MRA Alerts and Updates

Thursday, May 16, 2013

Relationships Are a Critical Part of Building Medical Homes

WEDNESDAY MAY 15, 2013

The small Nebraska town where I practice family medicine has a population of about 2,000. Although my practice is only 30 minutes west of Lincoln -- the state's capital and second-largest city -- solo and small family practices are common in the rural areas to my north, south and west.

As my colleagues in these small practices ponder the patient-centered medical home (PCMH), I know that it can seem overwhelming to implement. The bodies that recognize or certify PCMH practices have numerous confusing requirements that have more to do with processes than patient care. So when I talk to family physicians who have concerns about the PCMH, I suggest they read the original articles on the subject by Barbara Starfield, M.D., M.P.H.

Instead of a large number of boxes to check, Starfield thought there were three simple things at the core of becoming a medical home.

The first is to be comprehensive in your approach to health care. It is comprehensiveness that separates us from our subspecialty colleagues who focus on a single organ system or a single disease entity. It is comprehensiveness that separates us from midlevel providers who say they can deliver care as well or better than family physicians. Ordering more tests and referring to subspecialists is not comprehensive care. Family medicine is.

The second critical factor is disease management. We all know there are certain diagnoses that predispose patients to increased morbidity and mortality. The Academy has clinical recommendationsand resources to help your practice with chronic disease management protocols that fit your practice. You also can develop disease registries to be more proactive with these patients. By doing so, we can reduce morbidity and mortality and ultimately reduce costs to our health care system.

Finally, relationships and continuity of care are important. Knowing our patients and their families facilitates caring for them. This can reduce duplication of tests and improve compliance to treatment plans by understanding each patient's culture and concerns. I recently had this brought home to me by one of my long-time patients.

Oliver was a 92-year-old, retired minister who had contracted pneumonia and required hospitalization. I have cared for his family for years. In fact, I delivered two of his grandsons.

Oliver was not responding to treatment, so as I examined him, I talked to his family -- including those grandsons -- about other interventions we could try to improve his situation. As I talked, his son, David, got out of his chair, came to me and placed his hand on my arm. He said, "Dr. Wergin, you know my dad loves you, and we all love you. You are as much a part of our family as anyone in this room. We wanted to let you know that my father does not fear death and is ready for what's to come. In fact, we are all ready for what's to come, but we're worried about you. You don't seem to be ready."

I looked at David and told him I understood. I went to the nurse's station and wrote a prescription for morphine and other comfort measures. I continued to round on him and talk to him each day. There was no new hospice nurse or shift-working hospitalist. Instead, it was just me and Oliver's family. That's family medicine.

Oliver passed away a few days later. It was a quiet death, and his family members were with him.

Medicine is always changing, and we have to be prepared. It is important to develop a plan to meet PCMH requirements if you want to be recognized or certified as a PCMH practice. We know that our strict fee-for-service model, which has not served us well, is coming to an end. To be reimbursed in a new model of payment, we must show we deliver what we promise. Don't be discouraged, and remember that patient-centered care is based on these three things: comprehensiveness, disease management and relationships.

How do you build relationships with your patients?

Robert Wergin, M.D., is a member of the AAFP Board of Directors.

U.S. sets $1 billion healthcare innovation initiative

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Analysis & Opinion

The sequester is just as destructive as we thought

NYU launches ICD-10 medical coding certificate program

Author Name Jennifer Bresnick | Date May 15, 2013

ICD-10 represents more than just a disruption in a physician’s note taking habits, or a couple of new letters and numbers for coders to tap in to their billing claims. It’s a fundamental overhaul in the way that diagnoses and procedures are documented, and it will require specialized knowledge and a level of proficiency many ICD-9 coders will initially struggle to master. Enter New York University and its brand new Certificate in Medical Coding, offered through the School of Continuing and Professional Studies (NYU-SCPS). It’s one of the first major programs from an academic institution to be built upon an ICD-10 foundation, offering students the anatomical and medical expertise necessary to tackle the new system.

“We believe that as demands in the health information management industry increase, coding professionals will be required to have certifications or a credential to demonstrate they have met a minimum professional standard,” says Denisse Jimenez, program administrator at NYU-SCPS . “Many programs are still providing ICD-9 training which will be obsolete by 2014. Our program addresses the changes that are occurring in the health information management field and recognizes the expanded skill sets that will be required by medical coding professionals.”

