Friday, May 31, 2013

Family Physicians Group Improves Patient Experience through Use of PatientPoint® Care Coordination Platform

Published: May 31, 2013 

Read more here:
PatientPoint plays key role in strategic patient engagement initiative
 — /PRNewswire/ -- PatientPoint®, the leader and innovator in mobile-enabled care coordination and patient engagement solutions, today announced that Family Physicians Group (FPG), a multi-specialty group and CMS shared-savings ACO, has launched the first phase of its strategic patient engagement initiative. The initiative will improve the patient experience and strengthen patient-physician relationships of this leading managed care practice through the use of the PatientPoint Care Coordination Platform. The program supports the group consisting of more than 120 physicians across 25 NCQA PCMH Level III-accredited sites in eight Florida counties.
In April, FPG completed the first phase of implementation across all locations to automatically update patient records such as demographics, medical history and pharmacy information into GE Centricity, FPG's EMR platform, via PatientPoint electronic check-in tablets. With more than 90 percent of FPG's patient population consisting of elderly, Spanish-speaking Medicare patients, usage adoption rates are already as high as 70 percent for the intuitive and multi-lingual electronic check-in and check-out feature. PatientPoint facilitated multi-lingual preventative health screenings during the electronic check-in to trigger care gap closures with the patient and increase practice revenues. During the four months of initial implementation for FPG, more than 2,000 depression screenings were administered through the electronic check-in.
The vision for FPG is to expand and enhance point-of-care engagement by using the PatientPoint Care Coordination Platform to address gaps in care, ensure preventative screenings and increase medication adherence.  Addressing these areas pre-visit and providing additional information at the point of care allows physicians to treat their patients holistically. FPG's goal is to create an environment that supports a more meaningful visit and a stronger physician-patient relationship, ultimately resulting in better health outcomes. 
Khalid Moidu, MD, CIO at Family Physicians Group, states, "A critical component of our strategy to build and sustain new healthcare delivery models is to apply innovative technology and care coordination solutions and support strong engagement practices with care providers. PatientPoint solutions bring information together from multiple sources to engage patients in their own care and enhance care management. We are pleased with our partnership with PatientPoint and are seeing excellent results. Since the PatientPoint Care Coordination Platform is prevalidated by NCQA for medical home, we are able to achieve our goals of continuing to transform our practice and to improve patient engagement while keeping costs in check."
Recognized for innovation in patient engagement by the Microsoft Health Users Group, the Care Coordination Platform integrates with practice management software and EMRs, streamlines the clinical process at the point of care, automates outreach to noncompliant patients on behalf of the physician and reconciles gaps in care. In addition, the provider organizations gain clinical and administrative efficiencies, resulting in increased revenues and reduced care management costs. As the first mobile-enabled care coordination and patient engagement platform to be prevalidated by the NCQA for 2011 PCMH criteria, PatientPoint allows practices utilizing the platform's prevalidated functionality to gain automatic credit of up to 15 percent of total points required to achieve NCQA PCMH Level III.
"The results FPG has realized in a short period of time by using the PatientPoint Care Coordination Platform are increased proof of the impact patient engagement has on improving patient outcomes and keeping costs down," said Raj Toleti, president and founder of Coordinated Care Solutions and CTO of PatientPoint. "As a result, physicians can be more proactive in prescribing their care plans, and patients have more information and knowledge to make better decisions regarding their own care." 
FPG is using the PatientPoint solutions to address common ACO challenges such as: attribution loss, care coordination, operational burdens and cost containment. Join Dr. Moidu in a webinar on June 4 at 12 p.m. ET on "How to leverage patient engagement and retention strategies for ACOs."
About Family Physicians Group
With more than 120 physicians from Jacksonville to St. Petersburg, Orlando-based Family Physicians Group is a leader in primary care physician services in Florida. The group, which was established in 1987, has received a Patient-Centered Medical Home NCQA accreditation. Its delivery of health services focuses on a model with emphasis on the integration and coordination of care for illness prevention and management of diseases, such as diabetes, heart disease and others. For more information, please visit
About PatientPoint
PatientPoint® is the leader and innovator of patient and physician engagement solutions at the point of care. PatientPoint award-winning patient education programs and care coordination platform drive meaningful outcomes for patients, healthcare providers and program sponsors. The PatientPoint Care Coordination Platform is the first mobile-enabled care coordination and patient engagement platform to be prevalidated by the National Committee for Quality Assurance (NCQA) for 2011 patient-centered medical home (PCMH) criteria. PatientPoint serves more than 61,000 physicians across all programs and more than 570 hospitals throughout the U.S., and impacts over 456 million patient and caregiver exposures annually. Learn more
PatientPoint® Contact: Davida Dinerman/Pauline Louie Schwartz 781-684-0770

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Will missing data affect physician P4P scores?


