Medical DebtHow Can The Medical Debt Responsibility Acts of 2011, 2012 and 2013 Improve Medical Debt Collections?

U.S. Representative Heath Shuler introduced the Medical Debt Responsibility Act of 2011, H.R. 2086, with the support of three bipartisan Cosponsors. This bill intended to require credit agencies to remove paid or settled medical debt up to $2,500 per collection from credit reports within 45 days. This bill in its general form was reintroduced on 3/1/2012 as the Medical Debt Responsibility Act of 2012 and again introduced on January 28, 2013  as the S. 160: Medical Debt Responsibility Act of 2013.  The 2013 bill was referred to the Senate Banking, Housing, and Urban Affairs committee by its sponsors, Senator Jeff Merkley and co-sponsor Lacy Clay Jr.

Representative Heath Shuler, the initial sponsor of the legislation was quoted as saying that “Small amounts of medical debt cause huge credit problems for millions of responsible, hard-working Americans who have suffered an illness or accident,”. “This legislation would be a win for consumers and the economy. By keeping cleared medical debt off of credit reports, this bill will allow more Americans to have the credit score they deserve and need to buy homes and stimulate economic growth in their communities.”

Currently, medical debt that has been paid or settled can remain on consumer credit reports for up to seven years. An estimated 44 million Americans under the age of 65 have medical debt or medical bills being paid off over time and today 30,000,000 working-age American adults were contacted by a collection agency for unpaid medical bills. Medical bills account for more than half of all non-credit related collection actions reported to consumer credit reporting agencies. According to the Commonwealth Fund, medical bill problems or accrued medical debt affects roughly 73,000,000 working-age adults in America.

The passing of any of the aforementioned congressional bills would benefit the economy and consumers; however, it could also benefit medical providers and collection agencies. Providers have written off millions of dollars from consumers who have skipped payment on their self-pay balances, leaving their medical bills unpaid. Should any of these bills pass in their general form, it could give consumers the motivation to keep their credit clear and pay their outstanding medical bills under the $2,500 threshold. If consumers are moved by new medical debt laws and begin to pay a greater portion of their medical bills that are under the threshold, it could add millions of dollars to providers bank accounts.

Rep. Nydia Velazquez (D-NY), a Ranking Member of the House Small Business Committee an original cosponsor of H.R. 2086 bill said “Medical debt is not a reliable indicator of credit risk, yet nearly a quarter of Americans has seen their credit scores plummet because of small, routine medical bills,” “This bill provides a commonsense, simple solution to address this problem now and protect consumers in the future.”. Rep. Ralph Hall (R-TX) said “I am pleased to be a sponsor of the Medical Debt Responsibility Act,” said . “This bill, which costs the taxpayer nothing to implement, is a bipartisan effort that recognizes the difficulties and inconsistencies relating to medical debt. At a time when our economy is unstable, this is a small but important step to bolstering financial certainty for Americans.”

To some, this information is old news. This subject has been discussed at nauseam over the past three years. The fact that this bill still sits in the Senate Banking, Housing, and Urban Affairs committee makes me wonder what our lawmakers are really doing in Washington? The website Govtrack.us still says the bill has a 1% chance of passing. It’s really comical…. the world is changing at warp speed yet our legislators often move at a snail’s pace. Do they spend some of their time creating bills that have little chance of passing just so they can put their publicists to work creating positive public relations stories?

If this legislation should ever pass (the chances are slim to none), do you believe it will bolster financial certainly as Representative Ralph Hall believes? I don’t think so. Do you believe that Medical Debt legislation could pass in the near term or will future efforts to legislate Medical Debt collection of this type end up Dead on Arrival? I say, DOA!

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Phil C. Solomon is a healthcare finance and revenue cycle BPO strategist with experience spanning three decades. He is a sales, business development and marketing professional who provides business solutions for hospitals, health systems, large physician groups and channel partners. Phil has deep domain knowledge and expertise in revenue cycle optimization, clinical documentation improvement, healthcare technology integration and BPO outsourcing He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

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Protected Health InformationIt seems like every day, we hear another story in the news about a breach of security that caused personal health information and financial information to be lost or stolen by hackers and thieves.

With the increasing incidences of healthcare related breaches, providers must become more diligent in securing protected health information (PHI).

