Another CMS Eponym

What is a “ ZPIC”  ?  (see below)

 

 

WASHINGTON (AP) - They don't seem that interested in hot pursuit. It took private sleuths hired by Medicare an average of six months last year to refer fraud cases to law enforcement.

Have you looked in your post office lately? Perhaps your photo will be up there, soon.

 

According to congressional investigators, the exact average was 178 days. By that time, many cases go cold, making it difficult to catch perpetrators, much less recover money for taxpayers.

A recent inspector general report also raised questions about the contractors, who play an important role in Medicare's overall effort to combat fraud.

click on the image

Groucho, Harpo and Zeppo.  Question of the day, Who were the other two Marx brothers????

 

 

Out of $835 million in questionable Medicare payments identified by private contractors in 2007, the government was only able to recover some $55 million, or about 7 percent, the report found.

Medicare overpayments - they can be anything from a billing error to a flagrant scam - totaled more than $36 billion in 2009, according to the Obama administration.

 

As ranking Republican on the Senate panel that oversees Medicare, Grassley is trying to find out why it takes the contractors so long, and how much the government is currently paying the companies. In 2005, taxpayers paid them $102 million.

At least seven private companies Medicare calls "Program Safeguard Contractors" are working to detect fraud, part of a program that dates to the late 1990s. They oversee specific areas of jurisdiction, and some have more than one contract with Medicare.

 

In practice, their performance has been uneven. The contractors have widely different track records. One identified $266 million in overpayments in 2007, while another found just $2.5 million, the Health and Human Services inspector general said in May.

 

The private sleuths will now be called "Zone Program Integrity Contractors" - or ZPICs for short.

Technorati Tags: cms,medicare,marx brothers,fraud,contractors,zip

We’re Back !!!

 

As I promised the technical glitches have been fixed.

I reposted several previous posts to be sure it is working.

Have a nice weekend….

 

thank you Microsoft

The Clothesline

I don't know about you, but I and most physicians are fed up with being hung out to 'dry'.

Same old, same old.

Doctors with Medicare patients will start seeing a 21 percent pay cut this week after Congress failed to defer the cuts by two more years.

This Story appears today in the Washington Post.

• The Senate had until June 1 to avert the cuts. It is not expected to vote by Tuesday, when the Center for Medicare and Medicaid Services' temporary hold on Medicare claims expires.

Some members of the American Medical Association signed white lab coats instead of a petition to voice their displeasure on Sunday at the group's annual meetings in Chicago. The coats will be delivered to lawmakers in Washington on Friday, a spokeswoman said.

"The Senate's failure to act before June 1 made the 21 percent cut the law of the land," AMA President J. James Rohack said in a statement. "Physicians will start seeing a 21 percent cut in Medicare payments this week that will hurt seniors' health care as physicians are forced to make practice changes to keep their practice doors open."

Legislation to restore doctor's pay -- known as the "doc fix" -- is part of a broader aid package that includes jobless benefits and more financial aid for the states. In his Saturday radio address, President Obama called on lawmakers to avert the pay cuts, faulting Republicans for the delay. "After years of voting to defer these cuts, the other party is now willing to walk away from the needs of our doctors and our seniors," Obama said.

Republicans call the package fiscally irresponsible and said it would add $80 billion to a bloated federal deficit. Some moderate Republicans say they will vote for the package if the cost is offset by cuts elsewhere in the federal budget.

President Obama this weekend told us all how much he 'cares' about doctor reimbursement. 

 

What a sham.  

 

If that were the case there should have been room in the monstrous 1200 page heath reform bill to (link takes a while to load))include a permanent fix to the SGR (sustainable growth rate)

Better pony up and get some more clothespins....before they are all gone!!

Vending Machine Medicine

I was reading Distractible MD this morning and came across this photo that Rob Lambert posted.

I could not resist passing this along to my readers.  It says a lot about what has and is happening to our domain as physicians.  I wonder if it talks too.

The Yo-Yo Effect

The past several months reveal how disconnected the plan for health care reform has evolved. There was little transparency regarding the evolution of the bill, except for political posturing. The present administration has no experience in business leadership, nor basic economic theory.

