Guest post by Steve Jourdan, founder and CEO, BedWatch.
It’s a broken record – we need innovation in healthcare. Being the largest economy in the world by a significant margin, with a number of resources at our disposal, one would think that our ability to deliver healthcare services would also rank at or near the top. In fact, we don’t rank well at all. A Bloomberg ranking from last year finds the U.S. healthcare market ranked 46th in the world in terms of efficiency, with the second highest healthcare costs per capita reported[1].
But, innovation equals risk, and risk is a four letter word in healthcare, for good reason. Margins are thin, enforcement and compliance efforts related to HIPAA are increasing, and, ultimately patient care hangs in the balance at a time when reimbursement models are shifting from fee-for-service to being outcome-based. It makes perfect sense that healthcare organizations take a conservative approach to their business.
However, continuing to do the same thing will not move us forward. Private industry and even the federal government[2] are taking advantage of these advancements. Technology is here, but it needs to be embraced; current technologies need to be adopted by healthcare for the benefit of everyone.
If I can perform secure online banking and investing directly from my smart phone, provided by the highly-regulated financial industry, why do I have to wait to receive healthcare services because health workers are using the technological equivalent of a Big Chief Pad and no. 2 pencil?
There is great promise in current mobile and cloud computing technologies, in that they are more accessible, easier to use, more secure, more scalable and can enable people to be more effective. The technology advancements we need are already here.
That said, use of current technology is only half of the solution. The other half is the people side of the equation. A culture of improvement must be embraced by the organization from the top down in order for significant improvements to be realized.
Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced today that a nationwide takedown by Medicare Fraud Strike Force operations in six cities has resulted in charges against 90 individuals, including 27 doctors, nurses and other medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $260 million in false billings.
Attorney General Holder and Secretary Sebelius were joined in the announcement by Acting Assistant Attorney General David A. O’Neil of the Justice Department’s Criminal Division, FBI Assistant Director Joseph Campbell, U.S. Department of Health and Human Services (HHS) Inspector General Daniel R. Levinson and Deputy Administrator and Director of the Centers for Medicare & Medicaid Services (CMS) Center for Program Integrity Shantanu Agrawal.
This coordinated takedown is the seventh national Medicare fraud takedown in Strike Force history. The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.
Since their inception in March 2007, Strike Force operations in nine locations have charged almost 1,900 defendants who collectively have falsely billed the Medicare program for almost $6 billion. In addition, CMS, working in conjunction with HHS-OIG, has suspended enrollments of high-risk providers in five Strike force locations and has removed over 17,000 providers from the Medicare program since 2011.
The joint Department of Justice and HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. Almost 400 law enforcement agents from the FBI, HHS-OIG, multiple Medicaid Fraud Control Units and other federal, state and local law enforcement agencies participated in the takedown.
Healthcare reform, the newly insured and a growing interest in population health management are accelerating the market’s interest in telehealth technologies and services. Healthcare providers are developing integrated strategies for adopting these technologies with the goal of extending capabilities and patient interactions beyond traditional care settings. As more payers and employers begin to pay for telehealth services, the value of these tools is coming into focus. Market analyst IHS predicts the US telehealth market will grow from $240 million in revenue in 2013 to $1.9 billion in 2018, an annual growth rate of more than 50 percent, according to Forbes. Keys to the anticipated surge are the current physician shortage, an expanded patient base under the Patient Protection and Affordable Care Act and an effort to put consumers at the center of their own care.
Overcoming the obstacles
Historically, the healthcare industry has proceeded carefully in the world of digital advancements. High investment costs and uncertain return on investment have created a tenuous economic model. Healthcare providers also face three other key obstacles: uncertain reimbursement, varied state licensing laws and the potential for breaches in privacy and security.
Navigating reimbursement challenges
Reimbursement for telehealth services varies widely. Medicare pays for some services, especially in remote rural areas, but the program has several restrictions. It generally covers only services delivered “real time,” through videoconferencing, as opposed to “anytime,” through store-and-forward technologies.
Medicaid is the most common route states are taking to implement their telehealth programs. The National Conference of State Legislatures (NCSL) notes that to date, 43 states and the District of Columbia provide some form of Medicaid reimbursement for telehealth services.
