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.