HEALTH TRAIN EXPRESS
Mission: To promulgate health education across the internet:
Follow or subscribe to Health Train Express as well as Digital Health Space for all the updates for health policy, reform, public health issues. Health Train Express is published several times a week.Subscribe and receive an email alert each time it is published. Health Train Express has been published since 2006.
The CMS incentive payment programs have a strange void and lack of funding for certain health care organizations that are a major part of our health system.
It is obvious that incentives are pointedly directed at primary care practices, since the criteria for meaningful use have little application in many specialty practices, and would actually require redundant data entry for data that should be present in a patient’s file in the PCP practice.
In fact the original meaningful use metrics were manipulated to allow specialty practices to qualify for incentives.
Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments.
However, the incentive program excludes certain health care providers are such as:
Home health agencies;
Inpatient psychiatric hospitals;
Inpatient rehabilitation hospitals, Long-term acute care hospitals; and
Nursing homes.
The exclusion of SNFs is bizarre, since the medical record is essential when a patient becomes a resident for either a short or long term period in the SNF.
Hospitals that are not eligible for meaningful use incentive payments are less likely to adopt electronic health record systems, according to a study published in the journal Health Affairs, AHA Newsreports (AHA News, 3/5).
Furthermore this absence of EMR in SNFs, Home Health Agencies will weaken linkage of vital information and undermine the importance of linkage to a health information exchange.
The researchers concluded, "To advance the creation of nationwide health information technology infrastructure, federal and state policymakers should consider additional measures, such as adopting health information technology standards and EHR system certification criteria appropriate for these ineligible hospitals."
They also recommended that policymakers consider "low-interest loan programs for the acquisition and use of certified EHR systems by ineligible providers" (AHA News, 3/5).
N.H.S. adopts mobile phone apps in lieu of office visit, or prior to office visit for instructions:
An app a day keeps the doctor away: Patients told to use mobile phones for a check-up instead of visiting their GP Cancer sufferers, pregnant women and those with diabetes, lung problems and heart disease will be urged to take daily measurements and text them into a central computer system.
The scheme is being rolled out by the Department of Health in the hope it will save the NHS millions of pounds through unnecessary visits to the surgery or hospital Read more:
Ministers also believe that if patients are constantly keeping an eye on their condition they will be less likely to suddenly deteriorate and need to be urgently taken to A&E. Read more:
But senior doctors and campaigners say it would be a ‘big mistake’ to force patients to use this technology.
They point out that certain groups such as the elderly would be far better off making an appointment than downloading an app.
You can guarantee that elderly people will not be able to use it or anyone else who isn’t very good with technology. If used wrongly it’s a big mistake.’
Would this work in the American Health System? Would it reduce cost? Would it overload staff with text volume. Are there any physician practices willing to pilot this as a test program?
I have expanded our vista on health issues on Google plus at “Digital Health Space” Contributors and participants are invited, contact me at gmlevinmd@gmail.com or send a post to me at Gary Levin on Google plus.
Watch for the “Photo Walk Tour” which we have co-sponsored for patients who are immobilized and unable to travel about. More on this later.
In one of the nation’s first tests of how Obama care will work for the uninsured, the Sacramento region of California will implement a slice of President Barack Obama's health care overhaul.
All four Sacramento-area counties are joining a program that will insure tens of thousands of residents who have been without coverage, more than a year before federal health care changes kicks in.
For new patients, the plan could mean the difference between getting sporadic care in unfamiliar clinics (or simply staying sick), and having something that resembles full-fledged health insurance, paid for in county and federal dollars.
This program fills a void until the Federal Low Income subsidy program kicks in in 2014.
Short-lived as it may be, the program will help counties ramp up their systems of care.
By New Year's Day 2014, the federal law says, most adults with very low incomes must be eligible for Medi-Cal. But they can't get started overnight.
Counties first need to vastly expand their corps of doctors' offices that accept Medi-Cal, establish standards and payment systems, enroll patients, and educate them on how to use the new system.