The answer is yes, but maybe not as much as you may thought.
A paper by Ryan and Bao use data from a randomized controlled trial (RCT) called IMPACT (Improving Mood-Promoting Access to Collaborative Treatment) to determine if errors in physician quality  profiling are due mostly to random variation or missing data.  For this report, the authors outcome of interest is remission of depression symptoms at 6 months after the start of treatment.
The IMPACT data include both a clinical registry used by care managers in the trial to document exposure to the intervention and to track patient outcomes (“registry data”) as well as longitudinal research interviews, which independently assessed patient outcomes at regular intervals (“research data”).  The authors use both the registry and research data to to generate parameters for the simulation.
The authors describe their simulation model as follows:
To initiate the Monte Carlo simulation, we assigned each provider a true quality score and a rate of missingness, each drawn randomly from distributions shown in Table 1. On the basis of data from the IMPACT trial, we assumed a correlation between missingness and true quality that was common to all providers. Then, 200 patient-level random draws, first determining whether an observation was missing or nonmissing and then determining patient remission (conditional on missing status), were taken for each provider. We then aggregated information from these draws, calculating provider-level “observed” quality scores under one of the two conditions: (1) using remission outcomes only from patients with nonmissing data, so that profiling error was a combination of error from missing data and from random sampling; and (2) using remission outcomes from patients with both missing and nonmissing data, so that all profiling error was due to random sampling. 
The authors reached a number of findings:
  • Measuring quality using relative rather than absolute measures had lower error rates.  In fact, relative profiling approaches had profiling error rates that were approximately 20 percent lower than absolute profiling approaches.
  • Most profiling error is due to random sampling, not missing data.  Between 11 and 21 percent of total error was attributable to missing data for relative profiling, while between 16 and 33 percent of total error was attributable to missing data for absolute profiling.
There is an important caveat to these findings, however.  The reason the missing data error is so small is due to the observation that in IMPACT data, missing data were not strongly related to the remission outcome in the IMPACT data.  If patients with observations missing from the data were much more (or less) likely to experience remission, then the missing data error would have made up a much larger share of the overall profiling error.


Corporate Innovators at the cusp of the next iteration

THURSDAY, MAY 30, 2013

The more I read innovation surveys and comments from analysts and executives, the more I wonder about management thinking.  Recently Accenture published a nice survey of 519 executives in firms in the US and in Western Europe.  The survey repeats what many of us have known for years:  executives recognize the importance of innovation and are frustrated with the results.  According to the survey 93% of the executives surveyed felt their firms would depend on innovation for growth, but less than 20% believe their innovation strategy is delivering a competitive advantage.  These two critical points identify what is perhaps the most significant trap in corporate innovation:  the unrealistic expectations of return on innovation.

If we were to stop for a minute and contemplate the timescales for innovation, things might become a bit more clear.  For many firms, regardless of when the idea is generated, it will take several years to develop a new product, prepare it for launch and provide it to customers.  Then, after the launch, it may take another year or two before the new product reaches break even and begins to generate real profits.  So, from the generation of a new idea till the recognition of profits and differentiation from the new product or service, it's reasonable to expect the timeframe to span three, four or even five years for fast turn products, and even up to seven or eight years for products with longer development cycles.

Add to this the fact that many companies don't "bet the farm" when they start innovation activities, for several reasons.  First, no one wants to take on too much risk on unfamiliar and untried innovation tools and systems.  There's always an argument for "low hanging" fruit as the first innovation initiative.  Second, many firms single thread innovation activities, due to resource constraints, budgetary issues and general change management.  This means that for many organizations, their first foray into innovation is by definition a line extension.  Further, many innovators conduct serial innovation activities rather than attempt to run several innovation activities in parallel, due to the constraints mentioned above.  This means that not only are the first attempts line extensions, but due to the limited number of initiatives, few products are developed.  Add to these the fact that it can take several years for even simple line extensions to move through a tightly constrained organization, and three to five years on the CEO may be scratching his or her head, wondering where all the innovations are that they demanded and were promised.

From the tiny acorn mighty oaks grow

There's absolutely nothing wrong with incremental, controlled experiments to test new philosophies and methods, and the innovation results we are seeing now are simply the first harvest of careful innovation activities.  What will be telling for future innovation is whether or not executives recognize the fruit of their planting, and decide to extend and expand the activities, and hopefully accelerate them, or deem the whole activity a failure.   The limited supply and constrained result of innovation activities to date is entirely predictable.  After all, the vast majority of corporations have spent 30 years building highly efficient business processes, cutting costs and eliminating risk and uncertainty.  Over the last few years some executives have planted tenuous innovation programs or activities that have trouble grafting on to the efficient working and activities of modern streamlined business models.  It's not unreasonable or shouldn't be unexpected that the first innovation harvests are small.  But, as the old saying goes, mighty oaks grow from tiny acorns.  All it will take is time.

Compare these results to the people who examined the possibilities of some of our most important inventions.  After the luster of manned flight by the Wright brothers wore off, I'm sure there were many people who argued that the plane only flew a couple of hundred yards and could barely carry a single person that distance.  A good horse could cover the same ground in less time!  What those naysayers failed to see, and what corporations are at risk of today, is that the first harvests are always thin, but continued investment and development can lead to far greater results and outcomes. 

From furtive experiment to critical capability

Corporate innovation is simply in its initial phases, in many cases as furtive, inexpensive experiment in one small corner of the business, underfunded and poorly resourced.  Expecting miracles from this small experiment is unreasonable, but not surprising.  Executives are realizing that while their organizations are exceptionally efficient, they cannot cut their way to growth and differentiation.  Innovation is vital because it adds to the top portion of the income statement, rather than cutting away at the bottom end.  What's important now is a continued investment, a growing investment and engagement in innovation, to shift the concept from a furtive experiment tucked away in a corner to a central, critical, consistent capability.  Just as a few Six Sigma "black belts" entered organizations years ago and now dominate corporate philosophy and thinking, innovation is a nascent experiment that must be expanded and must become a cultural phenomenon.

Many writers and analysts, this one included, hold up Apple as the arbiter of good innovation practice.  What people forget is that Apple was near bankruptcy in 1997, and had no other choice but to cut product lines and develop new innovation strategies for survival.  Today, Apple progressed through a series of innovation maturity phases, and is a relatively mature innovator.  Of course they should be good at innovating.  Apple has had almost 15 years of innovation experience to build on.  When executives look at Apple and wish their organizations could innovate like Apple, they fail to see the challenges, investments and time it took for Apple to become a viable innovator. 

Out of sight of the shoreline

The real question for many corporate innovators is this:  now that the first attempts have demonstrated some limited benefit, will they take the next step and expand their innovation efforts?  Will they define larger opportunities, provide more resources, funds and time?  Will they shift innovation activities from the periphery to the center of their organization?