The HITECH Act, implemented and enforced by HHS, CMS, and OCR, and recently updated and finalized in the HIPAA Omnibus Rule seems to be having a slight positive impact on security. Even though payers and providers have stepped up their game securing data; the risks for data loss are still present.

According to Redspin, a healthcare IT security firm, there has been an explosion of protected health information security incidents over the past five years. For example, the following is a summary of healthcare breach highlights from 2009 through 2013:

– 804 breaches of protected health information since 2009
– 29,276,385 patient health records affected by breach since 2009
– 7,095,145 patient health records breached in 2013
– 137.7% increase in the number of patient records breached in 2012-2013
– 85.4% of the total records breached in 2013 resulted from the 5 largest incidents
– 4,029,530 records breached in the single largest incident
– 83.2% of 2013 of patient records breached in 2013 resulted from theft
– 22.1% of breach incidents in 2013 resulted from unauthorized access
– 35% of 2013 incidents were due to the loss or theft of an unencrypted laptop or other portable electronic device
– 20% of protected health information (PHI) breaches have involved a business associate each year from 2009-2013

The Annual Report to Congress on Breaches of Unsecured Protected Health Information for 2011 and 2012 identified the type of breaches, the causes of data breach and the source of data breaches. They are listed in order as follows:

Breaching Entity
1. Providers
2. Business Associates
3. Health Plans

Causes of Data Breach
1. Theft
2. Loss of PHI
3. Unauthorized Access
4. Hacking/IT incident

Sources of Breach
1. Laptop
2. Paper
3. Server
4. Desktop Computer
5. Other Portable Device
6. Email
7. Electronic Medical Records
8. Other

Here are some steps to protect patient’s health records and data in your organization:

1. Provide security awareness and privacy education training for your staff
2. Review and update your physical security and access control policies
3. Update the controls to protect networks to ensure safeguards against unauthorized users accessing PHI through such mechanisms as:
– Computer auto-locking and screen saver locks
– Unique usernames and password protection
– Extensive logging of computing activity
4. Physical access controls that include, but are not limited to the use of:
– CCTV coverage 24×7
– Proximity badge access and logging controls
– Periodical review of access rights and reconciliation
5. Incident Response
6. Adherence of Red Flag Rules
7. Develop a comprehensive incident response program to ensure proper and prompt identification of potential threats to physical and data network
8. Train the staff on proper notification channels if patient information compromise
9. Perform internal quarterly security risk assessments to ensure ongoing compliance and gap remediation between evaluation periods
10. Contract with a third-party security firm annually to perform a security assessment

More entities are following the advice of experts and updating (or creating) their security risk mitigation strategies for protected health information to secure their data and prevent breaches from occurring in the future. Let’s hope the results in 2014 shows a decline of security events. If so, I think we’ll all sleep better at night.

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Phil C. Solomon is the publisher of Revenue Cycle News, a healthcare business information blog and is a featured speaker at many industry educational conferences. As a business solutions provider, he leverages the latest revenue cycle optimization, medical coding, technology integration and BPO outsourcing strategies to produce sustainable financial improvements for hospitals, health systems, large physician groups and business partners.  

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Electronic Health Records: So Appealing, but Not Without a Cost

EHRComputers are nothing new to healthcare. They have been used for decades in physicians’ offices and hospitals for billing and insurance purposes as well as for some miscellaneous record keeping within practices. Nearly all advanced medical equipment used in diagnosis and treatment has long been computerized and automated with software. Now, the government wants to ensure that its Medicare and Medicaid patients will be cared for by physicians who are taking full advantage of this wave of health information technology by rewarding them for using Electronic Health Records (EHR).

Not surprisingly, the benefits of system-wide EHR are truly plentiful and the government wants to encourage EHR adoption as much as possible. To that end, the Center for Medicare and Medicaid Services (CMS) has established criteria called “Meaningful Use” that nudges and incentivizes providers to take the dive into a completely electronic practice. The program exists in a three stage compliance timeline, of which we are currently in Stage 2.

Though the specific advantages of EHR are too many to list here they may be said to stem from three main categories of mandated functionality and interface: clinical decision support tools (CDS), computerized physician order entry (CPOE), and the health information exchange (HIE).  Given the problems of paper records, such as the storage space required, the difficulty in locating and updating records, illegibility of records, and the immense challenge of coordinating communication, the transition to electronic seems like a “no-brainer.” Many of these problems are hoped to fade into unhappy memories, joining other ancient obstacles like hand-washing clothes.