There are many factors remaining to be seen. What will the reimbursement rates look like? Will physicians accept the new plans? Where will the primary care doctors come from when there is already a shortage of PCPs?
Health 2.0 encompasses a wide variety of software applications that go far beyond mobile apps on smartphones.
An entire new industry is developing around several ‘hotspots’ for technology development. This includes health care applications. One fertile ground is the MIT labs. Progress and practical applications are only limited by venture capital. Startup Incubators are a financial boost to new ventures whereby value-added resources are loaned (such as free space, equipment, furniture and promotional material) and/or also experience from a senior venture capitalist given to a hopeful entrepreneur.
A photo walk by Jared in the Mountains of Utah for M. Monica on Google Plus using a Hangout with an iPhone.
Watch as John Butterill moderates a Virtual Photo Walk for two challenged patients.
Social interaction is a critical factor in health and wellness. Many of our patients have reached a state where they are no longer well, however suitable means are available to improve quality of life.
Google Plus has several ways of collecting individuals with like interests and/or goals. The circles of G+ offer a collective approach for individuals with common interests, ie photography, disability, disease categories, etc.
Virtual Photo Walks provides a platform for invalids to participate in observation of scenic walks, visits to theme parks, cruise ships, casinos and perhaps even city council or other political activities.
Digital Health Space has partnered with Google, Veterans Today, and Virtual Photo Walk in this endeavour for patient advocacy for a group largely lost to social affairs due to limited mobility or very limited access to public spaces. While the Americans with Disabilites Act empowered the mobility impaired in the physical space, Virtual Photo Walks extends this Act into the virtual space with a flick of a mouse pointer.
Remarkable changes in attitudes by healthcare providers has occurred in the past three years, in regard to electronic medical records. Physicians were the leading naysayers with many reservations about cost, true effectiveness and return on investment. Now a significant number have become adopters of EMR and those providers who use EMR doubt if they could be as efficient without EMR.
Patient Opinions
About 18% of patients in paper-based practices said they would not find it very valuable if their physician adopted an EHR system, and about 10% said they would not find it valuable at all.
About 21% of patients whose physician primarily uses a paper-based health record system said they would find it very valuable if their physician adopted an electronic health record system, and about 52% said Read more:
When asked about the possible effects of their physician transitioning to an EHR system, about 48% of patients in paper-based practices said the transition would have a very positive or somewhat positive effect on their quality of care.
About 41% of patients in paper-based practices said the shift to EHRs would have no effect on their quality of care, while 10% said it would have a somewhat negative or very negative effect on patient care.
Read more:
The report is based on an August 2011 online survey of 1,961 U.S. adults, including 808 U.S. adults whose physician primarily uses a paper-based health record system. Read more: Physician Opinions
Eighty-four percent of health care providers say they consider health IT "invaluable" or "valuable," according to a survey by CDW Healthcare, FierceHealthIT Read more:
Among the 202 surveyed caregivers, CDW Healthcare found that:
50% said they considered health IT "invaluable" because it "delivers capabilities that could not be replaced by non-IT tools;" and
34% said they considered health IT "valuable" because it "significantly aids in the delivery of care."
In addition, 71% of health care providers said they would not be able to complete more than 50% of their workload without health IT
Read more: Health IT Professionals
Among the 200 surveyed health IT professionals, CDW Healthcare found that:
56% said they have deployed an electronic health record system in their hospital in the past 18 months (FierceHealthIT, 2/27); and
48% said they have deployed a computerized provider order entry system in the past 18 months (CDW Healthcare report, 2/27).
In addition, the survey found that:
Nearly 80% of health IT professionals said the infrastructure to support health IT sometimes is implemented as an afterthought; and
58% said they had implemented data storage, a server or a network program after adopting a new health IT system at least once (FierceHealthIT, 2/27).
Health Train Express believes that social media platforms and their use is at about 2008 in comparison. EMRs rapidly evolved and purchased during the period from 2008 to 2012 with the promise of $ 18 billion funding by the U.S.Government.
