Page 32 – Quest National Services

Medicare Spending Doesn’t Lead to Increase

Increased Medicare Spending on Advanced Cancer Care Doesn’t Lead to Increase in Survival Rates

A new study has called into question the notion that increased spending on cancer care results in greater patient survival rates. The study looked at hospitals in 80 different referral regions. These referral regions collectively represented 25 percent of the US population. In order to provide a context for cancer care and its link to spending, the study focused on patients suffering from advanced cases of prostate, pancreatic, breast and colorectal cancer between the years of 2002 and 2007.

The Findings

Results of this broad study yielded some interesting results: regionally, variance in cancer care costs was high; there was a 41 percent discrepancy between the highest and lowest-spending regions of the country. Most of the lowest-spending regions lay in the Midwestern and Western areas of the country, while the higher-spending regions were mostly located in Louisiana, southern California and central New Jersey. Yet despite the large degree of variance between regional cancer care spending rates, there was no clear data to demonstrate that increased spending resulted in greater rates of advanced cancer survival. Although survival rates certainly varied by hospital referral region, this could not be linked to spending with any sort of statistical certainty. Increased spending was linked to lengthier and more frequent hospital stays, however.

This study is particularly significant when considered in light of the high cost of cancer care in general – currently cancer care represents a full 10 percent of all Medicare spending. The authors of the study called for an increased focus on providing palliative care to those with advanced cases of cancer.

The primary guiding principle for those working in the medical field is to improve patients’ quality of life. But the associated costs can sometimes be instructive indicator as to what methods work best to make this so. It should be noted however that the results of this study are somewhat at odds with a study completed between 1983 and 1999 which compared higher cancer care costs in the US to lower costs in 10 European countries – in the case of that study, increased spending resulted in two year increase in patient life expectancy.

CMS Extends Payment Programs

CMS Extends Payment Programs for Rural and Low-Volume Hospitals

Rural and low volume hospitals will be experiencing a bit of good fortune in the coming months – this is because the Centers for Medicare and Medicaid Services have recently announced an extension to provisions which provide supplemental payment to hospitals which have fewer than 100 beds and a high volume of Medicare patients. The effects of these provisions are retroactive to October 1, 2012.

These policy extensions come as part of the deal which allowed the federal government to sidestep the fiscal cliff; The American Taxpayer Relief Act includes payment policy extensions for rural and low-volume hospitals. All told, revenue for these types of institutions may increase by millions of dollars.

Payment Extension Details

In the case of low volume hospitals, payment adjustments fall within certain ranges – for hospitals with 200 or less yearly Medicare discharges, payments will be augmented by 25 percent. But for those hospitals which fall above the 1,600 Medicare discharge per year mark, no further compensation will be made available.

Nationally, it’s estimated that approximately 600 hospitals qualify for low volume status. The specific qualifiers for this designation include being outside a 15 mile range of a comparable facility as well as reporting fewer than 1,600 Medicare discharges per year. It’s estimated that collectively, these 600 hospitals should qualify for $326 million in additional compensation in the coming year.

Although these payment policy extensions come as good news to smaller facilities looking to keep their doors open, it should be noted that they are only guaranteed to be around for the remainder of the year.

Though the American Taxpayer Relief Act has provided relief for rural and low volume hospitals, it has left many public hospitals frustrated with Medicare payment structure. Because not all appendages of the healthcare system stand to benefit under the current legislation, it’s debatable whether the net effects of these provisions are in fact positive.

Infection Rates Are On the Decline

A new report from the Centers for Disease Control and Prevention shows that hospitals are making headway in reducing patient infection rates.

CDC Infection Findings

Since 2008, infection rates have dropped in a number of categories. Central line-associated infections dropped by 41 percent, and these gains in prevention were particularly strongly represented in intensive care and neonatal intensive care units. Surgical site infections are down 17 percent, and catheter-related urinary tract infections are down 7 percent from 2009 numbers.

CUSP and Mitigated Infection Risk

Much of the drop-off in infections can be specifically attributed to the implementation of the Comprehensive Unit-Based Safety Program, or CUSP. CUSP makes use of a number of methods to address infections, especially in the case of newborns. These include encouraging caregivers to consider central line removal at specific benchmarks and taking closer notes of catheter need and usage. Additionally, front-line caregivers are provided with greater space in which to express their opinion as to potential improvements to infection prevention efforts.