However, when considering the transition to EHR, every provider is faced with an important question – “Is it worth it?” Does the transition to EHR truly provide a positive return on investment? Adding to that, are the government incentives actually succeeding in increasing the numbers of providers who convert to EHR? NueMD, a medical billing software and EHR company, recently produced an infographic detailing this dilemma – “Is Meaningful Use Helping or Hurting EHR Adoption?” There were indeed some interesting findings. For instance, provider satisfaction with EHR has actually decreased since the implementation of Meaningful Use. Attestations to Meaningful Use have also significantly decreased in 2013, as compared to the previous year, signifying that the momentum it created has quickly been lost. The reality isn’t as bright as one would predict for such great technology.

Additionally, the criteria for compliance with the different stages of Meaningful Use have drawn some criticism among healthcare and IT professionals.  Most of them have conflicting views on the priority of one feature of software functionality being implemented at an earlier stage than another feature of functionality.

In the meantime, the concerns of private practice doctors center around the time and cost of implementation especially with respect to the time needed to become proficient with the new system. Transitioning to any new software requires time and experimentation to find one’s way around. Finding that time means even longer hours and impacts every aspect of the practice, not to mention the frustration of having to contend with the demands, bugs and gremlins of the new software. Despite that the  purchase price of authorized EHR software has fallen dramatically and that eligible providers can qualify for the incentive payments to cover or defray the costs, many providers still remain stubborn in making the transition from paper. The disruption to the practice and its staff while they learn the new system is a serious obstacle faced by overburdened private practitioners in the already stressful industry that is healthcare.

Author: Carl Bergstrom is a registered nurse and writer with a passion for health technology. He also has experience as software developer for a company that specialized in health information technology.

Benefits and drawbacks of electronic health record systems. (2011, May).

Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270933/

Electronic Health records: The Good, the Bad and the Ugly. (2013, October).

Retrieved from http://www.beckershospitalreview.com/healthcare-information-technology/electronic-health-records-the-good-the-bad-and-the-ugly.html

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Phil C. Solomon is the publisher of Revenue Cycle News, a healthcare business information blog and is a featured speaker at many industry educational conferences. As a business process strategist, he leverages the latest revenue cycle optimization, medical coding, technology integration and BPO outsourcing solutions to produce sustainable results for hospitals, health systems, large physician groups and business partners.  

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This post’s content provides a great reminder to think twice before you email. Several years ago I had an employee who was very passionate about almost just about everything. He would get fired up and write these scathing emails that would get him into trouble. I suggested that when he is upset, write the email and save it. Look at it in the morning and if it is still applicable, go ahead and send it. If not, make the changes necessary and send the updated version. Sometimes I need to take my own advice!

3 Smart Questions To Ask Before Sending An Email

Keyboard PicGrowing up my Dad used to tell me, “be careful what you put in writing, once your words are in ink, they can only be forgiven, not forgotten.

With email as my main source of communication this is scary. And the average business person (including myself), sends/receives 110 emails per day. But oddly enough, there is very little training on proper email etiquette, protocol, and structure. Even scarier is this statistic…

Businesses Lose $650 Billion Per Year From Unnecessary Emails.
Furthermore, 10% of employers have actually fired staff for sending repeated “non-work-related” emails to other colleagues. Are you one of these people sending unnecessary email? Are you wasting people’s time? Are you costing your business or employer money? I’ve put together a few questions that will help you not only value people’s time, but determine if that “important email” is really that important.

1. Can I put NNTR at the end of my email?

When someone sends you an email, it’s courteous to think, “I’ll just respond to let them know I got their email.” Wrong. This costs both you and the receiver unnecessary time. Try getting in the habit of listing “NNTR (no need to respond) at the end of your email if it’s appropriate. This saves everyone time and tells the receiver you value their work hours.

2. Can I “Un-CC” someone?
I feel so bad for the poor souls CC’d to group emails. Sure there are exceptions, but more times than not, people are just trying to be courteous. This is not the way. Next time you see 3 people listed on the CC of an email, use your discernment and ask yourself, “can I remove one or two of them?” Be a hero and give someone back a few minutes of their life. They will be forever grateful.

