Approximately 45,000 physicians across the nation will qualify for as much as $63,750 in Medicaid stimulus money over the next six years to install health information technology, according to a new study released today.
The George Washington University School of Public Health and Health Services study found those 45,000 physicians—who represent 15% of the roughly 300,000 practicing office-based physicians in the country—will qualify for the Medicaid stimulus funding if they demonstrate meaningful use of HIT for a patient mix that includes at least 30% Medicaid beneficiaries.
Office-based pediatricians who do not meet the 30% Medicaid volume threshold but have at least 20% Medicaid patients will receive up to $42,500.
In addition, physicians who practice at federally qualified health centers or rural health centers can qualify if 30% of their patient base is characterized as "needy," including those covered by Medicaid, those who receive uncompensated care and patients who are charged income-related sliding scale fees. The study estimated that nearly all (99%) health center physicians meeting a predominant practice standard will qualify for the Medicaid HIT incentives.
About 16% of physicians now have fully electronic health records; another 15% report partial EHR, the study estimates.
HHS set a goal of 40% HIT adoption by 2012. To push the process, the $787 billion American Recovery and Reinvestment Act of 2009 earmarked approximately $49 billion to expedite HIT adoption through Medicare/Medicaid financial incentives targeted at specific providers. Although it's a considerably smaller piece of the incentive pie, Medicaid could pay out more than $2.8 billion for HIT if all qualifying physicians apply for incentives and receive the maximum payout.
HIT incentives through Medicaid are somewhat different than those incentives offered through Medicare, the study notes. First, Medicaid makes financing available on the front end for physicians who otherwise might not have their own money to invest. Also, Medicaid HIT implementation is optional for states, and not a condition of participation in Medicaid. Instead, the federal government hopes to lure states into the HIT movement through increased funding.
Despite the billions of dollars committed to HIT implementation, the study found that considerable challenges remain, including: finalizing a definition of the term "meaningful use"; determining how the additional costs generated by HIT will be financed over the long-term; determining how support will be extended to physicians who fail to qualify for either Medicare/Medicaid incentives; achieving interoperability; and the speed with which states implement the Medicaid incentives.
The Louisiana State University Health Sciences Center-Shreveport (LSUHSC) will pay $706,000 to settle allegations that the teaching hospital billed Medicare for services that were not provided, according to an article in the Shreveport Times.
Former LSUHSC employees William Overdyke, MD, a teaching physician in the hospital's orthopedic department, and Susan Belgert Hodnett, the orthopedic head nurse, blew the whistle on LSUHSC,s alleged fraudulent billing. Overdyke and Hodnett say that between 1995 and 2005, J.A. Albright, MD, and Kalia Sadasivan, MD, were routinely absent from surgical procedures they were scheduled to attend, but proceeded to bill as if they had been there. According to the article, the physicians and the hospital would then divide the reimbursement.
Overdyke and Hodnett filed the charges in October 2002, and according to the article, Hodnett was fired within a year of the filing. Hodnett also claims LSUHSC gave poor reviews of her performance to potential employers in retaliation for the suit. Overdyke, who was fired prior to filing the suit, was investigated by LSUHSC,s chancellor for receiving kickbacks. Overdyke claims the charges were unfounded and were an act of vengeance.
These claims of mistreatment could cost LSUHSC. The False Claims Act protects whistleblowers from being discriminated against by their employers. Overdike and Hodnett will split $141,335 from the settlement and plan to file another suit to collect lost wages, lost benefits, damage to their reputations, and other items allowed by state and federal whistleblower protection laws.
America's emergency room doctors have been feeling slighted.
For starters, they were left out of an influential White House health reform summit in March, leaving them grumbling that their new President didn't appreciate their crucial role in saving lives.