The fact that the flawed SGR formula, hastily conceived in the early 1990s, was not addressed in the health reform bill attests to the simple fact that cost is a major factor in the legislation. Universal care was never a top priority except to assuage the proletariat.  SGR was and is held out as a bargaining chip and as a diversion for most  physicians.

The effects of the SGR impact very severely on ophthalmologists, urologists, geriatricians, some internists  and somewhat on cardiologists and pulmonologists.  These practices serve a large medicare population, and the SGR impact as presently structured or not eliminated will be devastating.

Primary care physicians can select to minimize medicare or eliminate it all together from their business model, with much less impact on their practices.

Thus, some specialists will have little choice but to either quit entirely, or fire half their staff, and reduce the quality and accessiblity of their practices to senior citizens.  These practices will ill afford to acquire new technology.  The physical structures of medicine will decline, poor maintenance, bare floors, and peeling paint.

The past several months have been  a Yo yo  for physicians  with hope for resolution of the SGR fiasco, and then dashed as we are used as a political football.

del.icio.us Tags: yo yo effect,sgr,political footbal,bargaining chip,healthtrain express

Non Publishing Notice

I have just discovered my daily blog has not published for the past week.  I am working on finding the cause and solution.. I will be back!!!

Social Media ROI

Information Technology gurus often talk about Return On Investment or ROI. The term is used to assess the worth of IT investment, it's increase in productivity, or efficiency and it's long term ability to save on costs. 

It often is focused on the fixed capital investment and ongoing maintenance cost of purchasing and maintaining such systems.

Web-based Health 2.0 offers an immediate ROI.  ROI should be analyzed on the basis of what it does for you, the physician and your patient, not just a number based on dollars spent/dollars returned.  The numerator in that equation is close to if not zero.

If you substitute time as the numerator and results as the denominator it becomes even more apparent what health 2.0 offers you in your office or clinic.

Without notice the physician is able to lookup detailed specifications of medications, cross reactions,  in a fraction of the time compared to textbooks, and paper journals.  Google search or Pubmed search is an actual  world wide search.

Health 2.0 is driving advances in medicine and healthcare.

It is not a fad, and those who ignore it for much longer will be left in the dust.

The Mayo Clinic, an institution known for it's acumen in adopting new technology that has proven it's worth, has established a social media  presence.  May already has a significant presence on You Tube as a patient teaching media, and even on Twitter followed by 60,000 followers.

Admittedly this is a paltry following compared to more prurient interest sites such as Lindsay Lohan, Paris Hilton or Mel Gibson.

Twitter and Facebook have become more than social networks for communicating with friends.  It now presents a powerful platform for marketing and branding of products and services. It is more powerful than Google in that it provides an elective means of synchronous communications if chosen by participants.

And according to the Mayo Clinic, Social Media Networking presents substantial dangers due to it's inherent exponential Viral spread, much like a pandemic. 

What percentage of patients discover you via the yellow pages?

It is much more likely that they have found you on an online service via superpages, or an online listing in their health insurance website.  The classic paper yellow pages have become an indecipherable listing. The internet search engines allow a focused search for the individual patients. 

 

del.icio.us Tags: social media,mayo clinic,health 2.0

Coalitions of Collective Intelligence

Thanks to the marvels of the internet and webinars I was able to attend the ACE  2010 event in Chicago from my well worn desk chair in my  den here in California.  Glen Tulman, CEO and extrovert of Allscripts was very good at analogizing much of health care with other industries, for example, Education.

Mr. Tulmann led off with the well worn exclamation that "Health is not a Commodity", but rather a "Community", which he compares to a coalescence of a collective intelligence.

During the webinar I was interrupted by a telephone call from "Dr Chronos", a new iPad EMR vendor.

I will return to that a bit later.

Mr. Tullman compared the manufacturing of a pencil with that of a computer.  It seems the pencil requires a significant amount of 'collective intelligence to bring it forth from a tree, deliver it to a manufacturing plant, grind it into a pencil along with the graphite core, apply the eraser with a band of metal and label it correctly as a No. 2  pencil, or whatever. Also don't forget the distribution process, packaging, marketing, etc.