To keep up with mounting financial pressures resulting from ICD-10, EHR adoption, meaningful use, and a number of other health IT initiatives all hitting the industry at once, providers are changing the way they hire and retain staff. A recent survey indicates that a quarter of practices are cutting staff, including medical coders, just to stay in the black. But coders with ICD-10 proficiency are only going to become more and more valuable as the implementation date creeps up and providers realize the impact of the transition on productivity and timely payments.

“A huge component of ICD-10 transition planning is employee retention,” explains Bonnie Cassidy, MPA, RHIA, FAHIMA, FHIMSS. “You’re going to be dealing with a very competitive market of supply and demand. Those who embrace it and get trained, and become experts in ICD-10, are going to be a real commodity.” AHIMA and other organizations also provide training and education for physicians and coders alike, and constantly urge professionals not to delay education in anticipation of another pushback of the compliance deadline.

NYU’s certificate includes nine required courses ranging from instruction in anatomy and physiology to pathophysiology and pharmacology. The program is designed for both new students as well as experienced coders seeking a foundation in ICD-10 before the October 1, 2014 transition date. More information about the certificate program is available on NYU’s website.

MS-DRG shifts in ICD-10-PCS

In a perfect world, inpatient facilities would receive the same payments for diseases and procedures after the switch to ICD-10-PCS. We know that won’t happen, that facilities will see some shift in MS-DRG assignment and as a result, different reimbursement.

Why will certain conditions track to different MS-DRGs? In part, code assignment to MS-DRGs will change because the coding guidelines are changing. Specificity is increasing in many cases and decreasing in a few.

ICD-10-CM also changes the meaning of some of the diagnosis descriptions by including more combination codes and is also changing the CC/MCC designations for some codes.

Don’t forget about coding errors. Coders may be incorrectly assigning an ICD-9-CM code now, which could lead to incorrect MS-DRG assignment. In ICD-10-PCS, coders may also assign an incorrect code by choosing the wrong root operation. That could also lead to a change in the MS-DRG.

Hospitals should begin looking at their top MS-DRGs and determining whether the documentation is sufficient to code in ICD-10. Then code the case in ICD-10 and see which MS-DRG it ends up in. Is it the same MS-DRG, a higher paying MS-DRG, or a lower paying one?

Then try and determine why the MS-DRG changed. Maybe you have more specific information. You could be picking up a CC or MCC you aren’t currently reporting. Are you correctly sequencing the codes?

Once you figure out what will happen with your top MS-DRGs, you’ll have a better understanding of the financial impact of ICD-10 and also have a starting point for physician education.

Entry Information

About the Author: Michelle A. Leppert, CPC, is a senior managing editor specializing in outpatient coding for JustCoding.com, which provides coders, coding supervisors, and health information management (HIM) directors with educational resources to test their coding knowledge, employ correct coding guidelines, and stay abreast of CMS transmittals.

In addition, she writes and edits the HCPro Inc. publications, Briefings on APCs andAPCs Weekly Monitor. Email her at mleppert@hcpro.com.

A drop in the bucket…

WRITTEN BY: JASON SHAFRIN - MAY• 16•13

Every year, the Centers for Medicare and Medicaid Services (CMS) conducts a recovery audit. In a recent report, Medicare collected over $797 million in Medicare overpayments in 2011. Where do these overpayments come from?

Inpatient: $677m
Durable Medical Equipment & Other: $35m
Physician: $33m
Outpatient: $17m
Skilled Nursing Facilities: $0.2m

Recovery Audit Contractors returned $488 million in improper payments to the Medicare Trust Fund in 2011. Although this may seem like a large amount of money, Medicare spending in 2010 was $524 billion. Thus, the recovered funds amount to less than two tenths of a percentage of total Medicare spending.

Figures from the FY2010 audit are displayed below. These figures do not, however, include payments returned to the trust fund.

http://healthcare-economist.com/2013/05/16/a-drop-in-the-bucket/

Wednesday, May 15, 2013

Texas Bill Would Let Doctors Get Data From Driver’s Licenses

THE TEXAS TRIBUNE

By BECCA AARONSON

Published: May 11, 2013

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Health care providers in Texas could soon collect or verify patient information by swiping that patient’s driver’s license.