Private payers need to comply with state regulations. Currently, 19 states and the District of Columbia require private insurance plans in the state to cover telehealth services, according to the NCSL. Arizona will join this list in January 2015. Nontraditional payers for telehealth services range from charitable organizations, long-term care and community health providers to self-insured groups and agencies serving special populations.
Policies continue to evolve. Several bills are before Congress to establish a federal standard for telehealth, while Medicare’s 2014 physician fee schedule will expand coverage incrementally for telehealth services.
Guest post by Clyde Wesp Jr, MD and John T. Chang, MD, PhD, MPH, Zynx Health.
For years, physicians would – and many probably still do – advise patients with dust mite allergies to buy allergen-impermeable bed covers to control their symptoms.
The problem: The use of these high-priced linens has no clinical benefit for either allergic rhinitis or asthma, according to studies published in the New England Journal of Medicine.
This is just one example of the overutilization of an ineffective practice in medicine. Indeed, the problem runs rampant, according to a recently published Mayo Clinic study. In fact, researchers identified 146 common medical treatment protocols that offer no net benefits and that either have been or need to be reversed.
Such practices could have unfortunate consequences, according to Vinay Prasad, MD, one of the study’s authors. In a supplemental video to the article titled “A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices,” the oncologist points out that the proliferation of these ineffective practices could cause harm to patients, prompt patients to lose trust in the medical community, and result in unnecessary spending. Just think: Impermeable bedding was once a $26 million industry, according to Prasad.
The Mayo Clinic study, which was based on the analysis of 10 years’ worth of research in the New England Journal of Medicine, is valuable because it opens what we believe is a very worthwhile discussion regarding the value of evidence-based clinical content and clinical decision support (CDS) solutions. Such technology can be utilized to stay on top of emerging best practices and help healthcare organizations improve patient outcomes, enhance safety, and lower costs. By providing such clinical content electronically, healthcare organizations can work toward eliminating the overutilization of ineffective practices and work toward consistently applying standardized best practices at the point of care.
Start talking
Here are just a few considerations that medical professionals need to start thinking and talking about as they consider the need for CDS technology:
#1: Quite simply, why are clinicians implementing treatment plans that don’t work? To start, medicine is based on tradition. Typically, clinicians learn from their predecessors. Thus, many practices and treatment protocols took hold two, three, or even four decades ago. Therefore, these practices could be based on outdated or incomplete evidence. Indeed, some treatment practices came into being when there was absolutely no corroborating evidence. In such cases, clinicians based their decisions on logic and intuition, simply because that is all they had to go on.
There’s little argument that overwhelming responsibility is placed on practice leaders to protect the security of patient records. Maintaining the accuracy, privacy and control of this data is one of the most crucial roles within the care setting. Given the high level of risk for exposure of this information and because of expanded enforcement of HIPAA, practices managing the release of information (ROI) must be more vigilant now than they have been in the past. Their processes for handling ROI need to meet not only the requirements of the law, but what’s in the best interest of the practices’ patients.
Along with a significant rise in HIPAA enforcement, practices must remain sensitive of how they handle the data that’s released to third parties. Redaction of personal information from records is one important way practice administrators can improve security, though it’s not the only way. Automating the removal of PHI by integrating redaction solutions with existing practice technology – such as electronic health records – searching and removing any protected information becomes electronic, eliminating a manual, repetitive process.
Removing risks associated with the release of PHI is possible with automated solutions that can remove data fields like patient name, dates of service, medication lists and other general information in the health record. But, even though solutions exist to automate the redaction of protected PHI, most organizations process records manually even as they migrate to electronic systems in other areas. Continue Reading
The past year has been a turbulent one for U.S. physicians, according to the 2014 Practice Profitability Index (PPI). The PPI was conceived in 2013 as part of a partnership between leading cloud-based health technology provider, CareCloud, and Quantia, Inc., a leader in physician engagement and alignment. The research is intended to serve as an annual barometer for the operational wellbeing of U.S. medical groups in the year ahead. 5,064 physicians contributed their insights to the second annual PPI during March of 2014. To download the entire 2014 PPI, visit: http://www.carecloud.com/practice-profitability-index-2014/
Physicians Have a Darkening Outlook on their Practices’ Profitability
The key finding of the PPI survey was that U.S. physicians are now more than twice as likely to foresee eroding, not increasing, profits in 2014. Those with a negative outlook increased from 36 percent to 39 percent during the past year, while optimists declined from 22 percent to 19 percent. The issues weighing on finances are still led by declining reimbursements (60 percent);rising costs (50 percent); requirements from the Affordable Care Act (49 percent); and the transition to ICD-10 (43 percent).