At first glance the medical market place for social media would seem to be much smaller than EMR, however given it’s popularity healthcare in will fuel growth for the space. Many medical equipment companies both in manufacturing and sales use social media daily.
Social media has evolved from Twitter to Facebook to Google plus. With each iteration the capabilities of the platforms continues to expand.
We will continue to follow healthcare and social media closely.
Using Social Media, Digital Resources and Health 2.0 to your advantage
Time for all of us is precious and is one of those resources like finances that is limited.
Fortunately many changes have occurred which increase efficiency in dealing with healthcare. Many of these improvements are on the patient side as well and the physician side of the equation.
Let's categorize these
Insurance:
Search engines can be use to identify appropriate insurance policies for you and your family. Many insurance companies now operate a central source for different companies as well as programs that compare rates and coverage limits.
Enrollment applications can and are processed online. Much of your medical history can be entered because the online sites are encrypted and private in accordance with HIPAA regulations.
Insurance notifications and contact confirmation can be sent via email to confirm your application(s)
In addition to receiving ID cards via regular mail, some companies will also send you a copy via email.
Office or Clinic
Online web portals are becoming omni-present. These may include patient education, search engines by doctor location or specialty.
Not infrequently the web portal will contain significant information about physician's resumes, credentials, hospital staff memberships, office hours, and specialty interest.
Appointment scheduling.
Laboratory, Imaging result reporting online.
It's not necessary to sit and wait in a reception area with patients who may have infectious illnesses. If you have a cell phone or a smartphone ask your doctor's office to send you a text message or a 'tweet' when they are ready for you. (even a phone call works).
Bill payment online.
Pharmacy:
1. Physicians now frequently use eRx a form of electronic transmission of your prescription to pharmacies. This eliminates errors due to illegible prescriptions. However, it is not foolproof and recent studies have shown significant errors still occur. Double check your prescription when you pick them up.. It is important to update your doctor as to where you want your prescription sent to for each visit.Many pharmacies offer automatic refill at no additional charge. Ask your local pharmacy for their requirements. It will save time, your prescription will be ready, you will not forget, and it will reduce effort.
The health care overhaul is complex. It’s confusing. There are multiple misconceptions about it.
So Jonathan Gruber decided to set the record straight in simple fashion: a comic book.
It’s classified as a “graphic novel,” illustrated by award-winning artist Nathan Schreiber. But it’s not fiction.
In fewer than 150 pages, the two combined their expertise in “Health Care Reform: What it is. Why it’s necessary. How it works.”
The paperback volume is a primer to help people understand — and buy into — the ideas contained in the Affordable Care Act.
There’s no question that Gruber, a professor of economics at Massachusetts Institute of Technology, is an advocate of the changes.
He is director of the health care program at the National Bureau of Economic Research. He was the main designer of Massachusetts’ health care law. The Obama administration consulted him to help construct the national act. He is a member of the Institute of Medicine.
Gruber walks the reader through the situations fostered for each in today’s health insurance climate and explains the financial consequences. Then he presents a case for the changes envisioned by the Affordable Care Act.
Much like entertainment, health care information will become available on all media. The convergence of many technologies such as Television, cable, internet, smartphones, tablets, desktops and more devices stimulates openness and transparency. The convergence of all these formats is occurring rapidly each year.
We all know as according to Phil Bauman that “Health is Social” Yet why do physicians either recoil or are dismissive about social media?
Tonight I am watching the Academy Awards on an internet live stream with a choice of six different cameras with upfront face-to-face encounters. It’s all in HD. Television still does not yet have the events on live. (5PM PST).
I have four active windows to select from: Arrivals, Grand Entrance, Red Carpet and Interviews. All windows are in real-time and simulcast.
Who are the nominees for the Health Care Oscars in 2012 ?
