2014 midterm election, it’s natural to turn our eyes toward the future and begin to speculate about possible legislative developments, such as a permanent repeal of the sustainable growth rate (SGR), often referred to as a “doc fix.”
The SGR is a formulaic approach intended to restrain the growth of Medicare spending on physician services. The SGR requires Medicare each year to set a total budget for spending on physician services for the following year. If actual spending exceeds that budget, the Medicare conversion factor that is applied to more than 7,400 unique covered physician and therapy services in subsequent years is to be reduced so that over time, cumulative actual spending will not exceed cumulative budgeted (targeted) spending, with April 1, 1996, as the starting point for both.
In part because of the effective lobbying efforts of physicians, Congress has temporarily suspended application of the SGR by passing legislative overrides or doc fixes 17 times from 2003 to 2014. As a result, actual spending has exceeded budget every year during these years. Because the annual fee update must be adjusted not only for the prior year’s variance between budgeted and actual spending but also for the cumulative variance since 1996, the next proposed update, effective April 1, 2015, is a reduction in Medicare physician fees of 21.2 percent.
There are three reasons to be optimistic that a permanent doc fix will be passed in 2015.
Reason for optimism #1: It’s much cheaper than before.
Since 2012, the Congressional Budget Office (CBO) has released some 15 estimates of the 10-year cost of SGR fixes, usually assuming a freeze in rates (i.e., 0 percent annual updates to the physician fee schedule). These cost estimates have ranged from a low of $116.5 billion to a high of $376.6 billion. In August 2014, the CBO estimated that holding payment rates through 2024 at current levels would raise outlays by $131 billion, a figure near the low end of the range and relatively more affordable.
Guest post by Stephen Cobb, senior security researcher, ESET.
HIPAA’s privacy and security rules are often labeled as being burdensome and restrictive. The rules are increasingly criticized as ineffective and people wonder how an organization can be HIPAA compliant and still suffer a breach of protected health information.
A medical approach to answering that question might be to think about infection prevention and control. Infection control protocols exist to prevent the spread of infectious diseases. However, a patient can get infected at a hospital or clinic that has such protocols in place. The reasons for such anomalies include lapses in conformance to the protocol and inappropriate protocol relative to potential infection vectors.
Such language maps closely to the demands of healthcare data protection, which could be described as the prevention and control of unauthorized access to protected health information. Clearly there is a need for healthcare organizations and their employees to fully comply with “policies and procedures that are appropriate to the threats.” Getting people to comply requires organizational commitment from the top down, backed by the adequate equipping and educating of staff at all levels.
But what if those policies and procedures are not appropriate to the threats? What if the infection vectors are different from those you trained to defend against, or the threat agent more virulent than you supposed? That’s where a lot of health data security breaches occur, in that gap between established practices and emerging threats. The difference between being “HIPAA compliant” and “secure” often comes down to underestimating threats. Continue Reading
Healthcare leaders from across the nation are renewing calls for the Centers for Medicaid and Medicare Services (CMS) to shorten the meaningful use (MU) reporting period in 2015 and provide more program flexibility, citing concerns with lower-than-expected Medicare numbers and continued reports detailing nationwide difficulty in meeting federal guidelines for electronic health records (EHR) requirements.
According to newly released CMS numbers, less than 17 percent of the nation’s hospitals have demonstrated Stage 2 capabilities. Further, less than 38 percent of eligible hospitals (EHs) and critical access hospitals (CAHs) have met either stage of meaningful use in 2014, highlighting the difficulty of program requirements and foretelling continued struggles in 2015. And while eligible professionals (EPs) have until the end of February to report their progress, only 2 percent have demonstrated Stage 2 capabilities thus far.
Officials from the American Medical Association (AMA), College of Healthcare Information Management Executives (CHIME), Healthcare Information and Management Systems Society (HIMSS) and Medical Group Management Association (MGMA) called the results disappointing, yet predictable.
“Meaningful use participation data released today have validated the concerns of providers and IT leaders. These numbers continue to underscore the need for a sensible glide-path in 2015,” said CHIME president and CEO Russell P. Branzell, FCHIME, CHCIO. “Providers have struggled mightily in 2014, in many instances for reasons beyond their control. If nothing is done to help them get back on track in 2015, we will continue to see growing dissatisfaction with EHRs and disenchantment with meaningful use.”
CMS data required by Congress indicate that more than 3,900 hospitals must meet Stage 2 measures and objectives in 2015 and more than 260,000 eligible professionals (EPs) will need to be similarly positioned by January 1, 2015. Given the low attestation data for 2014 and the tremendous number of providers required, but likely unable to fulfill, Stage 2 for a full 365-days in 2015, healthcare leaders have pressed for a shortened reporting period in 2015, mirroring the policy of 2014.
We live on a small planet in a vast universe. Our ability to communicate globally has excelled at a lightning pace. I live in Miami, Florida, but I have spoken on this topic from many cities around the world. Within seconds my thoughts can be reported around the globe. This is a new era for innovation, communication, technology and science advancement that fosters a very rapid dissemination of new ideas from basic sciences to advanced technologies.