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Allison V. Smith for The Texas Tribune

Proposed legislation is part of an effort to enhance electronic records. Above, a patient in Plano uses an iPad for a screening.

Expanded coverage of Texas is produced by The Texas Tribune, a nonprofit news organization. To join the conversation about this article, go totexastribune.org.

The measure allowing such data collection is one of a handful that the Texas Medical Association is pushing this legislative session to help modernize medical practices. The association is also backing bills that would standardize preauthorization forms used by health plans for prescription drugs and health care services.

“A lot of these things are easy fixes,” said Dr. Michael Speer, president of the Texas Medical Association. “It’s just a matter of getting enough people to come together and agree that it’s the right fix.” (The Texas Medical Association is a corporate sponsor of The Texas Tribune.) The association, which represents more than 47,000 physicians and medical students, asserts that time and money are wasted on bureaucracy, and that each physician spends nearly $83,000 a year on administrative costs. It donated more than $1.3 million to state candidates in 2011 and 2012.

Medical practitioners must follow myriad procedures for billing private and public health plans. Many hire additional staff members to handle the paperwork, and simple errors can obstruct payment.

“It’s an extremely inefficient business model,” said Dr. Bernard Swift Jr., chief executive of Texas MedClinic, a network of urgent-care facilities.

Dr. Swift said Senate Bill 166, which is awaiting the governor’s signature, would eliminate repetitive paperwork by allowing licensed health care providers to collect accurate patient information from a driver’s license. Now, only hospitals in Texas are authorized to do so.

Senate Bills 644 and 1216, which have been approved by the Senate and referred to a House committee, would standardize the preauthorization forms required for prescription drugs and health services.

If health plans used the same or similar forms, it “could make a dramatic difference in the amount of manpower hours” spent on paperwork, said Representative John Zerwas, a Republican from Simonton. Dr. Zerwas, who is also an anesthesiologist, sponsored S.B. 644.

Although insurance industry representatives originally opposed the preauthorization form bills, they support the revised versions of the legislation that would set up expert advisory councils at the Texas Department of Insurance to ensure that the state’s standardized forms match federal standards and allow for electronic transmission of the records.

“Let the experts determine form and format,” said David Gonzales, executive director of the Texas Association of Health Plans. In health care, “standards at the national level are the preference. You don’t want 50 different state approaches.” (The Texas Association of Health Plans is a corporate sponsor of The Tribune.)

As physicians adapt their practices to the digital era, collecting accurate patient data — like that from a driver’s license — will help improve payment systems, ensure patient safety and prevent insurance fraud, said Nora Belcher, executive director of the Texas e-Health Alliance, an association of health technology stakeholders.

“What’s really best for the patient is complete data at the point of care,” Ms. Belcher said.

baaronson@texastribune.org

3 La. doctors indicted after nationwide Medicare probe

BY BILL LODGE

Advocate staff writer

May 15, 2013

3 COMMENTS

Two doctors in New Orleans and a third in Baton Rouge are among 11 new defendants indicted as a result of investigations by the Baton Rouge Medicare Fraud Strike Force, federal officials announced Tuesday in Washington, D.C.

Between $80 million and $100 million in fraudulent Medicare billings are alleged in two Strike Force indictments in Baton Rouge and New Orleans.

Attorney General Eric Holder and Department of Health and Human Services Secretary Kathleen Sebelius said the 11 defendants in the Louisiana cases are among 89 announced nationwide as people who sent Medicare a combined total of $223 million in fraudulent billings.

In Baton Rouge, Dr. Zahid Imran was identified last week as a new defendant in a Medicare fraud case that now targets 17 people for prosecution over losses prosecutors estimate at between $20 million and $49.9 million.

Imran, 55, said both before and after his indictment that he is innocent of charges that allege he conspired to commit health care fraud by falsely certifying patients for partial outpatient services at two Baton Rouge psychiatric clinics.

Those clinics were Shifa Community Health Center, in the 6700 block of Goya Avenue, and Serenity Center, in the 1000 block of Lobdell Boulevard. Imran, of Baton Rouge, also was an owner of Serenity Center.

Among those indicted in New Orleans federal court are Dr. Alvin Darby, 57, of Slidell, and Dr. Barbara Smith, 64, of Metairie. Both physicians are charged with conspiracy to commit health care fraud. They are alleged to have fraudulently certified ineligible Medicare patients for home health care services.