Early sailor never sailed out of sight of the shoreline, because they lacked navigational skills and weren't sure what was out in the deeper ocean.  Sailing near the shoreline was safer but ultimately limiting.  It was only when they took the next step that new lands were discovered.  The same analogy applies for corporate innovation.  Small attempts have been made and they've been moderately successful.  More significant results await if the resources are available and if the organization continues to develop innovation skills and capabilities.  

Many corporate innovators stand at the cusp of important decisions.  In one direction is additional investment to build innovation capabilities and expand the breadth and depth of innovation projects.  In the other direction is the safe and familiar efficient business model, where cutting costs and achieving greater efficiencies lie.  Successful firms will recognize that both capabilities are required, and will invest in developing and maturing an innovation capability.  These firms recognize that corporate capabilities don't grow overnight, and investment is required for multiple years before significant results are achieved.  Many executives will blanch at the investment and decide to "acquire" innovation by purchasing smaller, more nimble competitors or seeking out third party technologies, not realizing the bidding war that will unfold as the number of firms choosing these options increases.

Thursday, May 30, 2013

Tracking healthcare innovation at the world's end

May 30, 2013 | Benjamin Harris, New Media Producer

Afghanistan doesn't come to mind when you ask me to list some of the top crucibles of innovation in healthcare right now. With a majority of the population living in incredibly remote areas and a dearth of basic necessities such as medications and supplies, one would be hard pressed to think that game-changing strategies and techniques are being developed there. Adversity, however, can be a prerequisite for change.
"Sometimes it takes going to the edges of the earth, as it were, to be able to develop stuff you can use at home," says Peter Killcommons, MD, CEO of MedWeb.
We spoke at the American Telemedicine Association’s annual trade show  a few weeks ago, where I saw his presentation on using mHealth to serve rural and isolated populations. By focusing on the bare bones, setting up jury-rigged and low-power satellite networks to link remote clinics with the world at large, Killcommons' efforts show the effects that even a basic cell phone connection can have.
In many ways, the problems to overcome in Afghanistan are a mirror of the problems in our own health care system.
"When patients go to the hospital, somebody gets sick in a village, they pretty much wait until they're almost dead," says Killcommons. "Then they'll throw them on the back of a bike or motorcycle... they wait until the last, last minute until they're really terrified that something bad is going to happen if they don't do something."
Sound familiar? There may not be donkey traffic jams in front of your local ER, but the space in our hospitals reserved for the most threatening situations is increasingly becoming the first point of contact for people with health questions. People access health care when they can, where they can. Killcommons looked at the situation in Afghanistan and realized that before breaking out the advanced surgical machines well-intentioned donors had given to hospitals in the region, some less fancy steps needed to be taken first.
That basic infrastructure was communication. Killcommons worked with locals to source and set up solar powered satellite and cell phone networks to bring telemedicine programs to remote areas of Afghanistan.
"A cell phone is like $5 from China. That's all they need really," says Killcommons. "There's some cell phones with a solar panel on the back, we wouldn't consider it reasonable to use that because it takes 30 hours in sunlight to give it a full charge. However, for them, that's freakin' perfect because the phone will last for two weeks - it's not like they're getting a hundred calls a day."
Getting people access to the information they need in a timely and sustainable fashion was his first priority, and it translates from the mountains of Afghanistan to anywhere in the world. Speaking about a telehealth program his company has developed for pregnant women, Killcommons sees the technology's potential to assist people anywhere.
"In the United States we have exceptional healthcare, but still it may be inconvenient if someone is living in a rural area and they can't get in to see their obstetrician as often as they would like, and a tool like this can be used," Killcommons says.
Access to reliable information is the first step in lowering costs and keeping patients more engaged in their care. In a world awash with resources (many not so reputable), communities, and the technology to link pretty much anything to anything else, providing robust and simple channels of access for some of the most remote and at risk will become an increasingly important mission in reforming health care.
"We need practitioners who can counsel us on how to be discerning readers of what we come across, to assist us as we wade through the snake-oil cures and the potential conflicts of interest, and who can help us put newly published research into context with what it mean for us as individuals," writes Laurie Edwards in a recent story on WBUR.
It's easy to lose sight of the little stuff. We like to get carried away over the newest and the flashiest technology. In the case of a remote village in Afghanistan or even America, though, having access to a cell phone and someone at the other end who can offer some educated advice can be worth more than the most advanced ER. The more you know, they say.
Benjamin Harris is Editor of Future Care, where this post was originally published. To learn more about the site read Harris' introductory post, Welcome to Future Care. - Taking us to the "Next Generation of Patient Centered" Care

Our Mission
A unique opportunity currently exists for stake holders to improve the way our nation delivers care to its citizens. The current environment of regulatory reform, shrinking budgets and increasing patient populations has created the “the perfect storm”, thus setting the stage for the  greatest disruption in the history of the healthcare industry. There has to be a delivery system that is flexible enough to meet to the needs of every consumer on their own terms. How do we provide a valuable alternative for the 26 year old waitress without health insurance, the 46 year-old lawyer who doesn't trust the system and the 63 year old self-employed artist? I believe there is, and it is  seeks to connect patients, providers, researchers, educators and tech companies through an innovative mobile network. This collaboration will provide a direct connection at the point of care through a flexible digital platform.  The end result will be  “on demand” care delivered on any internet enabled device or through ERM’s proprietary Automated Community Health Machines (ACHM). These “mini-clinics”, about the size of a photo booth will private access to primary care, preventive screenings and disease management education to anyone anywhere anytime. When all you need is power and the internet the possibilities are endless. ERM believes that shared decision making relies on patient engagement and the only road to meaningful engagement is through education. A sustainable healthcare system will only be achieved through a partnership with the consumer. Value is in the eye of the beholder and provides meaningful solutions to every consumer. A positive patient/physician relationship is the greatest factor in compliance with treatment. The decision to seek or not to seek treatment is a personal one. Not one that can be dictated by big business. Thanks to the ACA, we have brought attention to the needs of certain populations like the elderly and the uninsured, but what about the insured who are turned off by the system? What are we doing to address the growing number of consumers who choose privacy over healthcare? 

