U.S. House Passes $39.7 Billion In Benefit Cuts, Freezes Physician Payments Congressional Quarterly reports that "States would have new power to determine the Medicaid benefits available to poor people and to make them pay more for their own care under a budget reconciliation conference report adopted by the House in a 212-206 vote just before dawn on Monday [December 19]." The plan would freeze payments to physicians and home health providers in 2006. According to Bloomberg, the U.S. House of Representatives agreed to $39.7 billion in budget cuts over five years that target entitlement programs including Medicare and Medicaid as part of a Republican-led effort to narrow the federal deficit. Medicare took a $6.4 billion hit, and House leaders are working on ways to shift Medicaid costs to the program's poor and handicapped beneficiaries. Bloomberg notes that Democrat House members "are against the budget-cutting plan [worked out between the House and Senate], saying it reduces resources for the needy and is negated by Republican-backed tax cuts for the wealthy that would increase the deficit." AARP's David Sloan stated in a Washington Post story on December 20 that "Congress should know that if the [budget-cutting] conference agreement becomes law, the AARP and its more than 36 million members will work tirelessly to hold those accountable for passing such irresponsible policy." House Republicans struggled feverishly to get the deed done before the year-end recess. According to the Post story, in one middle-of-the-night compromise, "nearly $2 billion of budgetary savings had to be scrapped... to meet the demands of Ohio Republicans seeking to protect a manufacturer of medical oxygen tanks, Invacare Corp. of Elyria, Ohio, from one Medicare cut." So for now we're still breathing... Download the bill from our archive (6MB scanned pdf). Read the AARP criticism of the budget agreement at California Healthline. [ top ] ONCHIT To Get $111.7 Million, $87MM+ for HIT Projects Government Health IT reports that the U.S. House approved $111.7 million to support selected projects funded through the Office of the National Coordinator of Health Information Technology (ONCHIT) in the final version of an appropriations bill passed last week. The appropriation would fall $16 Million short of President Bush's request for $125 Million. The funding includes: 42.8 million allocated directly to the office 18.6 million to develop four prototype NHINs (National Health Information Networks) 18.9 million for a Public Health Service network ONCHIT programs will also receive $50 million from the AHRQ budget for research that will establish scientific evidence of the health impact of HIT. View a directory of roughly $1 billion worth of federal HIT projects here. [ top ]
Foundation Awards $1.8 Million in HIT Grants The Robert Wood Johnson Foundation's InformationLinks program announced 21 grants on December 14, ranging between $74,000 and $100,000 each. The grants are to help fund the participation of state and local health departments in healthcare information exchanges (HIEs) such as regional healthcare information organizations (RHIOs). The program targets the use of EHR to pinpoint disease outbreaks, disseminate immunization records, and improve the sharing of newborn screening results in statewide HIEs. [ top ] eHealth Initiative: "We Likely Will Fund You" ...and a top priority will be standards development "If you're a community and you're mobilizing data and you've engaged the commitment of 30% of your market in terms of purchasers and payers to experiment with a sustainable business model, then we want to hear from you—and we likely will fund you." That's the word from eHI's Janet Marchibroda as reported by iHealthBeat. Among goals announced for 2006 is the establishment of four sustainable health information excahnges, apparently meaning eHI-seeded organizations that are no longer dependent on such funds. eHealth Initiative's top-listed emphases for 2006 are "national standards and multi-stakeholder-developed common principles." [ top ] White House Conference on Aging Calls for HIT for Seniors Once every ten years, a White House Conference on Aging is convened to make policy recommendations to the federal government on issues surrounding aging. Past conferences have shown a growing intensity as the Baby Boom approached its senior years. The report of the 2005 conference continues that trend with a new twist. It states that "The lack of effective communication has made management of care confusing, tiring, and even wasteful for seniors. Effective integration of health communication into aging networks would improve health and information referral, assist caregivers, and enhance individual decision-making. Furthermore, coordinated information can also assist local governments with planning public investments to fill gaps between seniors’ needs and available services." Read the conference's resolutions. [ top ]
Visit the News Page at HITtransition.com for daily and hourly updates on 100+ healthcare IT articles organized in topic areas vital to your interests.