Categories:
Best use of Health 2.0
Best Electronic Medical Record
Best Social Media Platform
Best mobile application
Best Health Information Exchange
Best Health Insurance Reform Plan
Best Translational Science application
Best genomic discovery an application in healthcare's
Best Health Blog
Best General Medicine Journal
Best Specialty Medicine Journal
Perhaps the Nobel Prize, Woman in Science Award, The National Academy of Sciences Awards,
Certainly one of the methods to reduce fraud is to catch the opportunists that see the U.S. Treasury as easy pickings. Hidden in the maze of billing, coding, electronic claims is software coding that can easily be turned to the white collar thieves.
As physicians we need to be aware of the potential of careless, negligence and even possible misuse of your own billing system. The buck stops and starts in your very own office.
Fraud can be construed when a charge is made for a procedure that has not been performed, or with creative 'up coding' to a higher management code. Another common procedure is a 'storefront' phantom medical practice.
LOST MONEY
Medicare billing errors, excessive payments and fraud have cost U.S. taxpayers hundreds of billions of dollars over the past decade. Medicare's annual estimates, however, do not account for all fraud nationwide.
FRAUD PROSECUTIONS
Federal prosecutors in South Florida scratched the surface of Medicare fraud in the 1990s. But it wasn't until a few years ago that they began to crack down on the corruption. Today the region's prosecutions account for more than one-third of all Medicare fraud cases nationwide.
Whenever Alexander McCray lights up his crack pipe, U.S. taxpayers help pay for his habit.
McCray has defrauded Medicare by selling his government-issued health card number to private clinics in exchange for kickbacks of $150 to $300 a visit -- as often as three times a day, three times a week over seven years, according to federal records and his own admission.
McCray has signed off on phony infusion treatments for his HIV illness -- therapy that is medically obsolete -- and he has received thousands of dollars from Medicare-licensed clinics all over South Florida.
Money that he has used to buy crack cocaine.
Dozens of clinic operators have in turn filed more than $1.1 million in false claims for fabricated HIV-infusion treatments billed in his name, according to Medicare records reviewed by The Miami Herald. Some 90 doctors, including one indicted in May, appeared on the phony prescriptions written on behalf of McCray.
''I'm the king of it all,'' the 40-year-old, unemployed Opa-locka man told The Miami Herald recently, when asked about his Medicare scams.
McCray, a ''professional patient'' with a 15-year criminal history of drug possession, is among thousands of con artists who have made South Florida the nation's capital of Medicare fraud. A six-month Miami Herald investigation has found that the corruption has spun out of control during the past decade with little effort by Medicare regulators to stop it here and in other major cities. This past week, during a policy forum to confront the crisis, federal lawmakers said Medicare fraud costs taxpayers nationwide at least $60 billion a year.
Federal agents raided health care facilities in nine states this morning, arresting dozens of suspects believed to be defrauding Medicare of tens of millions of dollars.
Federal authorities say this is one of the largest -- if not the largest -- take-down of Medicare fraud suspects ever conducted.
The raids began in morning in the pre-dawn hours. The targets: more than 100 doctors, nurses, therapists and healthcare company executives who have allegedly been stealing tax dollars to the tune of $200 million in recent months. Much of the fraud involved healthcare professionals billing the government for medical services never performed and medicine not provided.
Investigators say the Brooklyn scheme worked like this: Patients willing to go along with the scam were paid $40 per visit for three appointments per week, and were often diagnosed with vertigo or other ailments that would limit their mobility. Ambulettes provided by Medicare and Medicaid were transporting these patients back and forth for fraudulent appointments.
The clinic would then collect from Medicare or Medicaid for the ambulette rides, and the supposed services provided at the phony appointments. Taxpayers were billed millions for unnecessary treatment or treatment never provided.
The raids were conducted in Miami, Brooklyn, Tampa, Chicago, Baton Rouge, Houston, Dallas, and Los Angeles.
A combination of events created this break in security.