The Empirical Benefits
  • Greater Consumer Experience ·  
  • Transparent Pricing
  • Flexible Delivery
  •  Access at the Point of Care ·         
  • Shared Decision Making ·
  • Whole System Change ·         
  • Data, Data, Data    

How We Got to This Point… 
Empirical Risk Management began as an “experiment” to prove the positive impact that education could have on reducing costs, engaging patients and improving the overall experience of care.  Our pilot was a huge success and the ROI was incredible, but the greatest achievement of all was seeing the hunger for knowledge and the positive impact on human life that was reflected in patient centered whole system change. Please visit our website to find out more about our pilot: 
This project extends that valuable patient/physician relationship to every consumer in the healthcare market. will provide the platform necessary to launch this disruptive innovative technology into the hands of every consumer for $300 a year and as little as $25 A “virtual visit”. Consider the benefit this would allow employers to provide to their employees on any "job site". 
We know that our emotions play a significant role in the healing process. Could we reduce the time of recovery by allowing patients the comfort and security of their own bed? What about disease management? Could this be the tool that primary care providers have been looking for to encourage healthier decisions? What about monitoring changes in medication? What about the benefit of reducing of hospital admissions and re-admissions through earlier identification and prevention of exacerbations in chronic disease? 
The individual voice of a patient or a provider will never be enough, but together we can move mountains. Join our revolution, help fund the “Next Generation of Patient Centered” Care. 

The Minds Behind The Movement… 
Kameron Gifford, CPC 
Over the last twelve years, I have worked with physicians to develop efficient billing practices, implement value added processes and improve the entire experience of care for their patients. What can this knowledge contribute to developing compliant, engaging and transparent care delivery systems? 

Todd Gifford, MBA
My husband is a managed care executive with one the country's largest health plans. To him, this project represents a solution; an answer to some of healthcare's greatest barriers. But most of all he envisions a way to connect providers with their patients in real time outside of the “clinic”... a tool for chronic disease management. 

JM McCullough, MD 
My father celebrated his 70th birthday last week. He is the inspiration behind ERM's work and our proprietary model of care "The Preventist". His primary care practice is still located within 15 miles of where he completed his Residency and our average patient is an 83 years old male with 3 or more chronic conditions. His career in managed care began shortly after Reagan left office and continues today as an Associate Medical Director for a managed Medicaid plan in addition to seeing patients everyday.  His leadership and guidance was essential in creating a vehicle for the  “Next Generation of Patient-Centered”.

Render unto Cesar What Is His

By Todd Gifford, MBA    /    Political Writer   /   5.30.2013

Congressman Paul Ryan (Wi.) who sits on the House Ways and Means Committee was interviewed on Fox news last night discussing the House's subpoena power in relation to the latest scandal whereas the IRS has acknowledged the improper targeting of conservative groups applying for 501C4 tax exempt designations for political action committees and the levels of scrutiny placed on these right wing groups far surpass the levels of examination  political organizations that lean to the left or liberal groups experienced.
This action if proven true, attacks the heart of our governance and political system. The IRS is the body of government that should never show favoritism toward one party over another even if the bureaucrat has his own interest at heart, the illusion of transparency and an expected policy of non-bias treatment is non-negotiable.
The ability for a group to organize and fundraise is completely dependent upon the tax exempt status of the given group, if the tax exempt status is delayed this will have an apparent effect on that parties ability to mobilize supporters into a better directed coalition.
There seems to be great variation toward those who received scrutiny for requested tax exempt status. I am not Nostradamus, but I predict we have a special investigative council looking into this matter, at the very least it seems gross malfeasance has occurred and the origins of the directive must be revealed.
A visible chink has developed in the armor of Obamacare, now in its most vulnerable state, with the enforcement powers lying within the IRS. Many Americans already suffer from a fear of an Orwellian society. The very fabric that binds our great country together is unraveling before our eyes. That sacred trust in our leadership has been damaged, and we must act now.
Paul Ryan might be our last vestige of hope. Does he have the power to repeal Obamacare through his position in the House Ways and Means Committee?  In my opinion, he is our single greatest hope of preventing the machine of government from taking sole control of 17% of our Nations GDP. Stopping the eventual progression to a single payor system.
Could this IRS scandal be the impetus that Republicans have been so desperately searching for?
Americans want answers. President Obama's approval and trust ratings are dropping. Three-quarters of U.S. voters (and 63% of Democrats) want a special prosecutor to investigate the IRS’s targeting of Tea Party groups. All eyes should be on Ryan in the common weeks and months. If he finds success here, he will find himself center stage among the Republican nominees for President in 2016.