Second, they have been arguing for more respect from their hospital CEOs, who they say often turn a blind eye to gridlocked emergency rooms with loaded hallway gurneys. Several emergency room doctors this week complained that while the ED "boards" patients with respiratory illness and injuries waiting for an upstairs bed to clear, empty beds sit for hours on the units labeled "reserved," awaiting well-insured patients scheduled for elective surgery.
And third, they say they were insulted by Kathleen Sebelius, who no sooner than assuming the role of U.S. Health and Human Services secretary this spring, suggested most patients who end up in the emergency room don't really need to be there. In doing so, they say, she "perpetuated myths" and trivialized the very dangerous problem of overcrowding, even as hospitals everywhere prepare for a very different influenza season.
She was so mistaken, says Nick Jouriles, MD, president of the American College of Emergency Physicians, who pointed to a Centers for Disease Control and Prevention report that says only 12% of emergency room patients have non-urgent medical needs. More than half of patients who seek emergent care are admitted, so how can their medical needs not be serious?
And fourth, emergency teams are stretched as never before. The number of visits to the emergency room has increased from 90.3 million patient in 1996 to 119.2 million in 2006 just as the number of hospital emergency rooms has decreased, from 4,019 to 3,833. And the percentage of the population that visited an emergency department increased 18%.
With an underlying sense of umbrage, Jouriles and the College this week reemphasized the critical importance of emergency room teams, and turned up the volume in its call for attention.
Some of the most thoughtful scientists are suggesting that H1N1 might return with a vengeance, striking younger people, the ones in the hospital system's workforce, first. Yet not all hospitals are doing what they should to get ready, Jouriles says.
The report contained 27 plan topics, underscored with 93 suggested action items, which the College thinks hospitals wishing to make a serious effort at preparedness should be doing now.
Make sure support personnel have enough resources, check that all appropriate hospital staff are properly certified and trained and set aside time to rehearse with disaster drills—not for a flood or an explosion scenario—but a real live H1N1 pandemic.
For even the largest hospitals, it's a daunting "to do" list. And smaller and medium-sized hospitals, might not get around to completing a lot of what might be required, says Stephen Cantrill, MD, a member of ACEP's H1N1 Task Force.
Cantrill says these are three areas where hospitals are most vulnerable in the event of a pandemic attack:
Number one, Cantrill says, "is staffing. In a disaster like Katrina, you had people from around the country willing to come in and help out. But if the next outbreak is broadly population based, you will lose not only many members of your own staff, but the vast majority of your volunteers."
Hospitals need to start now to mobilize teams of nurses and physicians, even if it means recruiting those retired but who kept their licenses active.
Number two is supplies. Far too many hospitals are using "just-in-time" purchasing policies that will leave them scrambling for masks, gloves, gowns and ventilators, not to mention antibiotics and IV equipment, if a 1918-level flu season strikes.
"If you do the numbers of what would be required for a sustained pandemic, it just strikes fear in the heart of anyone who has looked carefully at this problem," say Cantrill, an emergency room physician at Denver Health Medical Center in Colorado.
"There would be a disruption in our supply chain." And hospitals that normally compete with each other will not be willing to help out if they themselves are running short too, he says.
Number three is communication. Hospitals and public health officials must have a routine, constant communication stream, a conduit he says has historically been a weak link. But the involvement of public health officials is essential to reassuring the public and the media, notifying patients when to go to the hospital, and when to stay away.
At his hospital last April, "the number of patients in our emergency department with respiratory complaints increased by a factor of three. It was overwhelming and debilitating and public health officials need to know about that, and do what they can to offload on other facilities," Cantrill explains.
Lastly, he says, is to imagine the worst. Hospital officials at all levels of care need to dust off their protocol books and spend some time thinking about how such a scenario would really play out when resources are stretched thin.
It's tough to think about, he says, but each hospital needs to have a plan, and a chain of command, for deciding how to triage patients for life-saving care. Who gets a ventilator and who doesn't when there aren't enough to go around?