Back in the early 1970s there was great excitement about the new IBM mainframe system. The purpose of this new computer in the bank I worked in was to keep track of several thousand accounts and mortgages. The system filled an entire floor of the building with multiple modules. Storage was on spinning steel with magnetic tape backup and memory needed was 28mb. It was basically the equivalent brainpower of a Nematode worm or bacterium, but one that kept accurate records and basic computations without the mistakes of a human bank teller. In 1984, the Mac computer was introduced, but the computing power was the same as the room full of IBM mainframes.
Today, because of advances in materials science and miniaturization we carry in our pockets small “supercomputers.” Computing power has advanced from microbe level intelligence to that of a small mammal like a mouse. Based on predictions of computer pioneer Gordon Moore more than 20 years ago this trend should continue; Moore’s Law, which has proven fairly accurate states that computing power doubles about every 18 to 24 months. Today’s cell phone computers are close to monkey intelligence now and human intelligence in less than a decade. We are almost there today with some cell phone chips containing over two billion transistors. It is estimated that in less than a decade all the intelligence of mankind can be on a chip.
The consequences of this for mankind are enormous and could prove to be one of the greatest tools for scientific, medical and human advancement.
This is already happening. I became an early tinkerer in the development of apps for computers and published some of the first online medical textbooks and first medical books in the newer interactive ebook format. My role as a developer was unique until earlier this year (2014) when attending a developers’ conference and hearing the CEO of Apple Computer Tim Cook state through an Internet broadcast that he was welcoming the nine million app developers from around the world. He proudly stated that this was a 47 percent increase from the previous year.
It should come as little surprise to me that no matter the healthcare sector — long-term care, ambulatory or in patient, for example – most of the worries faced are the same or very similar. Many of the same levels of attention is given to many of the highly complex usual suspects – interoperability, health information exchange, accountable care, HIPAA and even mandates like meaningful use. The murmurs of those working here are often similar and there is a fairly deep collective holding of the breath in regard to advancements or developments in these areas regarding the blowing winds of how these and other issues sway constituents throughout the marketplace.
The general sentiment of individuals, those leading large hospitals and multi-location care facilities, who express their opinions and concerns to organizations like HIMSS, to name one, are the same as the concerns voiced by many of the attendees at PointClickCare’s annual user meeting, to name one, in Orlando Nov. 2-5, 2014. These same sentiments also are expressed at variety of other meetings of the minds throughout the US in similar constituent groups or with vendor and other allegiances.
Educational and work sessions held at these gatherings always have the same look and feel; the same as those expressed at PointClickCare’s Summit 2014. Engagement, connection, care; ACOs, HIEs, and managing their relationships; EHRs, interoperability, and managing this relationship and the flow of information (or doing so when the information does begin to flow); and change management strategies that provide guidance and advice for … managing change.
The information exchanged in venues such as these and the sessions themselves are valuable, of course, and needed to fill an enormous information void. Most importantly, these healthcare education sessions draw together folks seeking guidance and those needing insight, as well as provide a dash of leadership at times when much seems to be lacking. Finally, these educational sessions – quick and concise as many of these sessions may be – alleviate fear during a scary and tumultuous time in healthcare.
High-demand healthcare providers have no good system in place to drive differentiating value at the time of patient scheduling. With an increase in demand and reduction of time, doctors need to be smarter about how they run their business. Some doctors need to prioritize based on completing a specific surgery. Others need to prioritize based on the greatest opportunity for high reimbursement. But through it all doctors need to maintain a full schedule and optimized revenue while keeping their patients happy and loyal.
Opargo focuses on delivering incremental value to healthcare providers through schedule optimization. Opargo’s patent pending solution takes into account healthcare insurance payment rates, office and procedure activities, historical practice demand and availability to calculate incremental value. This perishable inventory model is similar to how scheduling and payment has been managed for many years in the travel industry to optimize yield for airlines and hoteliers. The Opargo SaaS system seamlessly integrates with a practice’s existing calendar and revenue management systems to make it easy to install and manage.
Elevator pitch
Dr. Aaron Lloyd, co-Founder, president and chief medical officer
Opargo delivers incremental revenue to healthcare providers through schedule optimization. Opargo helps healthcare providers optimize the value of time.
Product/service description
Healthcare providers have previously used a “first come first serve” or “look and book” calendar approaches to schedule patients. This is also how airlines booked passengers in the past. However, as airlines started to incorporate revenue management principles at the time of booking, they saw significant increases in revenue and long-term corporate value.
Opargo is a patent-pending solution that integrates reimbursement rates, reimbursement timing, referral sources, visit types, historical demand and more to determine the value of each visit for healthcare providers. High-value visits are given prioritization to ensure patients don’t look for other providers, as wait times greater than two weeks cause patients to “shop around.” By ensuring high value patients don’t leave, healthcare providers have seen up to a 20 percent increase in annual revenue.
However, there are benefits to the patients of healthcare providers using Opargo, too. First, all patients are seen and no one is denied medical care due to type of insurance. Opargo ensures all patients are seen at the right time. Second, Opargo leverages its proprietary algorithm to ensure patients are seen by the most qualified provider. This helps patients get the most optimal care from the optimal provider as soon as possible.
Bookings made in Opargo’s cloud-based application are automatically passed into practice management systems to ensure all down-line processes remain in-tact. Currently, Opargo integrates with GE Centricity practice solution, Greenway PrimeSuite and AthenaHealth.