CIOs Seek Tech Prescription to Patient Privacy Rule

A new federal rule that gives patients more control over healthcare information they choose to share with insurance companies pose challenges for CIOs who must build out technology to support it. One CIO said software can be fashioned to filter out information before it is passed to another party. But such software raises the sticky issue of who is best positioned—the patient, the physician or another party–to decide when such data is best withheld.
revision to the Health Insurance Portability and Accountability Act requires doctors and hospitals not to disclose medical information to a patient’s insurer if the patient requests it and pays for services themselves. Doctors frequently make notations in their patients’ medical file, which could include information that allows insurers to make inferences about the patient’s health that patients may prefer to keep private. CIOs say that stopping the information from being revealed in notes is difficult, potentially setting up their organizations for paying millions of dollars in compliance penalties.
Beyond compliance issues, the new law brings into question whether patients would be informed enough to know the repercussions of their decisions. Speaking on a hypothetical software solution that would give patients the power to select data they didn’t want to share, Scott Joslyn, CIO of MemorialCare Health System, cited safety concerns. Clinicians would “lack a complete medical picture for the patient,” he said. Patients could check a default box that blocks potentially life-saving information from physicians providing them treatment.
The challenge of data segmentation isn’t limited to healthcare organizations. CIOs in retail and other industries offer consumers services that aim to take advantage of the glut of data people create on social software and mobile devices. Consumers often blindly opt-in, or agree to receive notifications or have their information shared with other service providers without realizing the implications of who they are allowing to do what with their data.
Given the topic, the stakes are higher when it comes to data segmentation and one’s own health records.
Physician notes about treatments provided and medications administered to patients’ healthcare records can help physicians better treat the patient in the future. But this is not always the case. For example, while it might be helpful for a dermatologist to read a note referencing a patient’s allergy to penicillin, a note that he had been treated for alcohol abuse at a clinic 20 years ago may not be germane to the treatment, said John Halamka, CIO of Beth Israel Deaconess Medical Center.
Under the new rule, a patient paying out of pocket for the service can choose that hospitals and physicians block service records from their insurer. This would provide patients more privacy and the peace of mind that insurance providers won’t use the notes as causes to increase health insurance premiums for patients they believe pose increased risks. “I, the patient, want to control data transferred for a specific purpose to a specific person,” said Mr. Halamka. Mr. Halamka equated the concept to the sharing on social networks where the user controls what information to share and with whom.
Mr. Halamka, a co-chair of a federal advisory committee on data standard, said healthcare CIOs need software that can identify potentially sensitive medical annotations in an electronic medical record (EMR), and redact them before the record is transferred. He said the problem could be addressed with an algorithm that automatically tags notes for removal before the record is passed to an insurer. The application would present check boxes that allow users to decide with whom what information gets shared.
Although such software is technically feasible — Facebook Inc. has built something similar for its social graph of over 1 billion users — it raises a significant question: who is best positioned to decide how data is segmented?
Martin Harris, CIO of the Cleveland Clinic, said such data segmentation is a “tricky area” because it is unclear whether the pathologist, a physician or a patient would have to set up the application to keep certain information private. Physicians might have to meet with patients to explain the potential outcome of selecting rules that would block information from the eyes of insurers and others. Even then, trying to account for every single nuance in who can see what is challenging. Mr. Harris said “many people need to be involved in understanding the nuances” of this issue.
These challenges will make it hard for hospitals to meet the Sept. 23 deadline for complying with the Congressional rule revision, which will be enforced by the U.S. Department of Health and Human Services Office for Civil Rights, the agency that oversees HIPAA. HHS declined to make a spokesperson available to comment in time for this article. But a spokesperson for the office told the Wall Street Journal earlier this month that HHS’ “hands are tied” with the out-of-pocket rule because it was mandated by Congress. That puts the onus squarely on CIOs at hospitals charged with implementing technologies and workflow processes that adhere to HIPAA rules.
Judy Hanover, an analyst tracking healthcare for IDC, said the issue is so complex that the only way she could think this could possibly work is if the patients paid cash, used an assumed name and a fake birth date. “It doesn’t fit the workflow in any way… it’s going to be hard to do it,” Ms. Hanover said.
Meanwhile, healthcare CIOs must brace for the fact that more patients may seek to eliminate paper trails by paying for healthcare services out of pocket. And they will reserve their right to have healthcare information stricken from their records. “There will always be a segment of the population that cares about granular control,” Mr. Halamka said.

CMS Meetings: Health and Human Services-Operated Risk Adjustment Data Validation

This Notice document was issued by the Centers for Medicare Medicaid Services (CMS)

This notice announces a public meeting on the Affordable Care Act HHS-operated risk adjustment data validation process. The purpose of this public meeting is to provide opportunity to discuss the HHS risk adjustment data validation process that will be conducted when HHS operates the risk adjustment program on behalf of a state under the Affordable Care Act. The meeting will provide information to stakeholders including, but not limited to, issuers, states, and other interested parties about key HHS policy considerations pertaining to the HHS-operated risk adjustment data validation process and will also provide an opportunity for participants to ask clarifying questions. The stakeholder meeting is being offered as both an in-person meeting and web conference for those unable to attend in person. The comments and information that we obtain through this meeting may aid future policy-making for the HHS-operated risk adjustment data validation process.
Meeting Date: The HHS-Operated Risk Adjustment Data Validation Stakeholder Meeting will take place on: Tuesday, June 25, 2013, from 9:30 a.m. to 2 p.m., eastern daylight time (e.d.t.).
Meeting Location: The public meeting will be held in the Multi-Purpose Room of the central building of the Centers for Medicare & Medicaid Services (CMS), 7500 Security Boulevard, Baltimore, MD 21244.
For Further Information Contact
REGTAP Registrar at 1-800-257-9520 between the hours of 9:00 a.m. and 5:00 p.m., e.d.t. Please note that this office is closed on weekends and federal holidays. Please send inquiries about the logistics of the meeting to Inquiries and comments pertaining to content covered during the meeting should be submitted in REGTAP using “My Dashboard” to select “Submit an Inquiry,” then select “Risk Adjustment Data Validation Stakeholder Meeting” to enter the question or comment. Users may submit their comments and upload attachments as needed. Users will receive an acknowledgement that the comment was received. Press inquiries are handled through our press office at (202) 690-6343.
Supplementary Information
Registration: Registration will be on a first-come, first-serve basis, limited to one participant per organization for the on-site option and three participants per organization for the web conference. Individuals may only register for either the on-site option or the web conference, not both. If an individual is wait-listed for one option, the registration must be cancelled before attempting to register for the other option. Registration deadlines are as follows:
On-site Participation: Register by June 7, 2013, 5 p.m., e.d.t.

