Healthcare Policy

MN requires insurers, providers to file electronically

Sun, 01 Jul 2007 20:01:36 -0400

Minnesota providers and insurers will soon become the first in the United States required to file all claims electronically. A new law, which takes effect in 2009, includes all business-to-business transactions, as well as transactions between providers, insurers and the state.

The law also impacts worker's comp claims, chiropractic, dental and pharmacy claims and medical care claims filed through auto insurance plans. Insurers and providers will be required to follow a standard e-claim format developed by a consortium of payers, providers and state agencies.

The rule comes after a 2006 state study found telephone follow-up for claims and eligibility cost the state $15.5 million to $21.8 million annually. State officials, who expect to see major cost savings through the new requirement, cite a study by America's Health Insurance Plans estimating e-claims costs at 85 cents each, while paper claims cost $1.58 each to process.

To find out more about the new rules:
- read this Minneapolis Star Tribune article

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Providers not moving fast enough on NPIs

Sun, 17 Jun 2007 20:01:35 -0400

When CMS agreed to give providers a bit of a breather on transitioning to the new National Provider Identifier, it might have given them a false sense of security, according to a consultant who coaches execs on this topic. True, CMS agreed to suspend penalties for providers who aren't NPI compliant yet, but are making reasonable and diligent efforts to get there. The problem is that grace period will expire on May 23, 2008--and the deadline is barreling down on providers, said Martin Jensen, COO and chief analyst of Healthcare IT Transition Group of Tulsa, OK. Now is the time for medical groups and healthcare executives to begin forming realistic plans for transitioning to full-time NPI use, particularly given that CMS isn't going to be much help, he says. Otherwise, not only will providers face CMS penalties, they may soon find that they'll have trouble tracking revenue and getting claims paid.

To find out more about NPI preparations:
- read this Healthcare IT News article

IRS gives physician EMR donations the OK

Sun, 13 May 2007 20:01:38 -0400

Non-profit hospitals across the U.S. got a gift this week from the IRS, which ruled once and for all they can safely donate EMR systems and related support services to affiliated doctors. Many of these hospitals have looked at giving doctors with staff privileges EMR systems, rather than waiting until the physicians were ready to invest themselves. However, until last week it wasn't clear whether the IRS saw such donations as providing "private benefit," something that could endanger a hospital's tax-exempt status. HHS already came forward last year with rules that explicitly allowed for such donations, but the IRS has lagged on the issue.

The new IRS ruling notes that when hospitals make such a donation, they must follow the related HHS rules, too; that hospitals must have access to all records created by the physicians whenever possible; and that all medical staff members have the same access to the same donation levels (or if donations differ, that hospitals must justify the differences in terms of community needs).

To learn more about the ruling:
- read this Health Data Management item
- read the IRS ruling (.pdf)

Related Articles:
HHS, IRS rules on EMR donations clash. Report
Still no IRS ruling on giving physicians IT. Report

MD group asks for federal help with EMRs

Sun, 01 Apr 2007 20:01:37 -0400

Wider adoption of EMRs would significantly improve U.S. quality of care, but small-group and solo-practice physicians will need help if they're going to get on board, according Congressional testimony by the president of the American College of Physicians. Right now, bringing an EMR on board costs $44,000 per physician, and generates an average ongoing $8,500 per year in annual costs, ACP president Lynne Kirk, MD told the house Subcommittee on Regulations, Healthcare and Trade of the House Committee on Small Business last week. "The business case does not exist to make this kind of capital investment," Kirk told the Subcommittee. The ACP is asking Congress to create a Medicare code which communicates the complexity of the healthcare IT expenses taken on by a practice. It also wants to see Congress finance initial EMR investments by small practices.

To learn more about ACP's advocacy on this issue:
- read this Healthcare IT News article

HHS backs genetics-driven, HIT-focused healthcare

Sun, 25 Mar 2007 20:01:38 -0400

HHS Secretary Mike Leavitt unveiled a new initiative on Friday which would rely heavily on advanced health IT tools to individualize and improve patient care.
Leavitt's "Personalized Health Care" program will link genetic information with traditional health records on a large scale, in an effort to predict and thereby prevent the onset of many diseases. Leavitt has said that this effort will be one of his top priorities for the next two years.

Overall, HHS agencies like the NIH, FDA and CDC will spend $277 million on personalized health care efforts this year, and should up that spending to $352 million in fiscal 2008. To boost this effort, President Bush has included $15 million in funding in his 2008 budget to create a new electronic network linking together data repositories across the U.S., Leavitt noted. To make sure these efforts don't compromise privacy efforts--or expose consumers to discrimination--HHS is beginning a comprehensive review of how the aggregation of this information will impact individual consumers. It will also work with the American Health Information Community to develop health IT standards for including genetic data in EMRs.

