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GAO: We'll Talk About You As Soon As You Leave the Room
Nobody has said much about why CMS commissioner Mark McClellan resigned last week, but Washington seems to be wasting no time to spread the blame for the Administration's failure to deliver on its HIT promises. In a Healthcare IT News story, the Government Accountability Office says that our national HIT leaders “still lack detailed plans, milestones, and performance measures for meeting the President’s goals” of fully interoperable health records by 2014. Says McClellan to the Washington Post regarding his departure, "I'll be happy to talk to you when I have something to say." David A. Powner, GAO's Director for Information Technology Management Issues, listed five areas in which the country has made significant health IT progress, but insisted that, overall, the effort has been short on clarity and organization. There was no mention of the Congress' failure to fully fund the Office of the National Coordinator, whose czar David Brailer left the room earlier this year. The GAO report notes that $48 million in federal grants spent on studying the project and creating prototypes for NHIN components has not yet produced the business intelligence promised last spring by Brailer. The President had proposed $170 million for HIT; Congress ramped down the goal to $100 million and has not yet delivered an ironed-out HIT bill. Read the GAO report.
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Technology, including HIT, Adds 7 Years to Your Life
What are you going to do with your extra seven years? According to a New England Journal of Medicine report titled "The Value of Medical Spending in the United States, 1960-2000," during those years the life expectancy for newborns increased by 6.97 years. But, of course, there's a price. Our extra time on the planet for living, loving, and spending your children's inheritance has been costing America on average about $20,000 per bonus year. Not such a bad deal, except that, at age 65, costs rise more rapidly than does life expectancy: the cost runs somewhere between $125,000 and $150,000 per year of life gained. So, what do we do with this information? Well, perhaps we should look very closely at the details to see how best to spend our health technology resources. While IT is cited as an exceptional value-producing health technology, other technologies are not so "valuable," as it were. Take pharma. (Please.) Largely because of skyrocketing pharmaceutical costs, the study found that inflation-adjusted healthcare expense from birth shot up fivefold in the 20 years from the 1970s to the 1990s, peaking costs for each additional year of lifespan at $36,300. So, according to the report, each dollar spent on healthcare in the '90s a time when increasingly costly drugs make ever-decreasing gains against cancer (for instance) -- contribute only one-fifth the real value as 20 years earlier when cheaper meds made huge health improvements for more people. HIT looks better than ever in that light. Read the NEJM abstract (free; full report $). [ HITSync top ]
Deficit Reduction: Stop Paying the Bills?
Get ready to add about a week to your Days In A/R this month. In a singularly confusing move, CMS announced that it will reduce its FY2006 expenditures by not paying its bills for the last nine days of the year. Let's think what that means... The new Congress, following mid-term elections, will inherit a nasty little bump for its '07 deficit, while the President in his January State of the Union Address can report that the Administration held the line on entitlement payments. According to CMS, "A brief hold will be placed on Medicare payments for all claims during the last 9 days of the Federal fiscal year (September 22 through September 30, 2006). These payment delays are mandated by section 5203 of the Deficit Reduction Act of 2005." Um, I thought that adding liabilities to your balance sheet was considered an increase in your deficit... Oh, yeah, my accounting experience was in business! [ HITSync top ]
Faint Praise for CMS' Outgoing McClellan
In a Washington Post article this week, Ron Pollack, executive director of Families USA, called Mark McClellan "a terrific person." With McClellan's resignation, another of the Administration's top healthcare wonks hits the road. ONCHIT's David Brailer resigned earlier this year. Says Pollack, "In the context of an Administration that doesn't make health care a high priority and that has made a series of harmful proposals that will exacerbate the health-care crisis, Mark McClellan served in an admirable way to try to implement the Administration's policies in the best way possible." Policies like Pharma's no-negotiation deal in Medicare Part D? "Admirable ways" like accidentally sending back $50 million worth of premium payments to 231,000 beneficiaries? Oops. [ HITSync top ]
Medicare’s addition of the requirement to include the National Provider Identifier on all re-enrollment forms is a startling wake-up call to the healthcare industry. The time for simple “NPI 101” training is over and payers, providers and vendors need information that is both authoritative and actionable. Click to learn more...
Solution: NPI Flash Point
With over three years of experience in NPI theory, analysis and practice, Healthcare IT Transition Group has created a pair of workshops to get healthcare organizations large and small -- providers, payers and others -- the information they need to make their NPI transition work.
Healthcare IT Transition Group offers two differently-targeted NPI seminars in October, presented by nationally-recognized NPI authority Martin Jensen, in Tulsa Oklahoma, October 19, 25 and October 26. Click for pricing and registration information.