Medicare received a series of paper claims for diabetic retinopathy laser photocoagulation from an ophthalmologist’s office. They were unusual, claiming a series of 8 treatments in a series for proliferative diabetic retinopathy. While a series of PRP for PDR is not unusual 8 is highly unusual. This medical practice used electronic billing exclusively, yet the claims were on paper forms. Each paper claim totaled 25,000 dollars and there was a series of claims totaling $ 875,000. The patient identification numbers and locations were not from the usual practice locations.
The paper claim had the correct MD name, Medicare Provider ID practice location ICD and CPT coding.
These events tripped off the Medicare fraud alert system. At the time the practice had been sold to another MD and a transition was in place. The original physician had relocated the to another state.
The claims were for procedures performed after the original physician had closed his medical practice.
The attorney general contacted the physician with many open-ended questions possibly suspecting the physician himself was the perpetrator of the fraud. It became readily apparent that this was not the case.
This physician's Medicare provider ID was compromised by a lack of security. It's important to remember that your insurance ID numbers are much like a credit card number, and are perhaps less secure since they do not require PIN numbers. The information is handled by many personnel in the billing office. In this particular situation there was also a change in office personnel.
It was determined that a previous biller was part of a scheme to defraud Medicare, either selling or giving the Medicare numbers to acquaintances who knew enough to use them to defraud the taxpayer of almost a million dollars.
A 'sting' operation went into operation allowing the thieves access to the money cashing their checks and tracing the money to a racetrack and a person attempting to cash the US Treasury check. Even more interesting was the checks were negotiated at a well known horse racing track in the greater LA metro area.
The perpetrators were confronted at the teller window by several FBI agents who inquired how they got the checks. The suspect turned around and said, “from that doctor over there'... (there was no “doctor over there”.
Fast forward about a month, when the MD received a call from an FBI agent who asked him to send him a copy of a photo of himself, a driver's license and a sample of his signature and writing sample. Even though completely innocent the physician realized how easily he could have been implicated.
As events turned out he was found to be an innocent victim of the scheme. He was required to appear before a grand jury where the guilty perpetrators were indicted, tried and sent to prison for felony fraud.
This was my personal story…it happened to me
This scenario while somewhat unusual is not unique. The moral of the story...treat your ID numbers as if they were credit cards, and if you make paper claims do not allow them to be known other than by your billing personnel.
HIMSS 2012 is the annual meeting of the minds where healthcare meets information technology, for better or sometimes worse.
It is one of those events where languages intermix. It is a cross-culture event where each side speaks, with the other side, sometimes with each party understanding the other party.
If you want detailed information in real time the best place to look is on twitter using the #himss12 to search or related #healthit.
2012 promises to be the year of the health mobile app. The maturation of the Android OS adding to the force of iOS allows many applications to be available in open source greatly expanding the ability of software developers in health care
UHC fooled us all with their end run around IT vendors, EMRs, HIEs and physicians. While the peanut gallery and bleachers were watching Howdy Doody, HHS, and CMS real entrepreneurs ran the pigskin into the end zone.
Insurers are much more than sending a bill and getting reimbursed for services. That is just the front end of their IT systems. IT experts know the real stuff in IT is in the ‘back end’, the guts of the system buried in non friendly code, algorithms, application interfaces, backdoors for different insurance companies, etc.
Dana Blankenhorn writes in “Seeking Alpha” , an investment newsletter,
“When I took on the health IT beat for ZDNet five years ago, it was with the assumption that this industry would act as every other industry had acted. That is, mainstream tech vendors would gradually take out the specialists.
It hasn't worked out that way. Last year Microsoft (MSFT) got out in favor of GE (GE), which has been involved all along. Google (GOOG) simply bugged-out, a rare failure for the company. Siemens (SI), long an also-ran in most enterprise computing, has also been a big player in health IT thanks to its imaging unit.
But the big winner may turn out to be UnitedHealth (UNH), a healthcare vendor based in insurance.”
While other insurers signed vendor deals seeing IT as an obligation, UNH bought small vendors, seeing it as an opportunity.