"We only have 105,000 ventilator in the U.S. and we would need six times that if we had a true pandemic," Cantrill says. "Hospitals are going to have to look at way to prioritize when we have limited supplies."
"These are tough ethical questions," no one can dispute, he says. And while some states and regions of the country have "really taken the bull by the horns," others have not.
The emergency room doctors have turned up the volume of their message. Maybe it's time to listen up.
It seems that many providers still struggle to understand the Recovery Audit Contractor discussion period that CMS has helpfully given them—much less take advantage of it when the permanent program rolls out in their area.
The discussion period is new to the permanent program, though it is somewhat akin to the rebuttal period, which was part of the demonstration program.
"The rebuttal period was used in the demonstration because it is part of the Medicare appeals process," says Camille Cohen, MBA, CHC, compliance manager at 3M Health Information Systems in Salt Lake City.
But CMS found providers had a slightly different need from the rebuttal process during the demonstration project, she says. Originally designed to discuss mathematical errors, providers instead used the rebuttal period for all kinds of discussions. Hence, CMS decided to initiate the discussion period specifically for RACs.
"The RACs and CMS are trying to work with providers, and the discussion period is a huge open door for providers to have a dialogue with their RAC," Cohen says.
Providers can use this chance to communicate with their RACs to discuss much more than math. Not only can they use it to try to change the RAC's mind on a denial, but they can use it as a learning opportunity. A RAC may discuss how it came up with the determination. Providers should seek out that information so they don't keep making the same mistakes, says Cohen.
That information may also be helpful during the appeals process, she says. "But the discussion period doesn't lengthen in any way shape or form the appeals process and it doesn't take the place of the appeals process," she reminds us. "All it does is open up the dialogue with the RAC to hopefully take care of problems such as missing or incomplete documentation before you have to go through the appeal process."
In addition, some RACs have indicated during outreach sessions that they will accept missing documentation. "CMS emphasized providers shouldn't go create documentation, but if a provider has documentation, but it is missing from the information received by the RAC, some RACs will accept the missing documentation after the fact," Cohen says. For example, if a physician discharge summary had been dictated, but never filed—the RAC would likely accept that during the discussion period, she says.
The discussion period has two different start times, depending on whether it is for an automated or complex review. With an automated review, the provider finds out there has been a review and a denial when it receives a demand letter from the RAC. Receipt of that letter kicks off the discussion period. But for complex reviews, the discussion period begins when the provider receives the review results letter, which would arrive prior to the demand letter, giving the provider additional time to discuss the denial with its RAC. The discussion period ends upon recoupment of the money (i.e., day 41) regardless of the type of review.
But providers shouldn't wait until day 39 or 40 to contact their RAC. "CMS was very careful to say to providers that they should contact their RAC as soon as possible during the discussion period because it doesn't stop the recoupment," Cohen says. "But if the provider can quickly convince the RAC that an error was made in denying the claim during the discussion period, and the demand/remittance step isn't initiated, there may be the opportunity to stop the process."
To effectively and efficiently take advantage of the RAC discussion period, Cohen recommends providers do the following:
Group similar denials whenever possible. Use your tracking database to group issues and then talk about them globally. "That way, when you talk to your RAC, instead of having 200 issues to discuss, you have 10. You'll probably be a lot more successful."
Stay organized. Especially when it comes to complex reviews, organization is critical. Use tracking databases or spreadsheets to document and track denials. They will help you keep on top of deadlines and recognize commonalities between denials that may help identify whether a claim is defensible during the discussion period or appeals process, or when you need to correct an error.
Use strategy. "You'll only want to go to the RAC during the discussion period for those claims you really feel like you want to defend," says Cohen. "I'd avoid calling them with 50 claims and asking the RAC to go through each one to explain why they denied it. I'm not sure you want to spend that much time, much less the RAC."