58% of IT Workers Looking for New Jobs
Following several years of uncertainty in the IT sector, workers are sensing a new period of growth and are looking for a change, says an Ecommerce Times article citing a new survey by the Computing Technology Industry Association (CompTIA). About 8 percent of the professionals surveyed were in healthcare organizations. Workers says they are looking for more money and more fulfilling work. Another study by the Society for Information Management (SIM) finds 21 million new U.S. jobs will be created by 2010, but only 17 million new employees will enter the workforce. Considering the federal Bureau of Labor Statistics recent report that the IT industry is the fastest-growing sector in the U.S. economy, and its prediction of 68% increase in output growth through 2012, CIOs can expect a growing challenge as they seek to find -- and keep -- skilled IT workers. Add to this the development of the NHIN, which may tap several thousand HIT workers, and the message to healthcare CIOs is: Look skeptically at pressures to downsize, maintain staff levels, and support job satisfaction wherever possible. [ HITSync top ]
FUNDING National Group to Review State Role in HIT Government Health IT reports that the National Conference of State Legislatures has begun an 18-month probe of the role of state governments in health IT, and to determine the best methods for advancing EHR adoption. The project, dubbed Health IT Champions (HITCh), is to be headed by Massachusetts State Sen. Richard Moore and Florida State Rep. Anna Benson, who head the health committees of their respective legislative bodies. Healthcare Information and Management Systems Society (HIMSS) has signed on as a sponsor. Likely subjects for the group's scrutiny include telemedicine, state support for RHIOs, patient safety, consumer transparency, pay for performance, privacy and workforce issues. [ HITSync top ]
Telemedicine Spreading Its Wings
Freshly published results of the 2006 Most Wired Survey and Benchmarking Study show significant growth in telemedicine among the nation’s top tech hospitals. The market reach of the nation's 100 Most Wired Hospitals has steadily increased through the implementation of digital technology. While EHR makes records available across a wide geographic area -- a prerequisite of effective digital healthcare delivery -- it is telemedicine that brings physician consultation to many rural areas where specialized practitioner presence has been declining. More than 40% of the Most Wired 100 provide hospital-to-physician-office patient consults, compared with 5% of the least wired. A six-month study of one program logged 538 patient encounters that saved almost $10,000 in nursing salaries and 9,816 miles of nurse travel, plus 89,792 miles of patient travel. A quick thumbnail calculation suggests that telemedicine saved more than $40 in the cost of delivering and acquiring care per encounter -- a remarkable sum when multiplied by the potentially millions of encounters that could be served annually by widespread telemedicine. [ HITSync top ]
Aetna Tells All
Want to know how much your doctor visit is really gonna cost? Aetna wants its members to know. The health plan's new service, launched about 12 months ago, allows roughy one million Aetna members around Washington, DC and another 1.3 million in other locales across the nation to access a website, pull up a provider's name, and preview price and quality info.
So, let's test your healthcare price moxie. Draw little lines to match the services in the "Dr. A. Does" column with the prices in "For How Much" column, as reported in the Washington Post:
More recently, I chided them on their new requirements for provider taxonomy on Institutional claims. Not on adding taxonomy per se, but on their peculiar "payer mandate" that employs a baroque logic it expects IT-strapped providers to decrypt in order to send claims that will get paid.
A Litany of D's
And in the past I've reported on the oft- (and now again-) delayed Data Dissemination notice. Originally described as a "policy" to be distributed soon after the May 2005 Final Rule, it is now posited as a draft "for public comment." Last month we learned that the expected publication date had been booted from probably-August to maybe-October of this year. Let's see -- add a maybe-60-day comment period to maybe-October and you get maybe-December or possibly-January. Bring the comments in for review, discuss, edit, carry the two, then push the regulatory spin cycle button and -- does anybody really think they will have a system in production by next May?
I've even gone so far as to suggest that healthcare organizations turn to private sources rather than rely on NPPES for their NPI data. Geez, that was over a year ago. Am I psychic or what?
Speaking of privacy, I haven't been very generous in regard to establishing NPI as a protected personal identifier. I think I called it, "dumb."
Maybe I've been a little rough. I don't actually hold CMS personally (or even bureaucratically) responsible for this entire mess. They just occupy the thankless playground status of having touched it last.
It's time to draw some distinctions and give some credit to CMS where it is due -- perhaps overdue.