Hospitals which made use of CUSP saw significant reductions in infection rates. In a year-long survey of 100 hospitals across nine states which made use of CUSP initiatives, newborn central-line infections were cut by 58 percent. But CUSP was also instrumental in lowering adult infection rates as well – over a four year period, infections rates dropped 40 percent at hospitals which made use of CUSP protocols.

By applying CUSP methods, hospitals are saving lives. But they are also lowering health costs. It’s estimated that the Comprehensive Unit-Based Safety Program’s efforts to limit infection alongside other proactive initiatives have resulted in a $34 million reduction in health care costs. Although the CUSP program specifically came with a $900 thousand price-tag, it has single-handedly been responsible for $2 million in avoided infection-related expenditures.

These recent, lower infection numbers are encouraging news for health professionals of all stripes, and no doubt bode well for further development of initiatives in the same vein as CUSP.

Change in Billing Option Leads to an Increase in Medicare Spending

A new study has found that a Medicare policy change which was intended to be spending-neutral in fact led to a 6.5 percent increase in spending on medical office visits during the year 2010. This measure, which eliminated a popular consultation billing option, has been tied to a resultant increase in billing by physicians for other higher-intensity services.

Because of the elimination of the consultation billing code, CMS proportionally raised the rates for other outpatient services. This was predicted to allow costs to remain flat. But although the number of patient visits did not change over the course of 2010, the resulting Medicare costs which were billed did. The findings of this study, which examined the claims of 2.2 million beneficiaries, found that per quarter in 2010, costs per beneficiary increased by $10.20.

The authors of the study caution that their findings do not make any broad statements about the effects of coding changes in general. It is important to realize that the spike in Medicare spending during the year of 2010 could in fact be a one-off anomaly as opposed to a trend. But the researchers were able to conclude that in this particular case of Medicare billing structure alteration, the projected results of the change were out of alignment with the actual real-world repercussions.

In the years since this change was made to policy, both the American Medical Association and American College of Cardiology have pushed to have the removed consulting code reinstated. In an arena where public policy shifts can affect your bottom-line, it is important that as a physician you stay abreast of the implications of these changes. In order to ensure your continued prosperity, having a skilled medical billing provider is a logical and necessary step.

Universal EMR Implementation in Taiwan

In the United States, current regulations and incentives have been put in place to pave the way for more widespread usage of EMR technology. In a perfect world, this will eventually lead to universal compliance by medical professionals and a streamlined system that improves patients’ care, while at the same time allowing medical professionals to discover greater success. As the United States experiences a few growing pains on the way towards universal EMR usage, it is instructive to look at how other countries have implemented the technology. It is encouraging to see that EMR software is working for them.

The Road to Success

During the past 16 years, Taiwan has moved toward simplifying the way that interconnected parts of the medical system communicate with each other. EMR software plays a key role in this process by standardizing doctor-patient interactions. The country’s health insurance providers were consolidated into a single, national health insurance provider in 1994. Electronic billing was then introduced into the country in 1995, as a logical first step towards integrating new technology into the traditional medical system.

EMR and the IC Card

In 2004, Taiwan introduced the IC Project. This initiative implemented the use of “smart cards” for all patients. Taiwanese citizens carry a small card that contains their complete medical record. When the card is swiped by the patient, and a complementary card is swiped by a medical professional, the patient’s complete EMR is made available for use in their diagnosis and treatment. It is estimated that the use of EMR and IC cards in Taiwan has led to a 10% reduction in outpatient visits, as well as a decrease in both fraud and the waste of medical resources.

The United States is far from Taiwan’s universal implementation of EMRs; however, the gains in efficiency are still possible on a localized level. Try utilizing EMR software for greater improvement within your personal practice.

EMR Software: Domestic & Abroad

EMR Software: Domestic and Abroad

Though there was a time when patients and doctors were weary of such things, many people are growing accustomed to the electronic storage of their medical records. Multiple studies across Europe and North America have shown that on both continents, EMRs are much more commonplace.

The Commonwealth Fund recently released a survey stating that primary care physicians in the United States reported more than a 20% jump in their use of EMR software during the last three years. This brings United States medical facilities up to almost 70% EMR software usage.

Data gathered from Canadian physicians revealed even more insight into EMR integration. The study states that the number of doctors using EMR software doubled from 23% in 2006 to 56% in 2012.

Greater Application, Greater Benefits

It is easy to see many of the upsides to EMRs replacing paper records. Benefits include reduced environmental costs and the safety of important medical documents. EMRs also provide direct access to critical elements of medical treatment, such as allergies.