He readily admitted the increased complexity of the computer and it's coalition of community involving Microsoft, Google, Wikipedia, You Tube, and Facebook.

While most computers have a common operating system, he correctly observes that Health Care does not have a common operating system.  He implies that what health care needs is an Operating System.

Mr. Tulmann also pointed out the disparity between professionals such as doctors and administrators, or business people, and compared to our teacher educators and their administrators.

Mr. Tulmann presented several projects where large dysfunctional or non functioning communities were revitalized block by block, one at a time. As an example he discussed Mr.Geoffrey Canada, a black American who was an instrumental leader in re-vitalizing Harlem in this same manner.  I can see this analogy as it applies  to  healthcare.

The presentation was broad, general and not very specific, although it seemed to be pointing toward the latest well-spring of governmental largess, health information exchanges.

He outlined several health systems goals in San Diego to integrate health data information retrieval. These are Scripps and Sharp Health System......

ACE 2010 was mostly a media event for Allscripts personnel, the marketing and sale force.  There were no really innovative ideas. It does however give one the sense of how the HITECH act has 'enabled' vendors' to sell their products.  Users are still skeptical...

del.icio.us Tags: Allscripts,health operating systems,google,you tube,facebook,wikipedia,glenn tullman

US Healthcare vs UK N.H.S.

 

Recent reports from the UK indicate changes that will decentralize control from it's present organization and distribute accountability and decision making authority to physicians.

This story represents when individuals have little or no control over their working environment.

 

Oxford hospital child heart ops 'should stay suspended'

The report cleared consultant Caner Salih of any wrongdoing

Child heart surgery should remain suspended at Oxford's John Radcliffe Hospital where four babies died until improvements are made, a report says.

Surgery was suspended when four children died between last December and February, after being operated on by consultant surgeon Caner Salih.

The report found the deaths were not due to errors of judgement but Mr Salih was not given appropriate supervision.

Mr Salih was cleared of any wrongdoing by the report.

The independent report, commissioned by the South Central Strategic Health Authority (SHA), found there were problems in Mr Salih's induction and mentoring when he began work at the hospital.

All four deaths occurred shortly after his appointment.

He subsequently decided to stop operating and told the trust of his concerns, including a lack of support.

The SHA's chairman Dr Geoffrey Harris has apologised to the families of the babies who died.

"We offer our sincere condolences and we apologise that, in the cases, the standards of care were not what was expected," he said.

Analysis

Continue reading the main story

Fergus Walsh, BBC Medical Correspondent

At first glance this report has worrying echoes of the Bristol inquiry a decade ago.

Both dealt with the deaths of babies following heart surgery.

Both listed failings in the management of surgery and the poor culture of reporting concerns.

But the Bristol inquiry was on an altogether bigger scale and dealt with failures stretching over a decade during which time 29 babies died.

Doctors were struck off and a radical overhaul of paediatric heart surgery ordered.

In this case it was the surgeon who performed the operations who raised concerns and there is no suggestion that he performed poorly.

Action was taken within three months of the first death whereas at Bristol the high death rate continued for years.

Aida Lo, whose daughter Nathalie was one of the four babies who died, told BBC News: "It makes me angry because if they were not ready to do the operation they should have waited to do it.

"It's about human life.

"I can't believe it. It makes me sad. I have been crying, it has been very painful."

Mr Salih complained about the age of equipment and poor working practices at the paediatric care unit, asking for operations to cease, the report panel found.

The report does not criticise his care, saying "all the cases were complex and surgery was high risk".

It found that arrangements for clinical management were "less than adequate".

"In Mr Salih's four cases, we found no evidence of poor surgical practice, but that he would have benefited from help or mentoring by a more experienced surgeon; and that it was an error of judgment for him to undertake the fourth case," the report found.

It recommended an overhaul of the way the hospital deals with serious incidents, better clinical and managerial leadership and to develop ways to identify adverse trends in surgical outcomes earlier.