Web Conference Participation: Register by June 19, 2013, 5 p.m., e.d.t.

Special Accommodations: The deadline to request a special accommodation is June 19, 2013, 5 p.m., e.d.t.
Deadline for Attendees that are Foreign Nationals Registration: Attendees that are foreign nationals (as described in section III. of this notice) are required to identify themselves as such, and provide the necessary information for security clearance (as described in section III. of this notice) to at least 12 business days in advance of the date of the public meeting date. Therefore, the deadline for attendees that are foreign nationals is June 10, 2013, 5 p.m., e.d.t.
Registration Instructions: To register for either in-person or web conference participation, visit the Registration for Technical Assistance Portal at Individuals must register as a user, if not already registered then go to “My Dashboard” and select “Training Events” to register for on-site or web conference. Registrants may only register for either the on-site session at CMS's headquarters or the web conference. If you are a potential auditor for the Initial Validation Audit process, please select “Auditor/Initial Validation Auditor” for the organization type when registering.
I. Background
This notice announces a meeting regarding the HHS-operated risk adjustment data validation process. Section 1343 of the Affordable Care Act establishes three programs (transitional reinsurance, temporary risk corridors, and permanent risk adjustment) intended to help stabilize premiums in the insurance market and minimize the potential effects of adverse selection that may occur in the initial operational years of the marketplaces and market reform which will begin with the 2014 benefit year. This meeting focuses on the data validation process for the permanent risk adjustment program when HHS operates a risk adjustment program on behalf of a state (referred to as the HHS-operated risk adjustment program). Health insurance issuers must comply with these risk adjustment data validation requirements in the first year of the program, the 2014 benefit year.
On March 11, 2013, we published a final regulation, the HHS Notice of Benefit and Payment Parameters for 2014 (also referred to as the 2014 payment notice) (78 FR 15410), that established the regulatory framework for the risk adjustment data validation audit process for the HHS-operated risk adjustment program. Although the overall framework for the six-stage risk adjustment data validation process was described in the 2014 payment notice, the detailed processes for several of these stages have not been specified. We committed to stakeholder engagement in developing the detailed processes. The purpose of this meeting is to provide information to issuers, states, and other interested parties about the HHS-operated risk adjustment data validation process and offer an opportunity for these stakeholders to comment on key elements of the risk adjustment data validation process.
II. Meeting Agenda
The risk adjustment data validation meeting will provide information to stakeholders including, but not limited to, issuers, states, and other interested parties about the Affordable Care Act HHS-operated risk adjustment data validation process and gather feedback on key elements of the HHS-operatedrisk adjustment data validation process. The stakeholder meeting will focus on topics including, but not limited to, data validation audit standards, sampling, initial and second validation audits, appeals, and error rates. The meeting is open to the public, but attendance is limited to the space available. There are capabilities for remote access. Persons wishing to attend this meeting must register by the date listed in the “Registration” section above, and by visiting
III. Security, Building, and Parking Guidelines
The meeting will be held within the CMS Complex, which is not open to the general public. Visitors to the complex are required to show a valid U.S. Government issued photo identification, preferably a driver's license, at the time of entry. Participants will also be subject to a vehicular search before access to the complex is granted. Participants not in possession of a valid identification or who are in possession of prohibited items will be denied access to the complex. Prohibited items on Federal property include, but are not limited to, alcoholic beverages, illegal narcotics, explosives, firearms or other dangerous weapons (including pocket knives), and dogs or other animals (except service animals). Once cleared for entry to the complex, participants will be directed to parking by a security officer.
To ensure expedited entry into the building, it is recommended that participants have their ID and a copy of their written meeting registration confirmation readily available and that they do not bring laptops or large/bulky items into the building. Participants are reminded that photography on the CMS complex is prohibited. CMS has also been declared a tobacco free campus and violators are subject to legal action. In planning arrival time, we recommend allowing additional time to clear security. Individuals who are not registered in advance will not be permitted to enter the building and will be unable to attend the meeting. The public may not enter the building earlier than 45 minutes before the meeting convenes. Guest access to the CMS complex is limited to the meeting area, the main lobby, and the cafeteria. If a visitor is found outside of those areas without proper escort, they may be escorted by a security officer out of the complex.
Please be mindful that, at the meeting, and subject to the constraints of the meeting agenda and allotted meeting time, there will be an opportunity for individuals to speak, and we request that individuals wait for the appropriate time to present their questions or comments. Disruptive behavior will not be tolerated, and may result in removal from the meeting and/or escort from the complex. Visitors may not attach USB cables, flash/thumb drives, or any other equipment to any CMS information technology (IT) system or hardware for any purpose at anytime. Additionally, CMS staff is prohibited from taking such actions on behalf of a visitor, or utilizing any removable media provided by a visitor.
We cannot assume responsibility for coordinating the receipt, transfer, transport, storage, set-up, safety, or timely arrival of any personal belongings or items used for demonstration or to support a presentation. Special accommodations, arrangements, and approvals to bring pieces of equipment or medical devices are required by June 19, 2013, 5:00 p.m., e.d.t. These arrangements need to be made with the It is possible that certain requests made in advance of the public meeting may be denied because of unique safety, security or handling issues related to the equipment.
CMS policy requires that every foreign national (as defined by the Department of Homeland Security is “an individual who is a citizen of any country other than the United States”) is assigned a host (in accordance with the Department Foreign Visitor Management Policy, Appendix C, Guidelines for Hosts and Escorts). The host/hosting official is required to inform the Division of Critical Infrastructure Protection (DCIP) at least 12 business days in advance of any visit by a foreign national. Foreign nationals will be required to produce a valid passport at the time of entry.
Attendees that are foreign nationals need to identify themselves as such, and provide the following information for security clearance to the by the date specified in the “REGISTRATION” section of this notice:
Visitor's full name (as it appears on passport).
Country of origin and citizenship.
Biographical data and related information.
Date of birth.
Place of birth.
Passport number.
Passport issue date.
Passport expiration date.
Dates of visits.
Company Name.