- Read the rest of the story at: See more at: http://dalepartridge.com/5-hard-questions-ask-sending-important-email/#sthash.KmvhwATI.dpuf

By Dale Partridge On 7/15/2014

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Phil C. Solomon is a healthcare finance and revenue cycle BPO strategist with experience spanning three decades. He is a sales, business development and marketing professional who provides business solutions for hospitals, health systems, large physician groups and channel partners. Phil has deep domain knowledge and expertise in revenue cycle optimization, clinical documentation improvement, healthcare technology integration and BPO outsourcing He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

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Revenue cycle news

Summary: Profitability can be achieved through addressing the denials portion of the revenue cycle.

Are you struggling with profitability? Have you reviewed your revenue cycle? Do you know why your claims are being denied? Have you analyzed your processes both human and technology?

Below are 10 steps to boosting profitability through the revenue cycle:

1.     Audit Claims.

In order to boost revenue through the revenue cycle, a thorough review should be conducted of denied claims over the past at least 3 months, preferably the last year.

2.     Root cause analysis.

Why are these claims being denied? Perform a root cause analysis to determine why claims are being denied. Are they missing required authorization? Were inappropriate billing codes used? Was a particular field missing? Were they filed late? Was it a system error with the billing system?

3.     Review the claim submission process.

A review of the claim submission process from start to finish might point to areas of inefficiency which could be slowing down the process. This analysis should involve input from the front-line staff demonstrating the process rather than upper management’s perception of the process. This also promotes greater buy-in from the staff knowing that their input matters.

4.     Fix any system issues.

Any issues such as incorrect CPT codes need to be addressed immediately to mitigate the denied claims.

5.     Educate the staff.

Once the root cause analysis is complete, it is critical to share the uncovered information with the staff in a constructive not punitive manner. If this step isn’t completed, the claims will continue to be denied and the organization will continue to lose profits through the revenue cycle.

6.     Resubmit claims.

Can these denied claims be resubmitted? Are they still within the timeframe to do so? Can you recoup some of your profits lost through denials.

7.     Review, review, review – and then review again.

Going forward, processes need to be put in place to make sure all claims are reviewed and audited prior to submission. Submitting clean claims reduces the time, effort, and cost involved with looking at claims a second time, fixing any errors, and going through the resubmission process.

8.     Set goals.

Once everyone has been educated and processes are in place to review claims prior to submission, goals should be set and shared with all staff.

9.     Monitor and document progress.

Make sure a mechanism is in place to monitor progress toward achieving goals. Where are we now? How far have we come? This should occur at least on a quarterly basis.

10.   Celebrate milestones and successes.

Achieving goals and celebrating those successes with the staff round out the process toward increasing profitability. The process should be a fluid and continuous, always striving to increase efficiency and profitability, always asking how things can be done better.

One of the easiest ways to increase profitability is through managing the claims process. Auditing, reviewing, documenting, and monitoring will begin to turn your profits around.

The post was written by Linda Ringquist, a Marketing Consultant for BHM Healthcare Solutions. BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services including healthcare transformation assistance, strategic planning and organizational analysis, accreditation consulting, healthcare financial analysis, physician advisor/peer review, and organizational development.

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Phil C. Solomon is a healthcare finance and revenue cycle BPO strategist with experience spanning three decades. He is a sales, business development and marketing professional who provides business solutions for hospitals, health systems, large physician groups and channel partners. Phil has deep domain knowledge and expertise in revenue cycle optimization, clinical documentation improvement, healthcare technology integration and BPO outsourcing He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

 

 

 

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 – Delivery of services, such as medical coding can keep up with healthcare’s growing demand, even though there aren’t enough qualified U.S. employees to fill those highly skilled jobs

– Providers benefit by reducing operating costs so existing services can be delivered at the same level without resorting to employee layoffs

– U.S. citizens benefit by receiving better care because providers can leverage operating costs savings and invest in advanced technologies and the best and brightest care providers

Not everyone is in favor of outsourcing work overseas, however the atmosphere is changing. Offshore BPO outsourcing soon will becoming less of a lightning rod than it has been reported Manufacturing and Technology News.  U.S. federal agencies involved in economic data are on the verge of a major and transformative change in the way they classify companies that have outsourced their U.S. production to foreign manufacturing and service contractors.