In addition, there are some less-known advantages for those that have already integrated EMR software into their medical practices. For example, 73% of patients polled said they would like e-mail or phone notifications announcing follow-up visits. Both of these communicative measures can be implemented with the use of EMR software. Other valuable aspects of EMR software include:

Letting physicians check documents to help with quicker diagnosis.
Being able to quickly scan a patient’s medicines and charts. Practitioners may then alert an administrator if there is a mistake.
Providing doctors with otherwise unreachable medical records in disaster areas.
Eliminating the need for a patient to fill out extensive paperwork on medical history whenever dealing with a new doctor.
Saving time, space, and labor that could otherwise be spent treating patients.

EMRs offer long-term support, success, and ease-of-use proving effective on a global scale. Let EMR software work hard as a simple solution for the improvement of your private practice.

Medical Billing in a Touch Economy

Medical Billing in a Tough Economy

Across the United States, and around the globe, many families are feeling the pangs of an ailing economy. The problem is, essentials such as living expenses, school expenses, and medical care remain the same. As businesses cut back on full-time employees and benefits, some families do not even have health insurance plans to supplement their health care needs. Other families are coping with underpaid work, or a lack of employment altogether.

Steps to More Effective Billing Methods

It is important to understand these present-day issues when considering payment. A medical billing and coding system is frequently the best route for a physician’s private practice. It cuts the overhead cost of acquiring money that is already owed. However, there are in-office practices the physician may implement to ensure payment and make the process less frustrating for everyone.

Here are some tips to prevent major billing difficulties:

Patients that understand the billing requirements, options, and procedures are more likely to pay. Furthermore, they are more likely to pay on time. It is wise for a medical practice to display their payment terms and billing information in an obvious area. For example, billing terms may be presented in the check-in area, so every patient is reminded of the payment process prior to seeing a physician. Key points should include health insurance requirements, the co-payment process, information on paying up-front, and any other essential billing criteria.
Another step that may be taken at time of patient check-in is to update all personal information on file. Request that each patient take a moment to review their residential address, billing address, multiple telephone numbers, employment, full name, and date of birth. It is also a good idea to occasionally double-check the patient’s social security number, since you will need this information if the case is turned over to a collection agency.
Make use of technology. High-quality billing and coding software will automatically adjust to comply with new regulations. Physicians may generate custom financial reports to assess how their practice will run in the most efficient manner.

medical billing and coding software

HIPAA Compliance Audits

HIPAA Compliance Audits: Current Beliefs, Future Expectations

By the end of 2012, 115 medical organizations will be audited for HIPAA compliance. The results of these initial audits will affect how the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) will manage future auditing efforts. Susan McAndrew, the deputy director of OCR, stated that all health care groups scheduled for HIPAA compliance audits within 2012 were pre-warned.

On behalf of OCR, McAndrew also states, “We are committed to continuing the audit program and actively engaged in looking at alternative for moving this initiative forward. We have already seen the very positive impact the audit program has had on compliance efforts even as a pilot program and we want to build on the momentum that this effort has begun.”

Future of HIPAA Conformance

It sounds unlikely that any HIPAA compliance audits will be conducted in 2013. McAndrew reasoned that the program will not be able to proceed “until all final reports are issued” and the OCR completes the slow process of evaluating results.

A former OCR official by the name of Adam Greene indicates that the analysis process is extremely time-consuming. Furthermore, Greene points out that any resulting changes within the HIPAA audit program will require a substantial amount of time as well.

Preparing for a HIPAA Audit

This may come as good news to any health care groups that are not currently being audited. The HIPAA audit was mandated by the HITECH Act. Its purpose is to measure, analyze, and manage conformance with the HIPAA security, privacy, and breach notification regulations.

If your medical organization was not already audited by the OCR, here are some useful tips for preparation:

Regularly evaluate the status of the HIPAA compliance efforts your company has in place. Assess all security and privacy standards. Organize documentation of your policies and procedures in an easily retrievable manner.
Ensure any notice of privacy efforts is regularly updated. Include all new policy information during standard communication with patients.
Retain and organize all HIPAA-related documents to provide evidence of conformance efforts during an audit. Record and document all staff training on HIPAA regulations.
Identify and keep track of all business associates. This is more complicated than it may sound. Document any privacy agreements and training involved.
Designate a team in charge of responding to a HIPAA audit notice. You will have 15 days to locate and organize any necessary documentation. If a group of briefed professionals is already in place, things will run more smoothly when the event arises.
Frequently visit the HIPAA audit protocol website. Protocol changed within this year, and it will likely change again prior to your audit.