Emdeon: 10 Former Employees Indicted Reuters reports that Emdeon, the corporate successor to WebMD, announced on December 15 that the U.S. Justice Department has indicted 10 former Emdeon employees and officers. The indictments cite alleged accounting improprieties over a four-year period. According to the St. Petersburg Times (FL), among those indicted by the U.S. Attorney in South Carolina were John H. Kang, president of Medical Manager® between 1996 and 2000. The government accuses the ten of conspiring to inflate earnings by more than $16.8 million between 1997 to 2001, as well as engaging in money laundering. Kang took Medical Manager public in 1997, and sold it to WebMD in 2000. According to Emdeon's hometown newspaper, The Gainsville Sun, named in the indictment were Kang, Frederick B. "Rick" Karl Jr., former vice president and general counsel, Mickey Singer, John Sessions, Lee Robbins, Charles Hutchinson, David Ward, Franklyn Krieger, Ted Dorman and Maxie Juzang. Meanwhile, health issues have led Emdeon's board to look for a new CEO, says NJBIZ. [ top ] Cerner Slumps After Accounting Practices Question The Kansas City Star reports that Kansas City-based Cerner Corp's stock shed several dollars per share following a December 13 article in the Wall Street Journal that questioned its accounting practices. According to the Star article, after the markets closed the company split its stock 2-for-1. The Wall Street Journal had reported that three independent forensic accounting firms concluded that "Cerner’s accounting had pushed the envelope and was lacking in disclosure." Glass Lewis, one of the firms, stated "Cerner has been roundly criticized within the investment community for providing conflicting and nontransparent accounting disclosures." [ top ] Florida's Sick Poor Hanging On by a Chad?
We're sure there was no irony intended, but starting with more than 200,000 Medicaid recipients in Broward and Duval counties, Florida's disabled and elderly are being drafted into an experiment in controlling state healthcare costs bordering on healthcare rationing. Gov. Jeb Bush last week signed into law sweeping changes that shift Medicaid recipients to private managed-care insurance networks. The Orlando Sentinel reports that these "State-approved 'provider service networks' will take unprecedented control over what health care, and how much of it, patients receive." The Sentinel story says that "Bush called his plan...the 'single biggest change and boldest reform that any state has ever embarked upon' in the 40-year history of Medicaid." Opponents of the plan say that the people to suffer the most will be the poorest and sickest Floridians. [ top ] Taking a Licking, but BlackBerries To Keep On Clicking The Washington Post reports that a top executive of Research in Motion Ltd. (RIM), maker of the BlackBerry portable email devices carried by many IT executives and physicians, says service will continue to work despite the patent dispute raging between RIM and NTP, Inc. The dispute threatens to shut down RIM's U.S. operations. Due in part to the mission-critical nature of such a shut down, the U.S. Patent and Trademark Office announced last week that it will speed its review of patents in the case. NTP has successfully sued RIM for infringement; however, according to the Post story, citing as its source RIM chairman James L. Balsillie, the patent office "has signaled that it will reject all of the patents in question. If that happens, it undermines NTP's entire case." Balsillie stated that even if the patents are upheld the company has a "software workaround" to keep BlackBerry service up for RIM's 3.65 million U.S. customers. [ top ] HITSync Scavenger Hunt: The AHLTA Mystery There's nothing like diving for ancient technical salvage to get veteran IT folks excited, especially those old enough to remember ARPANET. When the U.S. military announced its internationally-deployed mega-RHIO called "AHLTA," we just couldn't believe the government's spokesperson who said that "AHLTA is not an acronym." Oh, yes it is, say we! We'll just have to dive in and find it! We made it a challenge in the last issue of HITSync (issue #23, "Military EMR Up and Running"), and we have a winner!
The first person to get it right was Wayne Jonesof Bassett Healthcare in Cooperstown, NY. Thanks, John, for digging around and discovering what no publicly available government document seems to admit, that AHLTA stands for "Armed Forces Health Longitudinal Technology Application."