The change could radically increase U.S. production statistics by classifying “factoryless goods producers” as domestic manufacturers. Companies like Apple will no longer be considered “wholesale traders,” and their sales would be counted as U.S. production, even though none of their manufacturing is in the United States.

The changes now being finalized by the U.S. government would be implemented in the 2017 North America Industry Classification System when factory-less goods and services producers will be classified as U.S. producers. The new classification system of manufacturers would introduce “significant discontinuity” to a wide range of statistics gathered by the government, say those involved. This same change in classification will affect those American companies who own and run offshore service centers.

The practice of outsourcing is as old as business itself. A 19th-century manufacturing company might have had its own machines but not its own fleet of horse-drawn drays to distribute its wares. Today, many U.S. citizens, American companies and State run organizations still assail work performed by offshore manufacturers and service delivery companies. That sentiment hasn’t slowed the growth, acceptance and economic boon offshore outsourcing has experienced.

Those who question the strategy of global outsourcing should consider how their lives would be different without it. It is commonplace to buy goods and receive services from around the globe. For example, consumers don’t give it a second thought when they purchase a Canon Camera that is made in China, a Blackberry Cellphone that is made in Canada, Clinique Makeup made in Belgium and even produce imported from Chile. How many people would own iPhone’s today if they cost $2,500? If they were manufactured exclusively in the U.S., they likely would cost that much or more.

The State of New Jersey has taken a different approach to addressing the growing trend of offshore outsourcing of services. Due to its 2005 State law that prohibits foreign outsourcing of State services contracts, New Jersey residents won’t experience any of the benefits offshore service providers can offer. New Jersey’s decision to outlaw outsourcing of State services has created quite the conundrum. When President Obama attends a State run event wearing one of his expensive Ermenegildo Zegna suits, made from fabrics in Italy and constructed in Switzerland, is he acting un-American by attending a State run event wearing goods that were made offshore?

Is it un-American to support U.S. based companies who deliver services from offshore locations?  Should State run or non-profit healthcare providers shun offshore BPO outsourcers? It isn’t an easy decision to make for some providers. When deciding to offshore or not offshore BPO work, decision makers should consider how the global economy has changed their own purchases and their quality of life.

Many of the products and services purchased from the neighborhood Home Depot, Wal-Mart, Target, or grocery store comes from across the globe. Its becoming more difficult to find products and services exclusively made or delivered in the U.S.A. Many manufacturers such as BMW are leveraging a blended-shore approach by manufacturing their parts in Germany and assembling their cars in South Carolina. Many industries have embraced a global business strategy. Perhaps it’s time for healthcare providers to consider expanding the use of offshore outsourcers.

Note: I’m a patriot and I feel fortunate to be a citizen of the greatest country in the world. I am pro-American and I want to see our economy flourish. That said, our country is competing on a global stage where business competition is the major driver for operational strategy adjustments and change. American businesses need to be more nimble than ever. Healthcare providers need to do the same. In order to maintain their mission, medical providers must deliver the margin to stay in business. If offshore outsourcing helps providers stay competitive and thrive, then the strategy should be carefully considered. PCS

See the article from the Manila Standard Today BPOs changing Metro’s landscape Manila on Scoop.itREVENUE CYCLE NEWS

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Phil C. Solomon is a healthcare finance and revenue cycle BPO strategist with experience spanning three decades. He is a sales, business development and marketing professional who provides business solutions for hospitals, health systems, large physician groups and channel partners. Phil has deep domain knowledge and expertise in revenue cycle optimization, clinical documentation improvement, healthcare technology integration and BPO outsourcing He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

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See on Scoop.it – Phil Solomon’s POSITIVE NEWS NETWORK

Forbes 9 Core Behaviors Of People Who Positively Impact The World Forbes Those with huge positive influence understand the power of relationships, connection, and engaging with the world openly.
See on www.forbes.com

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President’s Council of Advisors on Science and Technology urge faster shift to value-based payment – New Ideas for Creating Change

Healthcare

Monumental changes must occur so our healthcare system can transition to value-based care. The change required for providing and paying for healthcare using a completely different model is analogous to moving the Moon closer to Earth so we can have another place where we can vacation. The task is enormous and a very important one. It begins with the payer’s decision to adopt a value-based reimbursement model so the rest of the industry can support the change and begin delivering healthcare in a completely different way.

