Saturday, June 1, 2013

Do You Practice in a "Virtual World"?

If you are involved in the “Digital Delivery” of Medicine in anyway, please share your thoughts, Ideas and Experiences on the following:


·        Patient Centered Care

·        Best Practices

·        Consumer Engagement

·        The Experience of Care

·        Frustrations / Inspirations

·        Further Integration

·        Lessons Learned

·        Future Resources Need

Consumers want an alternative. Taxpayers are tired. Patients want privacy.

How Do We Integrate Digital Health into America’s New Delivery System?

OIG: Flaws in CMS databases threatens integrity of Medicare

The inaccuracy, incompleteness, and inconsistency of provider data maintained by the Centers for Medicare & Medicaid Services (CMS) could put the integrity of the Medicare program at risk, according to findings from the Office of Inspector General (OIG).

The office with the Department of Health & Human Services (HHS) reviewed information of Medicare providers stored in the National Plan and Provider Enumeration System (NPPES) and Provider Enrollment, Chain and Ownership System (PECOS). As the OIG notes, providers are required to supply CMS with their National Provider Identifiers (NPIs), which are maintained in NPPES, in order to enroll in PECOS. Programs such as the EHR Incentive Programs require that eligible professionals and hospitals to have active NPIs to qualify and participate.
So what did OIG find?
First, nearly half of all records (48%) in NPPES contained inaccuracies with close to one-tenth (9%) of records being incomplete. The most common inaccuracies were found to be the provider’s or practice’s mailing address (34.1% and 33.3%, respectively). Based on a survey of 126 providers, most indicated that their mailing addresses were outdated (51; 53%), followed by those indicating that information was never correct at all (27; 28%) or only partially correct (18; 19%).
Second, PECOS was also plagued by inaccuracies, mostly in the area of address data with less than four percent of provider records missing data. Fifty-percent of Medicare-enrolled providers in PECOS had records that were inaccurate, with the most common inaccurate variable being their primary mailing address (46.8%). Similar to findings for NPPES, the largest number of the 126 providers surveyed reported that this information was outdated (60; 57%), followed by those reporting that their information was partially correct (25; 24%) and never once correct (21; 20%).
These findings in particular pose a significant threat to Medicare’s integrity. “Addresses, which are essential for contacting providers and identifying trends in fraud, waste, and abuse, were the source of most inaccuracies and inconsistencies,” writes the OIG.
Third, the OIG found that provider data between NPPES and PECOS were inaccurate for nearly all records, a whopping 97 percent:
Of the 987,266 records for providers listed in both NPPES and PECOS, 961,634 contained at least 1 variable that did not match. Only 11,682 records (1.2 percent of the mismatches) could potentially be attributed to the timelag between updates of the databases. Only 3 percent of records contained information that matched across all selected provider variables. More than half of the records were inconsistent between the databases for provider contact information, such as practice location address (89 percent), telephone number (59 percent), and mailing address (51 percent).
Fourth, the OIG is reporting that CMS fell short of properly verifying provider information in both NPPES and PECOS although the federal agency has processes in place to do so. “CMS had processes in place to verify the accuracy of provider data in NPPES and PECOS; however, the manner in which CMS implemented these processes impeded efforts to ensure that the databases contained accurate information,” states the report.
The OIG is recommending that CMS work closely with its Medicare Administrative Contractors to implement program integrity safeguards and require greater verification of NPPES enumeration data and PECOS enrollment data. Additionally, the federal agency should review and correct data for new and established records. CMS agreed with all the OIG’s recommendations.

