Wednesday, August 28, 2013

High-tech monitors will help patients and their caregivers

TVs in your hospital room are so yesterday.
In the near future, flat-screen terminals mounted on the wall or near your bedside might offer a lot more than entertainment. Patients will be able to surf the Internet, order their meals, communicate with nurses and view their latest X-rays — all through interactive patient-care systems.
Educational videos on managing medical conditions, prescription orders and medical records can be flashed on the same screen where patients view dozens of television channels and just-released movies.
“The nice thing is it really puts the patient in the driver’s seat,” said Gary Harper, a registered nurse specializing in information management and communication at the West Palm Beach (Fla.) VA Medical Center in Riviera Beach, Fla., where 259 high-tech terminals should arrive by year’s end. “And it will help the nurses give even better care.”
West Palm Beach VA is one of six veterans hospitals in Florida scheduled to have systems installed in the next year, according to GetWellNetwork Inc., the Maryland technology company handling the project.
Hospital technology experts predict interactive systems, which have been around for more than a decade, will start taking off for one simple reason: They make patients happier. And that could make a big difference to a hospital’s bottom line.
Medicare now collects patient satisfaction data and cuts reimbursements for facilities performing poorly, said Nathan Larmore, a principle-and-practice leader at Sparling, a Seattle-based technology consulting firm advising the health care industry.
And using interactive tools to get patients more involved in their care should reduce hospital readmissions, Larmore said, which is another factor affecting reimbursements.
“In the past, hospitals looked at bedside technologies that improved a patient’s experiences as luxuries. But once they were mandated to focus on patient satisfaction, there was renewed interest,” Larmore said. “Hospitals being built in the last eight years are starting to look more like hotels, which is the industry where some of this technology has come from.”

Larmore estimates that about 10 to 15 percent of acute-care hospitals nationwide have interactive patient terminals. Costs have held many of them back, he said, as systems can run “several hundred dollars to a couple thousand dollars” per room.
“Project managers are used to spending millions of dollars on a fancy lobby, but not several hundred dollars on a television system,” Larmore said.
Children leading the way
Many of the early adopters have been children’s hospitals, he said, “because kids focus on their environment and adapt to the technology.”
Joe DiMaggio Children’s Hospital in Hollywood, Fla., has replaced televisions with interactive monitors. The GetWell Town system, a pediatric product from GetWellNetwork, was part of the new Joe DiMaggio building construction in 2011, then was expanded into the original hospital.
“When we were doing the new building, we talked to the kids about what they wanted, and they said a computer in their room,” said Michelle Barone, director of patient and family centered care for Joe DiMaggio and Memorial Regional Hospital, also in south Florida. “They wanted to be able to get on the Internet and watch movies without waiting for a volunteer to bring them a DVD.”
GetWell Town does all that — plus medical education videos, a hospital-wide game show, and an interface that lets young patients bring in their own Xbox or Wii games.
Barone said Memorial has discussed bringing interactive systems to the adult hospitals, “but right now, it’s all about the numbers,” she said. “When kids are in the hospital, we go above and beyond to cheer them up. We forget that when you’re an adult, you want to be coddled a little, too.”
Officials with the VA, which has its own federal health care funding, say the monitoring systems will greatly improve life for veterans residing in their Community Living Centers, which will be the among the first units to get the terminals.
The Miami VA, the first Florida veterans’ hospital to receive its systems, started the $2.4 million project in June, installing 230 units in the living center and some inpatient rooms.
Chuck Rivenburgh III, 43, is one of four paralyzed vets in Miami’s living center who got a “sip and puff” adapter, allowing him to flip through 48 television channels and pick from among 30 recently released movies by blowing through what looks like a double-pronged straw. The monitor is mounted on a flexible arm attached to the wall, allowing it to be pulled close to Rivenburgh’s bedside.
Rivenburgh, who served in the Army during Desert Storm but was injured after returning home, has lived at the VA hospital for 14 years. Before the GetWell system, he said he was limited to 14 TV channels, none of which included NFL games.
He is thinking of adding a keyboard to his tray table so he can access the Internet through his bedside monitor rather than at the computer on the other side of his crowded room.
“My TV is on pretty much all day long, so all these functions are a huge improvement,” he said.
Louis Marcus, GetWell’s interactive patient care manager for the South Florida VA installations, said the system will be upgraded so that doctors and nurses can leave notes, check pain levels and allow patients to order meals. Such terminals will become even more valuable as medical records go electronic, Marcus said.
As for the veterans, “The feedback has been great,” Marcus said. “I had one family who was visiting sit down with me for half an hour and tell me how grateful they were.”