We should lean on payers to belly up to the bar and begin the reconstruction needed to affect the massive change. Changing the payment structure of healthcare is projected to improve the overall health of our citizens. I’m certainly in favor of that. At the same time, we should ask President Obama and his team at the White House to work toward simplifying the tax code, reducing taxes and stimulating the economy so patients have the money to pay their higher Healthcare Exchange Insurance costs, higher deductibles and higher co-pays. Enjoy the rest of this article. Click here if you would like to research the President’s Council of Advisors on Science and Technology’s report. – Phil C. Solomon

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June 3, 2014 | TODAY’s TOP STORY: Insurers should speed up the adoption of value-based reimbursement so the entire healthcare industry can implement systems-engineering principles that will boost efficiency of care, says a new report from the President’s Council of Advisors on Science and Technology.

Systems-engineering principles, which already have benefited other industries, analyze and measure complex systems to improve efficiency, productivity and quality, PCAST notes. Implementing these tools could help payers and providers eliminate one of the root causes of rising healthcare costs–inefficient care. But a systems-engineering method can’t be applied until insurers shift away from fee-for-service payment to a value-based system.

The current fee-for-service payment is exactly what encourages inefficient care. And although a “small number of healthcare organizations” have implemented systems-engineering into their processes with “dramatically positive results,” the report says incorporation on a widespread scale requires value-based payment as the dominant reimbursement method.

“To support needed change, the nation needs to move more quickly to payment models that pay for value rather than volume,” PCAST Co-Chairs John Holdren, director of the Office of Science and Technology Policy, and Eric Lander, president at the Broad Institute of Harvard and MIT, wrote in the report’s cover letter to President Barack Obama. “These new payment models depend on metrics to identify high-value care, which means that strong quality measures are needed, especially about health outcomes,” they wrote.

With widespread use of value-based care, the U.S. healthcare system can apply systems-engineering to redesign processes of care around the patient, in conjunction with support from community and medical resources, according to the report.

The PCAST also recommended the U.S. Department of Health and Human Services lead efforts to develop a “robust” national health information infrastructure, including urging providers to adopt interoperable electronic health records, FierceHealthIT previously reported.

To learn more: – here’s the report (.pdf)

By  – Subscribe at FierceHealthPayer

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Phil C. Solomon is a healthcare finance, clinical documentation and revenue cycle BPO strategist with experience spanning two decades. Phil has expertise in the areas of revenue cycle optimization, clinical documentation improvement, healthcare technology integration and BPO outsourcing. He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

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What processes have you put into place to affect CDI?

  • Meaningful Use Stage 2, including Electronic Medication Administration Records
  • ICD10, including clinical documentation improvement and computer assisted coding
  • Replacement of all Laboratory Information Systems
  • Compliance/Regulatory priorities, including security program maturity
  • Supporting the IT needs of our evolving Accountable Care Organization including analytics for care management

One part that crosses the 5 work streams is how electronic documentation should support structured data capture for ICD10 and ACO quality metrics.

How are most inpatient progress notes documented in hospitals today? The intern writes a note that is often copied by the resident which is often copied by the attending which informs the consultants who may not agree with content. The chart is a largely unreadable and sometimes questionably useful document created via individual contributions and not by the consensus of the care team. The content is sometimes typed, sometimes dictated, sometimes templated, and sometimes cut/pasted. There must be a better way.

Imagine the following — the entire care team jointly authors a daily note for each patient using a novel application inspired by Wikipedia editing and Facebook communication. Data is captured using disease specific templates to ensure appropriate quality indicators are recorded. At the end of each day, the primary physician responsible for the patient’s care signs the note on behalf of the care team and the note is locked. Gone are the “chart wars”, redundant statements, and miscommunication among team members. As the note is signed, key concepts described in the note are codified in SNOMED-CT. The SNOMED-CT concepts are reduced to a selection of suggested ICD-10 billing codes. A rules engine reports back to the clinician where additional detail is needed to justify each ICD-10 code  i.e. a fracture must have the specifics of right/left, distal/proximal, open/closed, simple/comminuted.

The following is a new process designed to improve the capture of data and create better work flows for coding.

Module 1  – disease specific templates

Module 2  – technology to capture free text and populate the templates i.e. my Wikipedia/Facebook concept describe above.