Interestingly, it seems that the Australians had use of the acronym first, standing for "Australian Heart/Lung Transplant Association," which we never would have known if not for Tom Polhemus of the HIPAA Project Team at Blue Cross & Blue Shield of Minnesota.
And it was LeRoy Southmayd III of INTEGRIS Health in Oklahoma City who pointed out that AHLTA was originally something else entirely, namely Composite Health Care System II (CHCS II). We suspect they changed it because everybody kept pronouncing it "chicks, too." :-J
EDITORIAL: CMS Proposal Would Bury Electronic NPI Enumeration in Wet Ink By Martin Jensen, Healthcare IT Transition Group Martin Jensen is COO and Chief Analyst at Healthcare IT Transition Group, and serves as co-chair of the WEDI Business Issues and Health ID Card Subworkgroups. His standards development experience includes work with X12 on the 5010 versions of the Claims standard, and in leading multi-organization collaborative efforts. He recently served as team lead for the WEDI/HL7/X12/AFEHCT National Health Care Claims Attachment Survey and is actively engaged in a national effort to improve the adoption rate of the 835 Remittance Advice transaction. Mr. Jensen recently received a WEDI Award of Merit for leadership.
Last week, CMS issued a request to OMB entitled "Emergency Clearance: Public Information Collection Requirements Submitted to the Office of Management and Budget (OMB)" announcing a one-week comment period on their strategy for EFIO (Electronic File Interchange Organization) Certification. Organizations wishing to submit files to enumerate indvidual providers would have to sign the certification, which affirms that they have the authority to do so on behalf of those providers.
Why the emergency? Because the rate of enumeration via individual web submissions and written applications has been too slow (barely 10% of an estimated 2 million in the first six months), and the quality of the resulting data is questionable. As CMS put it in a notice to OMB, "We cannot reasonably comply with the normal clearance procedures because public harm will ensue from the continued denial of access from providers obtaining national provider identifiers en masse." Unfortunately, the proposed solution is too much too late.
Burden Busting In its Supporting Statement (Link: CMS-10175.Supporting_Statement.v2.doc) for its Paperwork Reduction Act Submission (Link: CMS-10175.OMB-83-I.v2.doc), CMS estimates the burden imposed on the estimated 2,000 respondents at 1.5 hours each, for a total cost of "3,000 hours @ $150.00 per hour (professional wage) = $450,000." They generously assume that an attorney might need to look at the certification form before it goes out. The true cost is much higher when you look at the requirements embedded in the draft Certification Statement (Link: CMS-10175.Draft_Certification_Statement.v2.doc):
I certify that the EFIO has the written legal authority to act on behalf of any and all providers for whom the EFIO submits to...the Enumerator, [which] includes the submission of the provider’s application for a National Provider Identifier (NPI).... [Condition #1]
Not too awful. As most prospective EFIO's probably have existing agreements with their providers to perform such activities, presumably NPI enumeration could or has been included in the scope of such agreements.
But the term "written" foreshadows the real problem, which will force prospective EFIOs to reconsider this "efficient" process.
I certify that each provider on whose behalf the EFIO submits a NPI application has informed the EFIO in writing that the provider’s information that will be submitted to NPPES is accurate and complete. This applies to the provider’s initial application for a NPI and, if agreed to between the EFIO and the provider, updates and changes to the provider’s NPI data, and deactivations. [Condition #5, emphasis added]
This implies that every data element in the submission must be reviewed by the individual providers and validated with a wet ink signature. [Or does it? See the UPDATE directly following this editorial.] What's more, every update to even a single data element will require another round of paperwork. $450,000 starts to sound like a bargain.