To learn more about how this initiative is playing out across HHS:
- read HHS's press release
- check out this United Press International item
- review the HHS overview of the program

Related Articles:
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WI governor's EMR plan draws rebuke

Sun, 25 Mar 2007 20:01:37 -0400

A plan to foster EMR adoption by shifting millions out of the state's medical malpractice fund has gotten a sharp rebuke from state auditors, who say that the move could be illegal and would undermine the state's med mal coverage system. Governor Jim Doyle (D) would like to take $175 million out of the fund, which insures about 14,000 Wisconsin doctors and providers against claims over $1 million, and use the money largely to fund providers who switch to EMRs. Doyle argues that if providers use EMRs, they'll lower the number of medical errors that occur, offsetting the effect of the transfer.

But financial watchdogs don't buy this logic. In a letter to lawmakers, State Auditor Jan Mueller noted that while the fund had $737 million in cash and investments in hand as of mid-2006, it has liabilities of $685 million, and that a $175 million transfer would put the fund in the red. Meanwhile, the Wisconsin Medical Society has also come out against Doyle's proposal, concerned that funding changes could weaken the successful state malpractice program.

To learn more about the controversy:
- read this La Crosse Tribune article

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Schwarzenegger issues HIT mandate

Sun, 18 Mar 2007 20:01:38 -0400

Jumping on board an initiative kicked off by HHS secretary Michael Leavitt, California governor Arnold Schwarzenegger has signed an order pushing healthcare providers to adopt more health information technology and make pricing and quality information more readily available. The state, which has set a goal of 100 percent electronic data exchange within 10 years, will now push for HIT by supporting organizations that use e-prescribing and other health data exchange technologies.

The California Medical Association reacted somewhat negatively to the governor's announcement, stating that while it's all in favor of health IT adoption, it's against anything that imposes new costs on practices that can't foot the bill. "Many small practices and practices operating in poor and rural areas cannot afford some technologies and, in some cases, don't have high-speed Internet access," noted a CMA statement. "Without financial assistance, the governor's mandate would be an undue burden for these doctors."

To learn more about the new requirements:
- read this Sacramento Business Journal article
- see the California Medical Association's press release
- read the governor's executive order

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Still no IRS ruling on giving physicians IT

Sun, 04 Feb 2007 19:01:38 -0500

For a while now, the voluntary hospital industry has been nervously waiting for the IRS to offer some guidance on whether they can legally give EMRs or other IT equipment to physicians--and have gotten no response. Now, hospital executives are starting to get antsy. Last week the American Hospital Association issued yet another request urging the IRS to offer clear guidance on whether health IT donations to doctors are OK, acceptable some of the time or unacceptable.

It's now been established that hospitals can give physicians equipment created by CCHIT vendors without facing CMS kickback scrutiny--as long as it's interoperable--but it continues to be in question whether hospitals can supply technologies without risking their tax-exempt status. The question is whether hospitals can give away such IT assets and still be seen as fulfilling their charitable mission, rather than a "private interest." No word yet from the IRS when they'll take action. In the mean time, hospitals may still have a devil of a time getting doctors on board with, say, EMRs.

For more information on the tax issue:
- read this article from Health Data Management

Related Articles:
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CCHIT approves new vendors. Report

HHS grants improve Medicaid data management

Sun, 28 Jan 2007 19:01:38 -0500

HHS has awarded $103 million to 27 states, supporting programs a range of programs--including health IT initiatives--designed to improve the way Medicaid dollars are used. Congress has approved a total of $150 million for these "transformation grants," which will distributed over fiscal '07 and '08. While the states will be able to use the funds for a variety of purposes, key themes include the development of programs to encourage EMR use, clinical decision support tools or e-prescribing. Other areas include increasing utilization of generic drugs, implementation of a medication risk management programs and improving access to primary care and specialty physicians using integrated university-based hospitals and clinics. Interesting IT projects that were funded, included a health information exchange/e-prescribing initiative in Connecticut, which got $5 million, an $11.8 million Medicaid HIE in Arizona, an "open Vista ASP Network" in Hawaii, which got $3.2 million, and a $1.5 million grant integrating EHRs with clinical decision making. What I'd like to see added to this list, personally, is a grant which is explicitly designed to speed up how quickly at which Medicaid physicians get paid. Now there's an IT initiative everyone would love.

To learn more about the grant program:
- read this press release from HHS, which lists state by state awards
- get more background on the grant application guidelines

Raking in the CMIO bucks

Sun, 28 Jan 2007 19:01:34 -0500

Are you a highly computer-savvy physician? Well, now may be your golden hour, according to one blogger. The position of chief medical information officer (CMIO) is getting hotter by the minute, as hospitals seek doctors to manage their investments in clinical IT categories like EMRs, e-prescribing and clinical support systems. CMIOs often make $200K or more per year, with some enjoying much larger salaries than that. And this isn't a boring job--they get the shape the future of medicine, as defined by the new systems coming on board to manage data. Worth looking into, no?

For the skinny on CMIO pay and opportunities:
- read this blog