Operational Challenges Impact Patient Care
“The 2014 PPI results show that physicians are experiencing increasing strain on their practice operations as a result of healthcare reform and government mandates. This strain, in turn, affects patients – including the millions of new ones entering the system as a result of the Affordable Care Act,” said Albert Santalo, Chairman and CEO of CareCloud. “Nearly half of physicians say they cannot take on these patients, foreshadowing an access to care issue. Meanwhile, despite the hype about emerging reimbursement models, physicians are most likely to seek improvements through programs that help them engage with their sickest and most vulnerable patients.”
The complete 2014 PPI survey results, which also explore physicians’ opinions on technology adoption; time spent on administration rather than patient care; impact of healthcare reform; intent to stay independent or sell their practice; and strategies for improving operational performance, can be accessed at www.carecloud.com/PPI
Additional key findings from the 2014 PPI included:
Two healthcare organizations have agreed to settle charges that they potentially violated the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules by failing to secure thousands of patients’ electronic protected health information (ePHI) held on their network. The monetary payments of $4,800,000 include the largest HIPAA settlement to date.
The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) initiated its investigation of New York and Presbyterian Hospital (NYP) and Columbia University (CU) following their submission of a joint breach report, dated Sept. 27, 2010, regarding the disclosure of the ePHI of 6,800 individuals, including patient status, vital signs, medications, and laboratory results.
NYP and CU are separate covered entities that participate in a joint arrangement in which CU faculty members serve as attending physicians at NYP. The entities generally refer to their affiliation as “New York Presbyterian Hospital/Columbia University Medical Center.” NYP and CU operate a shared data network and a shared network firewall that is administered by employees of both entities. The shared network links to NYP patient information systems containing ePHI.
The investigation revealed that the breach was caused when a physician employed by CU who developed applications for both NYP and CU attempted to deactivate a personally owned computer server on the network containing NYP patient ePHI. Because of a lack of technical safeguards, deactivation of the server resulted in ePHI being accessible on internet search engines. The entities learned of the breach after receiving a complaint by an individual who found the ePHI of the individual’s deceased partner, a former patient of NYP, on the Internet.
Caring in Place helps family members become family caregivers for their aging loved ones. Based on the loved one’s health conditions, family members are taught what to do, when to do it and how to care for their aging loved ones. All instructions are doctor recommended and often include audio, video, images and text.
Elevator pitch
Caring in Place helps family members learn to become family caregivers for their aging loved ones. Through intelligent checklists, caregivers are taught what to do, when to do it and how to care for their seniors.
Product/service description
Caring in Place is a technology platform designed to help family members learn how to become family caregivers for their aging loved ones. Through an iPhone app, and a web portal (Android to be launched in the next few weeks), families are provided caregiving instructions based on the health conditions of their aging loved one. The platform also enables caregivers to coordinate care with other family members, friends, neighbors and even paid caregivers.
Founders’ story
Co-founders Josh Fotheringham and James Jarman met in 1996 while attending the University of Utah. Although they went separate ways with their careers, they knew that at some point they would join forces. In 2010, a friend running a skilled nursing facility in California asked for assistance with his facility. After several improvement attempts associated with Medicare billing, Josh and James began studying and interacting with family caregivers. Quickly they identified with the difficulty of caregiving and decided to help. Leveraging their backgrounds in technology, marketing and business, they started Caring in Place. In 2013 they received their first external investment from Blue Cross Blue Shield of Massachusetts and also participated in a four-month healthcare accelerator program called Healthbox. Today they are building partnerships across the healthcare ecosystem to find new and improved ways to help family members in their role as family caregivers.