The hospital's children's heart unit is the smallest in England, carrying out just 120 or so operations a year.

The report also recommended that there needed to be an adequate caseload so surgeons "can maintain their expertise", by a mix of expanding the trust's service and forging links with another centre.

Sir Jonathan Michael, chief executive of the Oxford Radcliffe Hospitals NHS Trust, which runs the hospital, said the hospital had improved its procedures since the deaths.

Continue reading the main story

Aida Lo, whose daughter Nathalie was one of the babies who died, said the report was "very painful"

• Mother's grief over heart death

But he added he did not believe child heart surgery should remain suspended, saying the unit had "a lot to offer the NHS".

In a statement, the trust said it understood the past few months had been "difficult for the families of the children whose deaths resulted in this investigation".

"Children's heart surgery has been carried out at Oxford since 1986, with good outcomes," it said.

It said a review of clinical governance and risk management had begun in April to "streamline our internal systems and reporting lines".

"We recognise that in such a large organisation, processes can become over-complex and we are working to address this issue and ensure that we adopt a more uniform approach across the whole trust in the future.

"We want to be clear that where there are things to learn from the report published today, we will develop plans to tackle those issues as a matter of urgency."

It has until 17 September to report back to the SHA with an action plan.

The Care Quality Commission, which independently regulates health and social care in England, said the hospital was being monitored and its quality and safety standards were to be reviewed.

Meanwhile a helpline has been set up by the hospital trust for patient inquiries: 01865 572900.

More on This Story

Related stories

• Mother's grief over heart death 29 JULY 2010, OXFORD
• Heart surgery unit under review 26 APRIL 2010, OXFORDSHIRE
• Children's heart surgeon leaves 05 MARCH 2010, OXFORDSHIRE
• Surgery halted after child deaths 04 MARCH 2010, OXFORDSHIRE
• Hospital suspends child heart surgery 03

Competition for Medi-Cal Patients

 

Although many physicians do not accept medi-cal as compared to private insurance, there is a trend toward accepting medi-cal patients.

Strange as it may seem, a recent analysis of the number of physicians accepting Medi-Cal is on the rise.

Physician Participation in Medi-Cal, 2008 (1.12Mb)

Physician Participation in Medi-Cal, 2001 (800k)

Physician Participation in Medi-Cal, 1996-1998 (402k)

Read more: http://www.chcf.org/publications/2010/07/physician-participation-in-medical#ixzz0v6FET6U4

 

Although these statistics seem to fly in the wrong direction, especially since physicians are so opposed to government intrusions into medical care there may be reasons this is occuring

1.The development of Managed Care Medi-Cal programs. This affords much easier billing and reimbursement guarrantees.

2. The shift from private small practices to larger medical groups, which afford more administrative support..

3. The real impact of decreased reimbursement by medicare and private carriers. 

4. The increasing number of patients who rely only on medi-cal for insurance. 

5. The increase in premiums for private insurance

6. The expansion of the CHIP program, and HealthyFamilys program.

Health Reform and the APPA will tilt the balance even further, if the states can even afford it. 

It Takes a Village.....

Recently I was sent an email regarding the development of "Healthy Howard".   No, it's not the "Truman Show".

 

Tech Firm, Howard County Partner to Help Uninsured

BETHESDA, MD (July 22) -- Howard County, Maryland, has enlisted local technology firm Healthcare Interactive to help manage its Healthy Howard program for uninsured residents.

"We're thrilled to count Healthcare Interactive among our partners in delivering critical healthcare services to Howard County residents who need them," said Liddy Garcia-Bunuel, Executive Director of Healthy Howard.

The program -- the first of its kind in the nation -- provides basic medical services at low cost to Howard County residents who cannot afford or obtain health insurance. For a small monthly fee, participants have access to primary care, discounted prescription drugs, emergency treatment, and inpatient hospital care, among other services. Concierge nurses and health coaches work with participants in their own homes and help them create personalized action plans for achieving their health goals.

Healthy Howard will serve as a model for the state-based co-ops and insurance exchanges that will soon be set up as a result of federal health reform legislation.