Rational vs. Regulated Now, if I were desiging a process to enumerate physicians for a hospital, it would probably take the form of an email that looks something like this:
Dear Dr. Jones
We're going to send a request to CMS to get you an NPI at the end of the month
We need to know that your information is up to date. Click here to review it. Make corrections if necessary. :o)
If you don't want us to enumerate you (i.e. you already have an NPI, or another organization is going to submit your information) Click here and tell us why. :o)
If you don't follow up by the 21st, the nice people in the Medical Staff Office -- the ones that make sure you have all the other certifications, education and numbers you need to practice medicine -- will start calling you with sweet, threatening reminders.... {:-(
Wet Ink Wonderland Such an efficient process would not be legal under the proposed certification rules. Instead, it would look like this:
Medical Staff Office prints a message for each physician that includes all of the data that will be sent to the Enumerator.
They mail it to the physician, or put it in one of the slots used for picking up the dozens of notices they distribute every month.
Physicians put it on a stack to be dealt with later.
Eventually, they scribble their corrections on the form, then sign it and return it to the Medical Staff Office.
Medical Staff Office makes corrections to the data from the physicians' handwriting. They either assume they have entered it correctly, or the process is repeated for each round of corrections.
Follow ups involve manual tracking, reprints and re-reminders. According to the ERIO rules, any change to the data during the interim between original printing and EFI submission requires a new signature.
Besides adding numerous cycles of manual labor and introducing thousands of opportunities for transcription errors, the distribution and retrieval process alone will add weeks to the effort.
Rational as Regulated The institutional providers I talk to who have been most pro-active about NPI are ready to give up on EFI. Even if this certification process were reasonable, they have been waiting so long for specifications that they can't wait for another regulatory process to work its way through the federal government. Instead, they are submitting applicatons for their hundreds or thousands of physicians via the web.
If they are, as I suspect, simply re-keying the data, they are introducing conversion error into data that has been fastidiously screened, validated and certified over a period of years, if not decades. Some may simply print the data from Step 1 on an NPI submission form and mail it to the Enumerator, letting the federal government take on the cost burden -- but that means they might never see the NPI that results.
Don't Blame CMS? I don't know if it's fair to pick on CMS. They've known about the wet ink problem, and I truly believe it would be in their best interest to avoid it -- if they could.
I've heard that the NPI was given the same federal classification as Social Security Number, so the regulators' ink-stained hands may be tied in terms of the privacy provisions. Likewise, their propensity for written individual confirmations may be a protective measure against duplicate submissions. There have been numerous assertions from CMS that the enumeration system can prevent the assignment of multiple NPIs to a single individual, but others say there are weaknesses, pointing to the matching logic embedded in the contract specifications issued by CMS and anecdotal evidence from early testers.
What is fair is to expect that without a substantial easing of the burden of becoming an EFIO, "public harm will ensue." Without a substantial flow of EFI, the data in the NPPES database will lose a significant amount of prevalidated content. The industry will waste tens of millions of dollars chasing physicians around with fistfuls of paper and felt-tip pens.
Oh, and any expectation of meeting the NPI compliance date of May 2007 will go down the tubes.
Holiday Commentary There are still a couple days to comment on the Emergency Clearance request and the draft documents (links above). Be sure to mail your comments by this Friday, December 23, to:
Centers for Medicare and Medicaid Services Office of Strategic Operations and Regulatory Affairs Division of Regulations Development—B, Room C4–26–05 7500 Security Boulevard Baltimore, MD 21244–1850 Attn: William N. Parham, III
and
OMB Human Resources and Housing Branch Attention: Carrie Lovett New Executive Office Building Room 10235 Washington, DC 20503
(No, they did not provide an email address or web form.....)
UPDATE: After this editorial was posted on our weblog, I received a private email from a person whose organization had committed to becoming an EFIO. She said that CMS had indicated that "written" approval can include an email confirmation. I am looking for any published confirmation from CMS that this is so, and whether other electronic records might also satisfy this requirement. If so, this is very good news, and may help facilitate the use of EFI to "catch up" the NPI enumeration process. But I am still concerned that, after all of the ambiguities, misdirections and delayed clarifications from earlier HIPAA implementation, CMS cannot simply state what the industry needs to hear. Without such clarification, the truth remains hidden and I fear that the disruptions I warn about in my editorial will likely take place.