Pushing Its Non-regulatory Buttons
First, let's point out that CMS-as-payer (Medicare) has firmly established its commitment to the NPI transition, and in the most part in ways that support CMS-as-regulator's Final Rule. Observers credited Medicare's re-enrollment requirements with boosting subsequent enumeration rates. Getting providers to pay attention was something that two years of industry awareness-building and outreaching had failed to achieve.
Likewise, Medicare has failed to blink on its own remediation schedule, which allows NPI dual use files now, and will (somehow) accomodate NPI-only submissions come October 2006. Of course, with the last 9 days of Septembers' payments already held up by federal budgetary shenanigans, I don't think many providers will be willing to risk the next weeks' Medicare revenue on a Day 1 NPI implementation.
The Numbers Just Keep Going and Coming Just this week I heard rumors that Medicare is no longer issuing UPINs to graduating med students. This would be another strong procedural vote indicating the NPI will be replacing legacy IDs inside the nation's largest payer organization. Can anyone confirm this for me?
And Medicare's recognition of its own need to require taxonomy codes puts that critical issue on the front burner for industry review and discussion. Some have even suggested they are requiring it, at least in part, for the benefit of their crossover partners (though I do wonder what those payers will think of "Type of Bill 72X and taxonomy code of 261QE0700X and a zip code different than any renal dialysis facility issued an OSCAR number that is located on that hospital’s campus").
Back to being nice.
A Class in Dismal Science
All of this adds up to a strong "yes, we really mean it" from CMS to an industry that largely continues to believe that HIPAA is just another arbitrary compliance issue. It's not. HIPAA is a mandate to providers and payers to straighten up their own houses and quit wasting taxpayers', employers' and patients' money on needless administrative overhead.
The good news for those fixated on compliance is that the enforcement cops are not going to hit them over the head. The bad news is that their competitors are taking advantage of the ROI offered by standardization, so the market is going to bite them in the assets. Can you say "industry shakeout?" Sure you can.
The Other Other CMS
Quite often, I've referred to CMS-as-payer to distinguish its Medicare (and not so much Medicaid) operations from its CMS-as-regulator role. But perhaps not often enough, I haven't given props to CMS-as-people. In fact, the people I've met from CMS are smart, dedicated and hard-working. Not just some of them -- every single one. I'm still waiting to meet the exception that proves the rule. Maybe the good guys are the only ones they send to conferences.
But when one of them comments on one of my editorials (or worse yet, a cartoon), I hasten to say that I am trying to give them ammunition to fight the good fight within the agency. Yeah, right, Marty.
Hoops Not of Their Own Making
When it comes to NPI and privacy, I know it's not CMS's wish that their dissemination policy be in a foot race with the May 23, 2007 compliance date. CMS-as-regulator knows that access to NPIs is an obvious requirement for implementation and CMS-as-payer would be the largest beneficiary of unfettered access to that data.
But there are some external forces to contend with -- even a gorilla has to show respect to other powerful jungle creatures.
Add to this the slow-moving, yet unpredictable, wheels of federal regulatory inertia -- not to mention the implicit gag order that forces knowledgeable staffers to stay silent and wait for the agency to speak through official channels. It's no surprise that some sensitive questions go unanswered for awhile. Okay, sometimes for a lo-o-ong while.
Changing Course
Perhaps most admirable are the subtle indications that CMS is listening. Just this week I got a note from one of those good-as-gold CMS staffers that the text of the NPPES NPI notification email now includes "the practice location (number/street/city/state/ZIP code), other identifiers (as reported by the provider on his/her NPI application), and Taxonomy code(s) as reported on his/her NPI application."
This was a clear -- and effective -- response to our complaints that requiring a paper copy of the NPI notification with Medicare's re-enrollment form was useless. I and others had pointed out that the individual provider notice only contained the physician's name and NPI without any crosswalking information.
What good is an NPI that can't be reliably tied back to a legacy number? No good, CMS agreed, and promptly fixed it. And had one of their NPI point people contact a lowly gadfly like me to tell me so.
Bon-bons and Bon Mots
But she wasn't just covering her agency. She went the extra mile for customer service. She explained that those who had received copies of the old notice could obtain an updated notification by called the NPI Enumerator at 1-800-465-3203.
Gee, maybe CMS really islike a box of chocolates. Kinda makes you glad to be a taxpayer, doesn't it? Keep up the good work, friends. And try to find somebody good to run the place, will you? You may have to send her to a conference or two.
______________________________ 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 leader for the WEDI/HL7/X12/AFEHCT National Health Care Claims Attachment Survey and is engaged in the 835 Coalition, a national effort to improve the adoption rate of the 835 Remittance Advice transaction.