With Healthcare Interactive's innovative point-to-point (P2P) software, Healthy Howard administrators will be able to interact with beneficiaries as they receive care. The technology will also support the program's health coaching initiatives by connecting participants directly with healthcare professionals.

"It's critical that Healthy Howard's participants take steps to lead healthy lifestyles," said Dr. Peter Beilenson, Howard County Health Officer. "Healthcare Interactive's software will help us engage members directly and support their efforts to stay healthy."

"With Healthy Howard, we're working to build a model public health community right here in Howard County," said County Executive Ken Ulman. "Healthcare Interactive's technology will help us reach that goal."

"The Healthy Howard Plan is an exemplary way of expanding access to health care," said Henry Cha, President of Healthcare Interactive. "We're proud to help Howard County extend low-cost health services to those in need."

###

Howard County Executive Ken Ulman, Howard County Health Officer Dr. Peter Beilenson, Health Howard Executive Director Liddy Garcia-Bunuel, and Healthcare Interactive President Henry Cha are all available for interviews.

For more information or to set up an interview, please contact Melissa Garner at 202-471-4228 or melissa@keybridge.biz.  

About Healthy Howard

Healthy Howard Health Plan is a new program designed to connect Howard County residents to affordable health care services and help our community overcome barriers to healthy living. The Plan is not insurance, but offers basic medical and preventive care to eligible residents who would otherwise not be able to afford or obtain health insurance.

The Plan was created to address the Howard County administration’s goal of creating a model public health community. Even though the Health Department has been involved since its inception, the Plan will be administered through Healthy Howard, Inc., a non-profit organization.

About Healthcare Interactive

Healthcare Interactive is a software development company that has created a platform called Healthspace®, which is a development and integration platform for creating seamless healthcare applications. Healthspace has been used to create applications for employers, third-party administrators, PBMs, and disease management within both the private and federal industries.

A VERY NICE EXAMPLE OF PRIVATE-PUBLIC COLLABORATION

del.icio.us Tags: healthy howard,concierge,health care interactive

What tha !?

 

 

Seems like Don Berwick was preaching to the wrong choir several months ago when he addressed an audience in the U.K.

Today, The New York Times announced,

 

LONDON — Perhaps the only consistent thing about Britain’s socialized health care system is that it is in a perpetual state of flux, its structure constantly changing as governments search for the elusive formula that will deliver the best care for the cheapest price while costs and demand escalate.

 

The new British government’s plan to drastically reshape the socialized health care system would put local physicians like Dr. Marita Koumettou in north London in control of much of the national health budget.

Even as the new coalition government said it would make enormous cuts in the public sector, it initially promised to leave health care alone. But in one of its most surprising moves so far, it has done the opposite, proposing what would be the most radical reorganization of the National Health Service, as the system is called, since its inception in 1948.

Practical details of the plan are still sketchy. But its aim is clear: to shift control of England’s $160 billion annual health budget from a centralized bureaucracy to doctors at the local level. Under the plan, $100 billion to $125 billion a year would be meted out to general practitioners, who would use the money to buy services from hospitals and other health care providers.

The plan would also shrink the bureaucratic apparatus, in keeping with the government’s goal to effect $30 billion in “efficiency savings” in the health budget by 2014 and to reduce administrative costs by 45 percent. Tens of thousands of jobs would be lost because layers of bureaucracy would be abolished.

In a document, or white paper, outlining the plan, the government admitted that the changes would “cause significant disruption and loss of jobs.” But it said: “The current architecture of the health system has developed piecemeal, involves duplication and is unwieldy. Liberating the N.H.S., and putting power in the hands of patients and clinicians, means we will be able to effect a radical simplification, and remove layers of management.”

The health secretary, Andrew Lansley, also promised to put more power in the hands of patients. Currently, how and where patients are treated, and by whom, is largely determined by decisions made by 150 entities known as primary care trusts — all of which would be abolished under the plan, with some of those choices going to patients. It would also abolish many current government-set targets, like limits on how long patients have to wait for treatment.

The plan, with many elements that need legislative approval to be enacted, applies only to England; other parts of Britain have separate systems.