The indictment, made public Tuesday, alleges Darby and Smith accepted payments from Slidell businessman Mark Morad, 49, to certify patients for receipt of home health care services provided by three of Morad’s firms — Interlink Health Care Services, Memorial Home Health Inc. and Lakeland Health Care Services.

Between April 2005 and December 2012, the indictment says, the three firms billed Medicare a combined total of $51.7 million for home health care services. The firms were paid a combined total of $42.4 million by Medicare during that time, according to the indictment.

Darby could not be located for comment Thursday.

Smith, however, said she has never worked for Morad or for any of his three firms.

Smith emphatically declared her innocence, adding, “I definitely have not” fraudulently certified any patients for Medicare-covered services for any business person or company.

Demetrias Temple, 52, of New Orleans, and Nicole Oliver, 43, of Napoleonville, are identified in the New Orleans indictment as patient recruiters for Morad’s three firms.

Neither Temple nor Oliver could be reached for comment late Tuesday.

All five defendants are accused of conspiracy to commit health care fraud. Morad, Temple and Oliver also are accused of conspiracy to pay and receive health care kickbacks.

In Baton Rouge, new defendants in the psychiatric services investigation include Baton Rouge resident Rafat M. Jafri, 55. Jafri was an owner of a third clinic, Shifa Texas, in Houston, according to the amended indictment. He is accused of conspiracy to commit health care fraud, as well as conspiracy to pay and receive health care kickbacks.

A request for comment left on Jafri’s home answering machine late Tuesday was not returned.

Three Houston residents also are charged in the amended indictment in Baton Rouge. They are 47-year-old James R. Hunter, 45-year-old Anna Ngang and 33-year-old Osborne “Patrick” Wallace.

According to the indictment, Hunter was a Medicare-patient recruiter for Shifa Texas. Ngang is described in the indictment as a therapist and program director at Shifa Texas. Wallace, the indictment states, “was a recreational therapist employed at Shifa Texas.”

Hunter, Ngang and Wallace are accused of conspiracy to commit health care fraud. Hunter also is accused of conspiracy to pay and receive health care kickbacks.

Hunter, Ngang and Wallace could not be located for comment Tuesday.

A sixth new defendant in the Baton Rouge case is Erica Williams, 42, of Beaumont, Texas.

Williams appeared in federal court Thursday and pleaded guilty to one count of conspiracy in the Shifa and Serenity fraud cases. Chief U.S. District Judge Brian A. Jackson did not immediately schedule a sentencing hearing for Williams.

http://theadvocate.com/news/5976028-123/3-la-doctors-indicted-after

People who may have changed your life - CNN.com

The IRS Raids 60 Million Personal Medical Records

PHARMA & HEALTHCARE

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5/15/2013 @ 11:28AM |5,379 views

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The Internal Revenue Service is facing a class action lawsuit alleging that more than 60 million personal medical records were improperly accessed, and stolen, by agents from the embattled agency. It’s just one more reason, as I wrote yesterday, to re-think the agency’s role under Obamacare.

Inevitably, Obamacare confers the IRS with broad access to information about our health insurance, as well as direct electronic linkages into a new government super computer that will also store a lot of bottom line information about our individual healthcare choices.

It’s a recipe for mischief by an agency that’s proving that it can’t be fully trusted.

This isn’t a fictional, Orwellian vision. It’s a reality of how Obamacare was structured. And how much the law depends on enforcement meted out by the IRS.

The Obama Administration probably didn’t set out to design the system this way. But a myriad of concessions made to accommodate the law’s vast scope and intrusive provisions has placed many of its applications in the lap of the IRS.

In a story reported by Erin McCann of Healthcare IT News, (You can follow her on Twitter @EMcCannHITN), the IRS is alleged to have improperly accessed some 60 million medical records from 10 million Americans, including medical records of all California state judges.

According to a story by Courthousenews.com, whose correspondent Rebekah Kearn first reported on the legal skirmish, an unnamed healthcare provider in California is bringing the lawsuit against the IRS and 15 of its agents. The personal health information was allegedly seized by the IRS on March 11, 2011.

The medical records included information on psychological counseling, gynecological counseling, sexual and drug treatment, and other sensitive medical treatment data. A copy of the legal complaint can be purchasedHERE for $35.

“This is an action involving the corruption and abuse of power by several Internal Revenue Service agents,” the complaint reads.