Don't get sidetracked. Providers should use the discussion period, but shouldn't let it distract them from determining whether they want to appeal the claim, or given the early deadlines they need to meet, if they want to stop recoupment (e.g., they can appeal by day 30). There are many decisions providers need to make, Cohen says. So it is important that they don't let the discussion period distract them too much from everything else that needs to be done.
This time last year, as we finalized the list of winners for the 2008 HealthLeaders Media Marketing Awards, the pickings were slim in the new media marketing category—it had the smallest number of entries by far. (We didn't even have a new media category in 2007, the first year of our program.)
And there were even a few campaigns entered into the new media category that didn't use new media at all. (Seriously, people—direct mail and billboards are not new media.)
What a difference a year makes.
In this year's contest, new media marketing is one of the most crowded fields. And it's not just about volume. The healthcare organizations that entered the 2009 awards clearly have a much better grasp not only on what, exactly, new media marketing is, they're also doing it much better.
Our contest is unique in that we place a lot of emphasis on goals and objectives, measurement, and results of marketing campaigns. That's part of the reason we only gave out two new media campaign awards last year. Both were large hospitals: Oakland, CA-based Kaiser Permanente and UK Healthcare in Lexington, KY.
Kaiser's new media effort built on an existing recruitment campaign. They created banner ads with subtle animation to get browsers' attention. The ads expanded when the user rolled his or her mouse over the ad to reveal copy about the benefits of working for the organization.
UK redesigned the site for its Markey Cancer Center, creating seperate portals for the three groups that use it—patients, medical professionals, and researchers. (Previously, the content for these three different audiences was all jumbled together.) They also strengthened the branding on the site, added a clear call-to-action, and made it easier to navigate. (The redesigned site looked much better, too.)
As for measurement, Kaiser's rich media banners allowed it to gather data on click-through rates and took that metric a step further by tracking how many of those visitors actually submitted an employment application.
UK didn't track data on the first iteration of its site—the shift to carefully measuring traffic and other analytics on the new site impressed our judges.
As much as the judges loved the 2008 Kaiser and UK campaigns, though, this year's competition would give them a good run for their money.
Healthcare organizations are creating truly integrated campaigns using a wide spectrum of tactics, from service-line specific microsites to online videos and podcasts featuring physicians and patients. They've created interactive widgets. They've built social networks. They've created user-friendly online find-a-doc programs. They've redesigned their Web sites not just to make them prettier (although most of them are visually striking) but to make them easier to navigate and more useful to their audiences. The sites have more content—not just an archive of press releases, but robust information that consumers, physicians, and staff will actually want to read.
The best part? Healthcare marketers are starting to figure out new ways to measure the returns on their new media marketing efforts. Click-through rates and unique visitors are great, but analytics and other ROI measurements have come a long way, baby.
We're not quite ready to announce the winners yet and I don't want to give away too much. But stay tuned—I'm looking forward to sharing the results with you.
Editor's note: The winners of the 2008 marketing awards will be honored at the 2009 HealthLeaders Media Marketing Experience in Chicago on October 14. At the day-long event, participants will participate in hands-on, practical exercises to help them better understand the power of experience design and execute tactics to improve the patient experience at their own organizations.
Note: You can sign up to receive HealthLeaders Media Marketing, a free weekly e-newsletter that will guide you through the complex and constantly-changing field of healthcare marketing.
With the goal of standing out among the many Web sites geared toward children, Children's Healthcare of Atlanta has launched a new online "spot" dedicated to promoting healthy families. The site includes educational games such as "Spelling Bee," "Time for Bed," and "Mission Nutrition." For parents, the site has healthy meal suggestions, exercise trackers, and body mass index trackers.
"While most wellness sites separately focus on either adults or says said Lucy Klausner, executive director of child health promotion at Children's Healthcare of Atlanta. "Research has shown that family participation is noted to be one of the most effective ways to incorporate a healthy lifestyle for children and young adults."