The government announced the proposals this month. Reactions to them range from pleased to highly skeptical.

Many critics say that the plans are far too ambitious, particularly in the short period of time allotted, and they doubt that general practitioners are the right people to decide how the health care budget should be spent. Currently, the 150 primary care trusts make most of those decisions. Under the proposals, general practitioners would band together in regional consortia to buy services from hospitals and other providers.

It is likely that many such groups would have to spend money to hire outside managers to manage their budgets and negotiate with the providers, thus canceling out some of the savings.

David Furness, head of strategic development at the Social Market Foundation, a study group, said that under the plan, every general practitioner in London would, in effect, be responsible for a $3.4 million budget.

“It’s like getting your waiter to manage a restaurant,” Mr. Furness said. “The government is saying that G.P.’s know what the patient wants, just the way a waiter knows what you want to eat. But a waiter isn’t necessarily any good at ordering stock, managing the premises, talking to the chef — why would they be? They’re waiters.”

But advocacy groups for general practitioners welcomed the proposals.

“One of the great attractions of this is that it will be able to focus on what local people need,” said Prof. Steve Field, chairman of the Royal College of General Practitioners, which represents about 40,000 of the 50,000 general practitioners in the country. “This is about clinicians taking responsibility for making these decisions.”

Dr. Richard Vautrey, deputy chairman of the general practitioner committee at the British Medical Association, said general practitioners had long felt there were “far too many bureaucratic hurdles to leap” in the system, impeding communication. “In many places, the communication between G.P.’s and consultants in hospitals has become fragmented and distant,” he said.

The plan would also require all National Health Service hospitals to become “foundation trusts,” enterprises that are independent of health service control and accountable to an independent regulator (some hospitals currently operate in this fashion). This would result in a further loss of jobs, health care unions say, and also open the door to further privatization of the service.

• Me?  I am moving to the U.K.

More Transparency Hospital Comparisons

HHS has released the latest comparison of hospital statistics website with searchable data on outpatient surgical infections, heart attack treatment success and more." Data released Wednesday "appeared to bolster that argument, at least for heart attack patients," which showed "a drop in the national 30-day mortality rate for heart attacks of 0.4 percent to 16.2 percent for the three fiscal years of 2006-09." Also, the new healthcare law will "likely" give the comparison data "even greater weight" because some of the information may be used to calculate hospitals' reimbursements after 2013. 

The Hospital Compare website was created through the efforts of the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (DHHS), along with the Hospital Quality Alliance (HQA). The HQA is a public-private collaboration established to promote reporting on hospital quality of care. The HQA consists of organizations that represent consumers, hospitals, doctors and nurses, employers, accrediting organizations, and Federal agencies. The information on this website can be used by any patients needing hospital care.

Patients searching for a hospital will now be able to compare how much they rely on medical imaging procedures, which can carry dangerous levels of radiation.

Information on the procedures has been added to HealthCare.gov, an online tool that lets users analyze and compare data on patient care from more than 4,700 hospitals across the country.

I examined the website and it appeared to be well designed with easy and intuitive interface, and depending on your choice it will display results in either graphic or numeric results.

This tool will give patients a means of analyzing a hospital of choice.  Whether these statistics are accurate, and/or biased by the particular demographics of patient responses, which could vary significantly depending on the patient's expectations of care. The statistics are based upon the percentage.  of patients who rate the hospital at 8 or above. This particular chart did not rate outcomes. 

There are two tabs at the header, one for consumers (patients) and another for professionals. 

The professional tab offers an outcome rating, based upon PQRI requirements, found at QUALITY NET

These numbers are more objective, not based upon subjective assessments by patients.

These tools represent part of   The plan for Open Government, the details of which can be read here.

I believe most patients will select the hospital at which  their doctor chooses to practice , or by convenience, perhaps limited by distance and socioeconomics.

I'd like to hear your comments..GML

 

del.icio.us Tags: HHS,PQRI,FREEDOM OF INFORMATION ACT,PATIENT SATISFACTION,HOSPITAL RATINGS,CMS,DHHS,HQA