With so many updates, don’t let anything slip through the cracks. Find out why our EMR software has your back.

News: Important of HIPAA Compliance

Results of Broken HIPAA Security Rule

Massachusetts Eye and Ear Infirmary, working in conjunction with Massachusetts Eye and Ear Associates, Inc., (MEEI) continues to cope with the aftermath of a broken HIPAA Security Rule that began over 2 years ago. MEEI must pay a total of 1.5 million dollars to the United States Department of Health and Human Services (HHS). Furthermore, the Massachusetts-based health care provider must commit to a 3-year Corrective Action Plan (CAP).

The purpose of the CAP is to improve the medical group’s overall security. During the 3 years, a government-designated MEEI consultant will conduct unannounced inspections of the facility. The consultant is required to stop by at least twice a year. MEEI’s new safety policies and procedures will be analyzed during these visits, and the consultant will report findings to the HHS.

Unexpected Complications

It’s not that MEEI did anything outrageous. The large payment and long-term CAP agreement comes as the result of an affiliated physician’s stolen laptop.

The laptop was unencrypted, enabling the thief to view private information of approximately 3,500 patients and clinical research subjects within MEEI. According to MEEI’s press release in 2010, the physician’s laptop was stolen while lecturing in South Korea. The issue was immediately reported to the HHS.

MEEI did the right thing when they immediately reported the burglary. However, they were scrutinized by the HHS Office for Civil Rights (OCR) as a result. The findings were clear: MEEI was not in compliance with HIPAA standards.

Risking Patient Privacy

Information from the 3,500 patients listed on the stolen laptop included names, e-mail addresses, birth dates, medical history, current prescriptions, and other clinical records. If MEEI was abiding by the HIPAA Security Rule, they could have dealt with a much smaller mess back in 2010. The medical group would have saved a large sum of money and years of unnecessary stress.

Time spent in a court room is time taken away from your patients’ medical concerns. Do not make MEEI’s mistakes. Through the use of our EMR software, your medical practice can achieve higher levels of security while functioning more efficiently. In addition, our medical billing services are 100% HIPAA compliant.

Use of EMR Software, Even in Rural India

International Reach

It can be difficult to find adequate health care in farther corners of the globe. Many people living in urban areas, within major cities or the surrounding suburbs, accept medical care as a fact of life. Hospitals are expected to be professional and easily-accessible. Patients expect ambulances to arrive quickly. The ambulance crew is always knowledgeable, and the vehicle is equipped with basic life-preserving necessities. This is not the case for everyone. There are places in America where hospitals received very low grades for efficiency and other basics, such as cleanliness. The Leapfrog Group recently established a Hospital Safety Score which is used to rate hospitals on their vital factors. Surprisingly, even metro and well-known hospitals are capable of receiving a B or a C on the Leapfrog Safety Scale.

Upgrades for Better Health Care

One can only imagine the difficulties faced by a medical facility in the small village of Chhattisgarh, India. Complications arise with lack of technology, locality, and funding. This is where the Jan Swasthya Sahyog (JSS) faction of The People’s Health Support Group steps in. The People’s Health Support Group was founded by an assembly of New Delhi doctors from the All India Institute of Medical Sciences. The doctors share a common dream: to improve the quality and accessibility of health care for under-serviced populations in India. Starting in September of 2012, the JSS medical facilities began using EMR software to supplement the efforts of these devoted doctors. The EMR software is being incorporated into daily medical practices during a 5-stage process. Each module allows for reasonable training time with the software. A wide variety of the staff, including volunteers, nurses, and physicians, will need to understand different components within the software.

Among many benefits, EMR software will pave the way to better rural patient care through features such as:

Built on a platform that is prepared for future needs and subsequent updates
Alternative to paper records
Alternative to x-rays, which may degrade in quality over time
All digital information is stored in a safe, encrypted server
Offers speech processing capabilities, including voice recognition
Provides support for doctors to make faster medical decisions, such as drug-drug interactions, drug allergy warnings, and immunizations
Supplements medical care with easier communication, medication alerts, appointment reminders, and more

Future of Health Care

JSS is scheduled to continue with the 5 phases of its pilot project through April 2013. If everything goes well, additional learning modules may be implemented. The EMR software may then extend to other areas in need of high-quality medical care at a low cost. Other interested health care organizations include facilities located in Nepal, Kenya, and Armenia, but interest circumnavigates the globe.

If it is possible for rural locations in India to experience great success with EMR software, isn’t it time your health care organization upgraded as well?