Wednesday, May 29, 2013

Idaho University Patient Records Breach Leads to $400,000 Levy, Corrective Plan

By Eric Topor

The Department of Health and Human Services May 21 announced a resolution agreement with Idaho State University (ISU) outpatient clinics--over a breach of approximately 17,500 patient records--under which the health care provider will pay $400,000 and implement a corrective action plan (CAP).
ISU notified the HHS Office for Civil Rights (OCR) of the data breach in August 2011.
OCR's November 2011 investigation report revealed Health Insurance Portability and Accountability Act Security Rule violations between 2007 and 2012 involving ISU's failure to conduct a risk analysis of the confidentiality of its electronic patient records; inadequate implementation of security measures to reduce patient record breaches; and inadequate review of information system activity to determine whether patient records were inappropriately disclosed.
The investigation determined that ISU patient records were unsecured for at least 10 months after firewall protections on ISU servers were disabled.
“Risk analysis, ongoing risk management, and routine information system reviews are the cornerstones of an effective HIPAA security compliance program,” OCR Director Leon Rodriguez said in a statement.
School Clinic Comments
“We want to reiterate that as far as we are concerned, and as far as our due diligence demonstrates, as well as the third party that we hired to come in and do an audit, that no patient records were accessed, and data was not compromised,” Greg Ehardt, HIPAA/assistant university compliance officer at Idaho State University, told BNA May 22.
“As we recognized that the firewall had been disabled for maintenance purposes, unfortunately that was not restored properly.” As ISU did its “due diligence and our external audit, we determined that as far as we were concerned, no patient records had been accessed. But we felt it appropriate, given the incident, that we need to report this to the Office for Civil Rights for their determination as well.”
He added that his hiring by the university was one of several steps ISU has taken to “fortify the security measures here.” Ehardt added that the university has implemented “an event logging system that will more closely track these types of events.”
The university also brought in and centralized the IT of the clinics, whereas before it was somewhat decentralized,” he said.
“We feel that with the number of changes that we've made, and the remediation that we've taken upon ourselves, that we're a much stronger, more fortified program and system at this time.”
Corrective Action Plan
The CAP, which began May 13 and will extend for two years, designates ISU as a “hybrid entity” and requires ISU to identify all covered health care components in its clinic system. The plan requires ISU to submit its current risk management plan, a report of its information system activity across all clinics, and a compliance gap analysis report, and to implement any changes to the plans and procedures suggested by HHS after review.
ISU is required to notify HHS if any ISU employee fails to comply with privacy and security procedures under the CAP, following an internal review by ISU. The CAP requires any notification to include the name of the employee involved, which security policies or procedures were implicated, the steps ISU has taken to mitigate any privacy or security breach, and what steps will be taken to prevent future similar occurrences.
The CAP also requires ISU to submit annual reports detailing security and privacy measures implemented, system activity review measures, an update of compliance gap analysis activity, any reportable events, and a signed attestation by an ISU officer that he or she has reviewed the report and believes it to be accurate.
ISU is required to retain all documents and records relating to the CAP for at least six years.
In January, another entity in Idaho, a small nonprofit hospice, agreed to pay $50,000 to HHS to settle allegations of federal data security rule violations over the loss of a laptop containing the personal health information of 441 patients. That settlement was the first involving a breach of protected health information affecting fewer than 500 individuals under the HIPAA Security Rule, HHS said (12 PVLR 41, 1/7/13).

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Wales' first cancer patient survey to be launched

The Welsh Government and Macmillan Cancer Support launch the first national survey allowing cancer patients to report back on the quality of their care

Cancer patients across Wales will be able to report back on the quality of services they have received after the launch of the first national patient experience survey today.
The survey, developed by the Welsh Government and Macmillan Cancer Support, aims to look at patient experience and drive up standards for cancer services across the country.
It comes just days after campaigners voiced their disappointment that vital cancer targets set by the Welsh Government were missed again.
Figures showed that just 83.6% of people needing urgent treatment for cancer were seen within the two-month target.
The Welsh Government target is for 95% of patients to begin treatment within 62 days of diagnosis, and has not been met since 2008.
Targets for 98% of non-urgent cases to start treatment within 31 days were also missed, with 97.4% of cases being seen in that timeframe.
The publication of the survey, which will be sent to patients in the next month, is part of the Welsh Government’s Commitment to improve care for cancer patients as part of its Cancer Delivery Plan for Wales.
The survey will be issued to patients who had a hospital stay between June 2012 and March 2013.
Health Minister Mark Drakeford said:“The best people to ask about how cancer services are being delivered in Wales are the patients themselves. They have a raft of experience and are experts in their own lives. There is a great deal to learn from what they have to say.
“When a patient hears a doctor deliver a diagnosis of cancer, it is a life-changing moment. How the doctor delivers that diagnosis and the support the individual receives, not just for their medical care, can impact on the outcome for the individual.
“The cancer experience survey asks questions that cover each stage, from diagnosis to hospital care to home support. I would encourage all those who receive a survey to take the time to complete it. The information you provide can help improve services in the future.”
Susan Morris, general manager for Macmillan Cancer Support in Wales, said:“Macmillan is delighted that the Welsh Government is conducting an all-Wales cancer patient experience survey.
“It is the first time such a comprehensive survey of cancer patients’ experiences of care has been conducted in Wales and Macmillan is really pleased to be a partner in this important initiative.
“It is vitally important to measure survival rates and cancer waiting times targets, but it is equally important to find out what patients really think about the quality of the care they receive.
“Local health boards must take the survey’s results into consideration to inform planning for future cancer services to make sure these services meet people’s clinical and non-clinical needs and that they are truly person-centred.”
Fellow cancer charities welcomed the publication of the survey.
Dr Rachel Iredale, director of Tenovus’ cancer support Team, said: “We welcome any attempt to improve service delivery by asking patients about their experiences.
“We know from our own experience that feedback is vital. We recently surveyed over 1,600 people who use our services and we can clearly see certain issues emerging.
“These include the quality of care patients receive from the NHS, the need for their care to be closer to their home and that patients want to be viewed and cared for as a whole person, not just their cancer, with support for the whole family which continues beyond their treatment.”