Module 3  – natural language processing to codify SNOMED-CT concepts

Module 4  – mapping of SNOMED-CT concepts to ICD10 codes

Module 5  – rules to ensure documentation is complete enough to justify the ICD10 codes

Industry leaders like Kaiser, Geisinger and Mayo are already working on elements of this approach. There will be challenges. They are:

1.  Clinicians are not broadly trained in the use of SNOMED-CT. It may be that SNOMED-CT should be used for internal storage of structured data but only friendly plain text descriptions are displayed to users.

2.  Will CMS, the Joint Commission, and malpractice insurers accept the concept of jointly authored care team notes?

3.  Implementing all 5 applications/modules at once may be too much change too quickly, making the overall project high risk

4.  Will SNOMED-CT map to ICD-10 cleanly enough to ensure neither upcoding nor downcoding, but “right coding”

5.  Will companies be willing to create such modules/services at a time when few EHRs are likely to interface to them? As Meaningful Use Stage 3 is finalized, I expect some of this functionality to be required

We now have 15 months before ICD-10 compliance is required and complete documentation in support of the new codes must be available. The radical change must happen quickly in order to experience the full benefit. What are your thoughts?

Read the complete article here 

Author: John D. Halamka, MD, MS, is Chief Information Officer of Beth Israel Deaconess Medical Center, Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the HIT Standards Committee, a full Professor at Harvard Medical School, and a practicing Emergency Physician.

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Phil C. Solomon is a healthcare finance, clinical documentation and revenue cycle BPO strategist with experience spanning two decades. Phil has expertise in the areas of revenue cycle optimization, clinical documentation improvement, healthcare technology integration and BPO outsourcing. He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

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This post isn’t focused on the attributes and success of a healthcare leader. It highlights the strength and commitment any leader must possess to succeed at any endeavor they choose.

I read this article about Sara Blakely and was astonished at the success she has achieved. The real story is not Sara’s rise to become the top woman billionaire in the world, but the rules she followed to achieve greatness. Below are 5 simple rules anyone can follow to become successful in their business life.

Healthcare Leaders

Blakely launched a start-up with $5000 in savings to becoming the youngest self-made female billionaire in history. She has a net worth of $979.1 Million, is listed on Forbes as the #1565 of Billionaires worldwide, #474 of Billionaires in United States and #90 of the most powerful women in the world.

She experienced business success through her vision that women of all sizes can look great, regardless of what they decide to wear. You see, Blakely gave the world Spanx: the world’s first invisible pants.

Given her notable first in the Global Rich List, you might think that Blakely is a completely driven alpha female. Interviewers have remarked on her incredible energy and passion for helping women look and feel their best, but also on a vulnerability, empathy and honesty which they have found most endearing.

These qualities are reflected in Blakely’s answer to the question, “What advice would you give entrepreneurs or intrepreneurs?”

  1. Pay it forward. Solve people’s problems, make their lives easier, make them happier and the money will follow.
  2. Go with your gut. It seems to know things your head doesn’t.
  3. Push through your fear. Blakely says she was terrified when she started her business and still pushes herself through her fears every day, which include flying all over the world, despite a chronic fear of flying.
  4. Spend time each day on your own: ideally at least half an hour in silence. Blakely says that the best ideas always come to her while she is having her evening soak in the bath.
  5. Believe in your work and treat failure as a key part of the process. Blakely said she heard the word “No” over a thousand times before someone first said “Yes” to her idea.

Great Healthcare leaders are not born, they rise to the top because of their desire to succeed, their commitment to their organization and their strength to break through any impediment in order to achieve success.

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Phil C. Solomon is a healthcare finance, clinical documentation and revenue cycle BPO strategist with experience spanning two decades. Phil has expertise in the areas of revenue cycle optimization, clinical documentation improvement, healthcare technology integration and BPO outsourcing. He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

 

 

 

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ICD-10 Debate – Who Will Come Out The Winner?

by Phil C. Solomon March 30, 2014

7 Strategies to Stay The Course – Continue Preparing for ICD-10 Transition CLICK THIS LINK TO VIEW THE ICD-10 DEBATE Today the Senate is scheduled to vote on a bill (HR 4302) that would implement a temporary fix for Medicare’s sustainable growth rate formula and delay the ICD-10 compliance deadline until 2015, The Hill’s “Floor […]

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