Volunteering Benefits Patients, Communities and the Docs Who Do It

FRIDAY MAY 31, 2013

Are you safe?
Have you eaten today?
Did you take your medication?
Those questions can be heard every day in any primary care clinic in the country, but they stopped me in my tracks when I heard them recently on a sidewalk in Washington, D.C.
In town to lobby Congress about physician payment and in the shadows of the U.S. Capitol, I heard those words spoken by a primary care physician tending to a homeless man on the city streets. For Catherine Crossland, M.D., medical director for homeless outreach services at Unity Health Care, working the streets of Washington with a backpack full of medical supplies is a regular part of her job. My brief glimpse of her inspiring work brought to mind how much good primary care physicians do every week through volunteering.
The AAFP's vision is to transform health care to achieve optimal health for everyone. Health care reform has expanded coverage to millions of people who previously were uninsured or underinsured. But even after the Patient Protection and Affordable Care Act is fully implemented, the number of Americans without insurance will still stand at 15 million to 30 million, depending on how many states fail to expand Medicaid coverage.
In other words, there are people who are falling through the holes in our health care safety net today and who will continue to do so for our foreseeable future.
We still have a job to do, in D.C. and in all our communities.
The uninsured and underinsured receive primary care in three places: community health centers, free clinics and through the generosity of physicians in private offices. In fact, the average family physician provides free or discounted care to eight patients per week.
The years I spent volunteering at the Stout Street homeless clinic in Denver were tremendously challenging and rewarding. Caring for the homeless raises questions we never had to consider in my then suburban practice. How do you dose insulin when the next meal is uncertain?
Of course, volunteering doesn't have to be anything as time-consuming as providing care at a free clinic. Family physicians make a difference every day in their communities, from making time to see the extra uninsured patient to teaching medical students in the office or presenting Tar Wars in the local schools.
During my Academy travels, it always amazes me to meet the innumerable family docs who make a difference even beyond their medical expertise by coaching youth sports or getting involved with their local school boards.
And the interesting thing is, when we help others, we are also helping ourselves. Volunteering enriches our lives in many ways. It connects us to others, refreshes our souls and even has medical benefits. Research has shown that people who volunteer have less depression and less stress than those who do not volunteer.
Thank you for what you do every day. Your patients, your community and you are healthier for it.

CMS Estimates Medicare Physician Payment Cuts, Outlines Cost-Containment Steps

CMS estimates that Medicare payments to physicians will decline by 10.6% below current levels on July 1 and by 15.4% below current levels on Jan. 1, 2009, under the current payment formula, CQ HealthBeatreports. The estimates were released on Friday in a letter from Jeffrey Rich, director of the CMS Center for Medicare Management, to the Medicare Payment Advisory Commission. The cuts reflect an increase in the volume of services provided by physicians that exceeds growth targets. 

Nancy Nielsen, president-elect of theAmerican Medical Association, in a statement on Friday said that lawmakers should "replace 18 months of looming Medicare physician payment cuts ... with funded payment updates that reflect medical practice cost increases," adding, "This sensible approach will give Congress time to work with physicians to legislate a solution to the long-term Medicare physician payment problem." Nielsen said that if the 10.6% cut goes into effect on July 1, about 60% of physicians say they will have to limit how many new Medicare beneficiaries they can treat, and more than half say they will have to reduce office staff.

Congress is working on a Medicare package that would block the cuts, according to CQ HealthBeat. One plan by the Senate Finance Committee would block all cuts in 2008 and 2009.

Rich in the letter also outlined steps CMS is taking to improve quality and efficiency, including:
  • Continuing and expanding the Physician Quality Reporting Initiative, which pays physicians an additional 1.5% of their billed charges for reporting quality-of-care data;
  • Implementing "structural measures," which include purchasing and using electronic health record systems;
  • Intensifying efforts to collect and share data on physicians' comparative costs to improve efficiency; and
  • Testing pilot programs, which currently include one that pays for efficiency in treating chronic conditions and another that develops medical homes for beneficiaries.
Rich in the letter wrote, "The real issue is how Medicare can rapidly transform itself from a passive payer for services into an active purchaser of high-quality care by linking payment to the value of care provided" (Reichard, CQ HealthBeat, 3/3).
HHS Denies Request To Halt Competitive Bidding 
In related news, HHS last week denied a request by the American Clinical Laboratory Association to suspend a pilot program that tests competitive bidding for Medicare clinical laboratory services, CQ HealthBeat reports. The three-year program will be tested in the San Diego market and affects any laboratory that has Medicare revenues above $100,000. The trade group requested that the pilot be suspended for a minimum of 180 days. Meanwhile, a lawsuit brought by clinical labs that aims to halt the program is pending (CQ HealthBeat, 3/3).

Reprinted with kind permission from You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at The Kaiser Daily Health Policy Report is published for, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.