Last year it rolled out a new brand, Optum, for its health services, and this week it rolled out what it calls the Optum Cloud, backed by a new data center.
The healthcare law, meanwhile, will bring UnitedHealth and its competitors, like WellPoint (WLP) and Aetna (AET) millions of new customers, but also a level playing field in many cases. It's an incentive for insurers to cut physician costs. That would translate into lower rates on health exchanges, thus more income.
The question becomes, can UNH break out of this high? Well, consider that now it only has to execute on a strategy that has government approval, with new services and new platforms coming on quickly. Signs point to yes. This administration has done UnitedHealth some big favors.
So, Meaningful use fueled interest in insurers to maximize their profits through health insurance exchanges, if those ever come to pass in some states. The money invested by the tax-payer will come around into insurers and Medicare (federal government)
How to sign up for Google + (even if you don’t have an EMR)
Besides +Peter McDermott there are many other YouTube video tutorials or you can contact me +Gary Levin and I will bring you into the fold.
Many of you already know I am a fanatical proponent of Google Hangouts and Google +
My enthusiasm is borne from the innovative IT and developers using this platforms interacting amongst each other in the google plus space. G+ allows me access to sources before they are released to the general public or those in the HIT space.
In order to obtain this level of efficiency I organized my Google + circle of friends into categories for healthcare, providers, mobile apps, Health 2.0 and others.
Once I had my circles organized it became productive and efficient to just open my 'stream' and information “streamed” out in ways that Facebook could not deliver. Twitter also has some of these attributes if you know how to use the hashtag to filter what you are interested in reading. It's main limitation is 140 characters which do not tell a story unless a hyperlink is eymbedded in the tweet.
My morning is spent reviewing my feeds, twitter, facebook and Google +. Although I am intrigued by the possibilities of using Google Hangouts it is restricted by it's lack of security and privacy required by HIPAA for healtcare.
Jonathon Schwartz CEO of Care-Zone has developed an application, Care-Zone which is a secure private system that providers, patients, and family can trust in communicating private information that should not be in the public domain.
Care-Zone has both a desktop and a mobile app availble in iOS, or iPhone.
The website uses https// a secured internet protocol. Care-zone allows you to upload files, created a medication list, create a contact list, but has multiple short-comings that render it almost useless for caregivers.
1.It is little more than a private secure notepad
2.There is no ability to chat in real time, nor interface visually or audibly
3.Different care givers must log in after being invited to Care-Zone
4. The application has no ability to interface with either a PHR or EMR.
A team of researchers at Harvard University are working on the logical next step: A smartphone app that can help treat mental health issues.
Mobilyze is a development tool that would work much like the Nike+Fuel Band.
The FuelBand has a few neat tricks to set it apart. Sure, it'll track your perambulations, but it also converts all of your physical activity into a kind of health currency called NikeFuel. It tracks steps walked and calories burned, but it also uses oxygen kinetics to take a more precise measurement of your exertion — and in true Nike fashion, it turns the result into a competitive sport.
The app uses a simple approach developed by an Australian psychologist. Users of the app are shown two different faces on their phone screen: One friendly and one hostile. The program merges the faces together, and then flashes a letter that you need to correctly identify. It's believed that those with social anxiety tend to fixate on faces in the crowd who are hostile. The app helps break this fixation, re-training the brain and reducing anxiety.
Recent studies show that using the new smartphone app helped reduce subjects' anxiety by 22 points on a questionnaire, as compared to an 8-point drop experienced by a group who didn't use the app.
But before you start trading in your doctor for an iPhone, it's important to note that not everyone believes that the app is special: A similar 22-point drop was experienced by a control group who looked at pairs of faces without the letter to distract them. It could just be that the key to feeling better is simply the act of taking the initiative and doing something about your anxiety. According to one Chicago-area control group participant in the study, "I felt good about myself, that I was doing something for my issues, and a lot happened in those two months outside the study that could have helped." (source)
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