The Centers for Medicare and Medicaid Services has released a fact sheet on participating in the 2013 Physician Quality Reporting System/Medicare Electronic Health Record Incentive Pilot Program.

Under the program, eligible professionals can meet Stage 1 meaningful use clinical quality measure reporting requirements while also reporting for the PQRS program by submitting their clinical quality data electronically. Participating physicians must submit 12 months of CQM data between Jan. 1 and Feb. 28 of 2014.
The six-page fact sheet covers determining eligibility for the program, indicating intent to participate, verifying that an EHR vendor is PQRS-certified and the EHR is MU-certified, choosing measures to report, generating required reporting files, and submitting test data prior to data submissions for payment, among other issues. 
The fact sheet is available here.

7 Accountable care groups serving Medicare patients in Illinois

CHICAGO (AP) — More than 200,000 Illinois Medicare patients will have their health care needs coordinated by federally designated accountable care organizations. 

Below is a list of the seven ACOs based in Illinois and another six based in other states but serving some Illinois patients:
  • Alexian Brothers Accountable Care Organization, based in Arlington Heights: 16,000 Medicare patients.
  • Christie Clinic Physician Services, Champaign-Urbana: 7,500 Medicare patients.
  • Independent Physicians' ACO of Chicago: 14,000 Medicare patients.
  • Medicare Value Partners (Presence Health), Chicago: 18,000 Medicare patients.
  • Advocate Physician Partners Accountable Care, Rolling Meadows: 119,000 Medicare patients.
  • Chicago Health System ACO (Vanguard Health Systems), Westmont: 9,800 Medicare patients.
  • OSF Healthcare System, Peoria: 33,000 Medicare patients.

Accountable care organizations in other states with Illinois Medicare patients:
  • Franciscan Union ACO, Terre Haute, Ind.: 1,700 Illinois Medicare patients.
  • BJC HealthCare ACO, St. Louis: 5,500 Illinois Medicare patients.
  • Deaconess Care Integration, Evansville, Ind.: 760 Illinois Medicare patients.
  • Jackson Purchase Medical Associates, Paducah, Ky.: 550 Illinois Medicare patients.
  • UnityPoint Health Partners, West Des Moines, Iowa: 19,400 Illinois Medicare patients.
  • Genesis Accountable Care Organization, Davenport, Iowa: 5,600 Illinois Medicare patients

Telemedicine conference speakers say technology to connect patients, doctors is "effective and efficient" |

Telemedicine, the delivery of health care services using technology such as video conferencing, is “a cost-effective, hassle free and patient centered” approach to health care.
That’s the message State Rep. Cary Pigman and a dozen other speakers delivered Tuesday during the 2013-2014 Telemedicine Public Policy Symposium, held at the Mayo Clinic’s Jacksonville campus.
The symposium was hosted by State Rep. Mia Jones of Jacksonville and by Pigman, an emergency physician. After the conference, Jones said she and Pigman plan to co-sponsor a bill that would require Medicaid and private insurers in Florida to reimburse health care providers who treat patients using telemedicine. Currently, 21 states have such legislation.
Telemedicine “is effective and efficient,” said Anne Burdick, the associate dean for Telehealth and Clinical Outreach at the University of Miami Miller School of Medicine. “It should be reimbursed.”
“So much of what we do in health care is directed toward rescue,” Pigman said. “This would enable [physicians] to do more maintenance and preservation.”
Jeff Wacksman, practice operations director for Mobile Physician Services, which provides in-home visits to homebound patients in the Tampa Bay area, noted that 5 percent of Medicaid patients account for 54 percent of Medicaid spending.
One major reason the care of those patients is so expensive is that “they are accessing health care at its most expensive point” by showing up often in emergency rooms.
Providing new ways for such people to access health care could save a lot of money, he said. In fact, if the law were changed to allow homebound patients anywhere in the state to be treated in their homes using telemedicine approaches, the state could save billions, Wacksman said.
Toree Malasanos, a pediatric endocrinologist who is director of the Florida Initiative in Telehealth and Education at the University of Florida, said that using telemedicine techniques to treat kids with diabetes at a clinic in Daytona Beach had resulted in a 70 percent drop in emergency room visits and an 88 percent decrease in hospitalizations.