The three-hospital system created the site to help families learn how to keep tabs on their children's activity and nutrition and experiment with health motivators, such as rewarding the child's healthy decisions with interactive games and reward points. The Web site has information geared toward parents, teens, and younger children. The home page features health headlines, children's activities, and healthy meal suggestions.
"MyFamilyHealthSpot.org is a valuable resource not only because it's free, easy to use, and fun for families, but it allows children to take an active role in their own health," added Klausner.
A video for Ethicon Endo-Surgery's Realize adjustable gastric band is available for viewing on Realize Band's branded YouTube channel.
"Video is such a powerful medium for people who are having this type of surgery," said Mary Ann Belliveau, managing director of Google Health Vertical. "What the channel does is give the patients a home for this, so they can get a more thorough experience, specifically with the company and the brand."
There are more than 40 Web sites offering consumers the chance to rate and review their physicians. But a lot of doctors argue that the information on physician rating Web sites is of little value, could jeopardize physicians' practices, and could actually harm patients.
Of the 1.1 billion people aged 15 and older worldwide who accessed the Internet from home or work in May, 734.2 million visited at least one social networking site, according to a study by comScore World Metrix. That represents a penetration of 65% of the worldwide Internet audience.
Today, when you read about healthcare, you read about reform. There is no doubt that the healthcare industry is changing, and demand for quality outcomes plays a big role in this change.
Value-based medicine and value-based benefits design are here and it is time for health plans to leverage their long-held mantra that improved clinical results also result in economic efficiencies.
General surgery is one area of healthcare that has evolved, specifically, with the growth in minimally invasive surgery (MIS), which provides benefits not only to payers, but to patients and providers alike. Typical MIS patient benefits include faster healing, less pain and scarring, and quicker return to normal activity.
By implementing a well designed benefits plan that reflects the value of MIS, health plans can continue to advance patient care and overall outcomes, as well as reduce costs related to health benefits.
A case in point is the Colorado Springs School District 11 (D11), a K-12 school district representing the majority of students in the Colorado Springs area and "home" to 3,400 employees, with a self-funded and governed medical plan that covers a total of 6,000 individuals.
D11 needed to decrease the escalating costs of healthcare benefits, in large part brought on by an aging workforce and an increase of chronic illnesses. The escalating healthcare costs were hurting the district in more ways than one—it reduced the flow of money that went directly to education and hindered the district's ability to offer competitive salaries and hire qualified teachers.
In collaboration with its third-party administrator, D11 revamped its health plan to emphasize and promote the benefits of minimally invasive surgery to its members over more invasive, open surgeries when appropriate.
For five pre-selected surgeries, the health plan offered a member who opted to undergo a minimally invasive surgical procedure over open surgery a reduced co-payment: $400 less for an in-patient surgery and $200 less for an outpatient surgery—a monetary incentive for patients in addition to the physical benefits of MIS.
D11 also provided members with the necessary educational resources to become better consumers of health and to make well-informed decisions when it came to MIS. For example, D11 distributed informational materials and links to Web sites, such as MIPInfo.com.
In addition to improving the quality of care for its members, D11 saved about $1 million in direct hospital and surgeon claim costs over a two-year period—a conservative cost savings estimate given that only direct costs were assessed. Indirect benefits included reduced employee absenteeism, improved productivity, and reduced expenditures for post-surgery prescription drugs and rehabilitation services.
Other benefits incurred from the MIS initiative included lowered premiums, reduced costs for substitute teachers (because of a quicker return to work by employees), and reduced hospital-acquired infections and related costs.
Health plans can continue to promote the adoption of value-based procedures by promoting minimally invasive surgery, in order to establish a win-win-win scenario for themselves as well as employers and patients.
Ken Detweiler is an officer of the Colorado Business Group on Health. He was previously director of risk-related activities for Colorado Springs School District 11. He worked for the district for 14 years and was responsible for employee benefits, risk management, insurance, and safety.
