School isn't my favorite thing to do. I think 'Eh' about school." Not an uncommon sentiment among 10-year-olds like Eli Bak of Belmont, but there's one subject he really struggles with: writing. "He has difficulty with things that require a lot of handwork and difficulty with things that require a lot of steps," says Randy Bak, Eli's father. Bak's parents consulted with Dr. Marilyn Augustyn, a developmental and behavioral pediatrician at Boston Medical Center. She wanted to rule out attention deficit hyperactivity disorder. Mehealth for ADHD is an online application developed by a company in Marlborough.
A Kenosha company is poised to begin marketing bacteria-killing light fixtures that could open a new front in the war on hospital-acquired infections. Light, though not the visible variety, already has joined the fight. Many hospitals, including some in Milwaukee, have recently deployed robot-like devices that disinfect rooms with powerful pulses of ultraviolet radiation. Kenall Manufacturing Co. is taking a different approach. Unlike ultraviolet lights, its fixtures can be left on continuously and be used while people — and the bacterial baggage they often bring with them — are in the room. "It just seemed to me like this was a game changer," said Clifford Yahnke, Kenall's director of clinical affairs.
Opponents of the new coding standard are calling on Congress to divorce ICD-10 from reimbursement policy altogether and to provide a better transition to a system that is "more appropriate" and "less burdensome." From MedPage Today.
WASHINGTON -- Grumbling about the much-delayed but now firm launch of ICD-10 in the U.S. -- set for Oct. 1 -- continues unabated, but the message seems to be shifting from demands for another postponement or outright cancellation to pleas for a phase-in period and forgiveness for the inevitable hiccups.
"What we're asking for is a set of training wheels on this new bicycle if we're forced to ride it," said Gerald Harmon, MD, a member of the American Medical Association's Board of Trustees, a family medicine specialist in private practice in Georgetown, S.C. Harmon spoke on a panel hosted by the Heritage Foundation, a conservative think tank, here on Wednesday.
Proponents of ICD-10 argue that the current ICD-9 system is outdated and lacks specificity. They also contend that the new method of coding and reporting disease will enhance research.
But opponents say ICD-10 saddles doctors and other providers with unnecessary financial and administrative burdens without compensatory benefits and cuts into time with patients. The new system is also unnecessarily complex, they argue: it boasts more than 150,000 codes (compared with the 7,000 codes in ICD-9), often minutely specified such as being sucked into a jet engine a second time.
John O'Shea, MD, a senior fellow for health policy studies at the Heritage Foundation, and John Grimsley, a second year medical student at the Georgetown University School of Medicine, also participated in the foundation's panel. In an article they had written for the foundation, they wrote, "Since the 1980s the U.S. has conflated the disparate goals of research and reimbursement by linking the ICD codes to payment for healthcare. This unwise policy will be compounded by replacing the current ICD-9 with the newer -- vastly more complex -- ICD-10."
They called on Congress to divorce the coding system from reimbursement policy altogether and to provide a better transition to a system that is "more appropriate" and "less burdensome."
Speaking at the panel, O'Shea scoffed at heightened specificity as a benefit. He noted that there are separate claim numbers for breaking a right wrist versus a left one.
"Certainly in a clinical realm this is crucial, obviously; in a billing process ... who cares."
As for the idea of the new system providing useful scientific data, O'Shea said claims data have never been good sources for research because the goal of the coders is to maximize reimbursement.
"What I would rather see would be an investment in good research tools such as clinical patient registries," said O'Shea.
Grimsley said he is concerned that the cost burdens imposed by the new billing system will force providers to consolidate, which he argued would increase costs of care and reduce provider productivity.
Harmon outlined requests the American Medical Association recently made to Congress in order to mitigate potential problems. These include:
Providing a learning period during which claims would not be denied or recouped due to errors in specificity
Developing a hardship exemption if a provider's billing software or claims processing clearinghouses cannot smoothly transition to the new system
Expanding the appeals process for other Medicare quality reporting systems when payments penalties are doled out following calculation errors related to ICD-10 implementation
What seemed to concern Harmon most about the looming "ICD-10 hurricane," as he dubbed it, is the disruption he anticipates for his small practice. Several years ago, when his practice switched its National Provider Identifier, "[w]e had a nightmare of a transition," he said. Payments from the Centers for Medicare and Medicaid Services totaling over $200,000 were delayed 3 to 6 months. He predicts similar problems if ICD-10 coding isn't done correctly.
He added, "Large organizations may have the resources to weather this disruption. Small practices such as mine do not."
As an intern fresh out of medical school at Columbia University, Joe Mayer says one of the most frustrating tasks in the ER was spending hours trying to track down a patient's primary care physician. It was tedious, yes. But more than that, it was just one more obstacle to making a decision about that patient's care in an already byzantine healthcare system. And so, during his intern year, Mayer, who had worked for and founded several healthcare IT companies in the past, started work on a company to cut through this complexity.
Nearly 20 years after such videoconferencing technology has been available for health services, fewer than 1% of Medicare beneficiaries use it. Anthem and a University of Pittsburgh Medical Center health plan in western Pennsylvania are the only two Medicare Advantage insurers offering the virtual visits, and the traditional Medicare program has tightly limited telemedicine payments to certain rural areas. And even there, the beneficiary must already be at a clinic, a rule that often defeats the goal of making care more convenient. Congress has maintained such restrictions out of concern that the service might increase Medicare expenses.
House calls are mostly a thing of the past, at this point. Today's patients are looking for Facebook calls. A national survey of over 2,000 American customers of a retail pharmacy found that many patients want more online resources. More than a third of the patients surveyed had contacted their doctor via email in the past six months, and 18 percent sought medical help via Facebook, according to the study, which was published in the Journal of General Internal Medicine. As many as 57 percent of the patients who participated in the survey expressed that they wanted to be able to use their physicians' websites to access their medical information.