Telemedicine conference speakers say technology to connect patients, doctors is "effective and efficient" |

Yakima Doctor convicted of Medicare fraud to forfeit $129K

YAKIMA, Wash. — A sentencing hearing has again been postponed in the case of Dr. Curtis Holden, who late last year was convicted of Medicare and Medicaid fraud. However, under a recent settlement, Holden agreed to pay $129,000, far less than what a jury found he stole from the U.S. government.
Holden, formerly of Advanced Podiatry Specialists of Yakima, was convicted in early December on 32 counts of health care fraud for routinely “upcoding” patient visits billed to Medicare and Medicaid, effectively changing patient records to exaggerate what services he had performed in order to get higher reimbursement from the government.
Prosecutors in the case said his fraudulent billing practices lasted for several years in the 2000s, though the counts on which he was found guilty are from 2006 and 2007.
In the forfeiture document, filed Friday, Holden agreed to turn over his 2004 BMW X5 along with $129,675.84 seized by the FBI from various bank accounts.
The document also noted that Medicare is still holding $54,157.32 in payments that Holden had billed but the government suspended when it discovered he had misrepresented the services billed.
The forfeited funds will go directly toward restitution to the government health plans. The document says that figure “settles all criminal and civil claims” filed last June and “the Complaint for Violations of Federal False Claims Act” filed in June 2010.
The government previously contended that Holden owes Medicare and Medicaid about $630,000 more than the settlement amount. But the defendant disputed the sum, and at a hearing on the matter, “the amount was compromised,” according to court documents.
Assistant U.S. attorney Joe Harrington said the settlement was determined to be appropriate by both parties, and that the decision to accept the figure was made by U.S. attorneys after consulting with Medicare. Part of the reason for settling was the “litigation risk” attorneys would carry if they tried to further pursue the full amount in court.
“We have an adversarial criminal justice system; there’s two sides to every story ... There’s always litigation risk that your position wouldn’t be accepted by the court,” Harrington said.
The court has scheduled Holden’s sentencing hearing for Oct. 22. It was originally scheduled for July 9, then was pushed back by a postponement of the forfeiture hearing, which was canceled this week as the two parties came to an agreement on forfeiture motions.
It’s possible Holden could receive a prison sentence, but Harrington said it would be impossible to speculate on that likelihood.

Mobile Doctors CEO, physician charged with Medicare fraud

The head of a Chicago-based company that manages physicians who make house calls and one of its most prolific doctors were arrested Tuesday on charges the company fraudulently billed Medicare for millions of dollars by inflating the level of care given patients.
A criminal complaint charged Dike Ajiri, chief executive officer of Mobile Doctors, with health care fraud and Banio Koroma, a physician who has worked for the company since 2007, with making false statements.
Federal agents raided Mobile Doctors' headquarters in the 3300 block of North Elston Avenue and branch offices in Detroit and Indianapolis and also sought to seize about $2.6 million in alleged fraudulent proceeds from various bank accounts, prosecutors said.
During a brief hearing at the Dirksen U.S. Courthouse, U.S. Magistrate Judge Mary Rowland ordered Ajiri, 42, of Wilmette, held in custody at least until a detention hearing Thursday. Koroma, 63, of Tinley Park, was freed on $50,000 bail but barred from contact with patients.
Before the hearing, Ajiri, a former college football and rugby player, stood with his hands cuffed behind his back, joking with supporters in the courtroom.
Prosecutors said that Mobile Doctors operates in six states, arranging hundreds of thousands of home visits and contracting with doctors who perform the visits. Current and former employees and doctors told investigators that a typical visit with a patient lasts 10 to 30 minutes and is routine in nature.
But according to the charges, Ajiri schemed over the last seven years to increase Medicare billings by falsely claiming the patient visits were more complicated and took longer than they actually did.
A former manager of the Chicago office told investigators that Ajiri set up a system so that the two highest fee codes allowed by Medicare automatically kicked in so that patient visits would be worth the doctors' time and the cost of gas, according to prosecutors.
According to the complaint, the manager quoted Ajiri as telling his physicians, "I don't pay for the ones or twos," a reference to the lower fee codes. From 2006 to 2012, Mobile Doctors received more than $34 million in payments on claims using the two higher codes, according to the charges.
The charges also alleged that Mobile Doctors' physicians falsely certified that patients they visited were confined to their homes, enabling home health care agencies to claim fees for additional services for patients who were not actually qualified to receive them.
Some 16,000 patients had been certified as homebound by the company since 2006, leading to more than 83,000 home health visits, many of them fraudulent, according to prosecutors. Koroma alone accounted for more than 6,000 of the certifications and allegedly billed Medicare for about 17,500 patient visits he made, more than any other Mobile Doctors physician, prosecutors said.