Cosmetic eyelid lifts costing Medicare millions

WASHINGTON — Aging Americans worried about their droopy upper eyelids often rely on the plastic surgeon's scalpel to turn back the hands of time. Increasingly, Medicare is footing the bill.
The public health insurance program for people older than 65 typically does not cover cosmetic surgery, but for cases in which patients' sagging eyelids significantly hinder their vision, it does pay to have them lifted. In recent years, though, a rapid rise in the number of so-called functional eyelid lifts, or blepharoplasty, has led some to question whether Medicare is letting procedures that are really cosmetic slip through the cracks — at a cost of millions of dollars.
As the Obama administration and Congress wrestle over how to restrain Medicare's growing price tag, critics say program administrators should be more closely inspecting rapidly proliferating procedures like blepharoplasty to make sure taxpayers are not getting ripped off.
From 2001 to 2011, eyelid lifts charged to Medicare more than tripled to 136,000 annually, according to a review of physician billing data by the Center for Public Integrity. In 2001, physicians billed taxpayers a total of $20 million for the procedure. By 2011, the price tag had quadrupled to $80 million. The number of physicians billing the surgery more than doubled.
"With this kind of management malpractice, it's little wonder that the (Medicare) program is in such dire shape," said Sen. Tom Coburn, R-Okla., who is a physician. "The federal government is essentially asking people to game the system."
Plastic surgeons say there are a number of legitimate reasons for the spike, including a tendency among the elderly to seek fixes for real medical issues they might have quietly suffered through even a decade ago. But surgeons also acknowledge an increased awareness of the surgery fueled by reality television, word-of-mouth referrals and advertising that promises a more youthful appearance. And doctors concede they face increased pressure from patients to perform eyelid lifts, even when they do not meet Medicare's requirement that peripheral vision actually be impaired.
Quick, easy and relatively painless, eyelid surgery is one of the most popular cosmetic procedures, with patients paying out of pocket for more than 200,000 a year, according to the American Society of Plastic Surgeons. The process for purely cosmetic surgeries and Medicare-funded blepharoplasty is the same. Doctors numb the eyelids with a local anesthetic before removing fat and excess skin, often with a laser. The entire process usually takes less than 30 minutes.
Medicare reimbursement ranges from $574 to $640 per eye, depending on the setting, but the rules for Medicare coverage are firm. Purely cosmetic surgeries do not qualify. Before filing a Medicare claim, doctors are required to test a patient's vision and document that drooping skin significantly compromises a patient's eyesight. The exam usually involves lifting a patient's eyelids with tape and comparing their vision results to tests performed without tape.
Unlike private insurance plans, though, Medicare does not require preauthorization of eyelid surgeries. Robert Berenson, a health policy expert at the Urban Institute and a former commissioner of the Medicare Payment Advisory Commission, has pushed for selective preauthorization for some Medicare services. But Berenson questioned whether reviewing physician records in advance would help much in the case of blepharoplasty, if surgeons have learned how to document the need for the procedure in order to work the system.
Some eyelid surgeons were willing to discuss their Medicare billing.
"I'm disappointed that I am not No. 1. I wish I was on top," joked John LiVecchi, a Florida plastic surgeon who was among the top 10 billers listed in 2008 Medicare data. LiVecchi, an eyelid specialist, said his practice at St. Luke's Cataract and Laser Institute is one of the largest in the country, which accounts for his numbers. St. Luke's operates five offices in the Tampa Bay area.
LiVecchi, who has had an eyelid lift himself, disputes that patients are flocking to the procedure primarily with vanity in mind. Patients with droopy eyelids often don't realize how much the droopy skin is narrowing their field of vision, he said. LiVecchi said he jokes with his patients that he doesn't want them driving in his neighborhood until after the surgery. "It's safer for society," he said.
As for the cosmetic boost, LiVecchi compared eyelid surgery to removing a cancerous lump from a patient's face. In both cases the doctor's primary objective is keep a patient healthy, he said. A more youthful appearance is only a pleasant side effect, which he sees no problem with. "Doesn't everybody want to look good?" he asked.
The benefits of functional eyelid surgery for some patients are documented. A 2011 study published in the journal Ophthalmology, for example, found that the surgery provided "significant improvement in vision, peripheral vision and quality of life activities."
Plastic surgeons interviewed said vision problems are not always the draw. Dr. Michael Migliori, the president of the American Society of Ophthalmic Plastic and Reconstructive Surgery, said he sees three or four people a day who need the surgery at his practice at Rhode Island Hospital. But he conceded he faces a lot of pressure from patients who do not qualify. "They come in begging for you to do this surgery," Migliori said. "You get a lot of pressure to bend the rules."
Migliori said fudging the paperwork wouldn't be hard. "You could tell the patient to squint," he said, regarding the requirement that the condition be documented by a photograph, and then fake the vision test. But he thinks the majority of his colleagues are honest.