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Source: Angry Bear

by Tom aka Rusty Rustbelt

As we were busy watching the election the Obama administration agreed in late October to settle a class-action lawsuit with disability advocates on Medicare services for the disabled and those with chronic conditions.

Medicare has historically required for certain coverage there be a likelihood of medical of functional improvement before services would be authorized. This precluded coverage for those with chronic conditions or disabilities and unlikely to see improvement.

This is a significant change which, when put into full operation, will be a improvement in coverage for some patients and a major relief for their families. How long this will need to be put into full effect? I am not certain but will certainly keep an eye on it.

Source: Angry Bear

by Tom aka Rusty Rustbelt

The 2009 stimulus bill kicked off the process to install electronic medical records (EMR) tied into electronic health records (EHR) networks. The stimulus bill included financial rewards for installing systems and meeting “meaningful use”standards.

Couple of problems, with unfair heat aimed at the Centers for Medicare and Medicaid Services.
First, it is difficult to really audit the “meaningful use” standards, even if the auditors were available, so we really don’t know if the stimulus money is being used properly. This was a problem baked into the cake.

http://www.nytimes.com/2012/11/29/business/medicare-is-faulted-in-electronic-medical-records-conversion.html?hp&pagewanted=print

Second problem , the physician office systems tend to direct docs through a check-a-box, drop-down-box, and standard language environment. The entered information (in many systems) then interacts with a coding program to send billing codes to the appropriate billing system. Now it seems some physicians using EMRs may be coding higher than physicians who are not. (see NYT archives, 9/24 and 9/25/2012)

Is this higher coding fraud, lack of training, incompetence or could it be the docs were under-documenting and under-coding previously. We won’t know for a while, with billions at risk, and the docs at risk for civil and criminal actions.

Third, THE BIGGEST PROBLEM, EMRs just do not seem to work as neatly as the vendors promise and the bureaucrats imagine. Like many panacea remedies, the implementation is tougher than the dream.
And we haven’t even gotten to ICD-10 implementation yet.

Or the privacy and security nightmares sure to follow.

Source: Angry Bear

by Tom aka Rusty Rustbelt

For the past two months I have been absorbed more so than usual in health care strategic and regulatory compliance issues. One of the top trends is the scramble for a workable business model for providers. The announcement this week of the Beaumont system merger with the Henry Ford system in Detroit is a good example.

Integration and consolidation are clearly the early winners, although the Obama administration still has not gotten the DOJ and FTC on the same page with Health and Human Services.
Integration is supposed to pave the way for innovative payment systems, better data accumulation and better clinical quality. The jury is still out.

In a somewhat related note, I have heard a similar comment from all over the country – rolling out electronic medical records tied into networks (EHR) is a slow, expensive, agonizing process.

Source: Angry Bear

by Tom aka Rusty Rustbelt

I have been spending a great deal of time lately communicating with health care experts far above my modest standing, mostly on publishing projects and seminar scheduling for next year.

One hot topic among the wired in folks is hospital layoffs, not usually large per hospital but a steady drip drip since 2009.

The buzz I am getting is the next two or three years will see a net job loss of about 400,000 as Medicare and Medicaid cuts, combined with incentives to reduce stays and re-admissions, chip away at hospital budgets. Most of the cuts will be from clinical and maintenance areas.

Notice the “net,” hospitals will be doing some hiring during the job cuts. The hospitals will be hiring IT geeks, finance and accounting geeks, nurse managers, case managers and executives.

Some of this is fallout from the economy, but much of it will be changes necessitated by PPACA, especially for those organizations moving into accountable care organizations.

More accountants, fewer nurses. Beware of unintended consequences.

(Dan here…I have some comments and questions in comments hopefully tonight)

Source: Angry Bear

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Source: Angry Bear