“No search warrant authorized the seizure of these records; no subpoena authorized the seizure of these records; none of the 10,000,000 Americans were under any kind of known criminal or civil investigation and their medical records had no relevance whatsoever to the IRS search. IT personnel at the scene, a HIPPA facility warning on the building and the IT portion of the searched premises, and the company executives each warned the IRS agents of these privileged records,” it continued.

The claim asserts that the IRS agents’ seizure of medical records violated the 4th Amendment.

“These medical records contained intimate and private information of more than 10,000,000 Americans, information that by its nature includes information about treatment for any kind of medical concern, including psychological counseling, gynecological counseling, sexual or drug treatment, and a wide range of medical matters covering the most intimate and private of concerns,” the complaint states.

“Despite knowing that these medical records were not within the scope of the warrant, defendants threatened to ‘rip’ the servers containing the medical data out of the building if IT personnel would not voluntarily hand them over,” the complaint reads.

“Moreover, even though defendants knew that the records they were seizing were not included within the scope of the search warrant, the defendants nonetheless searched and seized the records without making any attempt to segregate the files from those that could possibly be related to the search warrant. In fact, no effort was made at all to even try maintaining the illusion of legitimacy and legality.”

According to the complaint, the IRS agents had a search warrant for financial data pertaining to a former employee of the John Doe company, however, “it did not authorize any seizure of any healthcare or medical record of any persons, least of all third parties completely unrelated to the matter.”

The IRS has not returned requests for comment.

Recent mischief over the political targeting of conservative groups should give us pause about turning over to the IRS a greater role in regulating healthcare.

Truth is, every indication suggests that the agency doesn’t even want the obligations it’s being given under Obamcare. It rightly recognizes that it has enough on its plate already.

There is no reason these bureaucratic burdens can’t be discharged elsewhere inside the government. The IRS was pulled into Obamacare not out of necessity, but expediency. It was judged that handing over certain obligations to the IRS would be the fastest way to get the law implemented.

The Obama Administration shouldn’t settle for this. Neither should we.

Americans should demand that the Obama team work a little harder to get its signature legislation off the ground without pulling the IRS so deeply into our healthcare choices — and bringing the agency so close to the private information about our medical care.

Follow Dr. Scott Gottlieb on Twitter @ScottGottliebMD

NeHC helps Healthwise spur engagement

eHealth Readiness Tool will help gauge consumer engagement processes

WASHINGTON | May 15, 2013

National eHealth Collaborative and Healthwise, a nonprofit organization that develops patient education and engagement technology, announced Tuesday that, as part of their collaborative efforts, Healthwise will make NeHC's Consumer eHealth Readiness Tool available to clients.

NeHC officials note that Healthwise is a longtime partner in helping to advocate the use of eHealth tools to help patients become full partners in their care. Healthwise Senior Vice President for Policy Leslie Kelly Hall is a member of the NeHCBoard of Directors and NeHC's Consumer Consortium on eHealth Steering Committee. She led an effort to bring stakeholders together to develop the NeHC Patient Engagement Framework, which was developed to guide healthcare organizations in developing and strengthening their patient engagement strategies.

The Patient Engagement Framework, which was developed with input from consumer and patient advocates, policymakers, technology organizations, healthcare providers and health plans, has been downloaded from NeHC's website nearly 8,000 times, officials say, and is being used as a conceptual model to inform patient engagement strategies.

The NeHC Consumer eHealth Readiness Tool is mapped to the Patient Engagement Framework and meaningful usecriteria, and serves as an online diagnostic tool to help organizations quantify, prioritize, and focus their improvement efforts and measure their progress toward IT-enabled consumer engagement.

In addition to working with NeHC and other interested stakeholders to spread the word about the Patient Engagement Framework and the CeRT, Healthwise is sponsoring several annual CeRT subscriptions that will be provided to select Healthwise clients.

Big Data and Healthcare Analytics Forum June 4-5 Washington

"Healthwise is a leader in the healthcare community, working to accelerate the use of health IT tools that help physicians and other providers better connect, communicate and empower their patients to take a more active role in their care," said NeHC CEO Kate Berry in a press statement.

"Engaging patients directly is critical to the transformation of healthcare - engaged patients take better care of themselves, which leads to better outcomes and lower costs," added Hall. "Making the CeRT available to Healthwise clients supports our mission of helping patients make better health decisions."