What to Pay for a Hip Replacement…Hmmmm?

February 12, 2013

JAMA Network | JAMA Internal Medicine | Availability of Consumer Prices From US Hospitals for a Common Surgical ProcedureAvailability of Consumer Prices From US Hospitals.

$5k Per EHR Lab Interface | EMR and HIPAA

February 9, 2013

$5k Per EHR Lab Interface

A provider organization recently reached out to me to discuss the issues they were having trying to get their EHR vendor to do a lab interface with their lab. It was a pretty standard large EHR vendor document where they nickle and dime you for little things like a lab interface. Looking at it always reminds me of when I’ve seen the $5 aspirin charge in the hospital.

The problem with the lab interface charge is that it’s usually $5000 instead of $5. When an organization is choosing to implement an EHR, they often forget about many of the future hidden costs associated with an EHR vendor like the EHR lab interface. Plus, they also forget that the EHR vendor will often charge them $5k for the interface and then the lab will charge them another $5k for that interface. This is often true even when an EHR vendor has created many interfaces with a particular lab vendor before.

In fact, the organization that I mentioned above brought a new light to the cost of lab interface. It turns out that this organization was on its third lab and thus its third lab interface with their EHR. I don’t expect clinics change labs this often, but it is very common for a medical organization to switch from one lab to another. Plus, let’s not even get started on the challenge of getting a hospital lab to integrate with your EHR.

Not all EHR vendors are like those I mention above. In fact, a number of EHR vendors have seen this as a great way to differentiate their EHR from other competing EHR vendors. I know of at least one EHR vendor that’s done a few hundred lab interfaces (all at no cost to the doctor). The large number of labs partially illustrates the challenge associated with lab interfaces. There are just so many of them that need to be done. It’s not like there’s 1 or 2 labs that dominate the market. However, many EHR vendors are offering a free lab interface as part of the EHR purchase. Be sure to ask before you buy.

The sad part of the lab interface story is that because of the items mentioned above, many doctors just end up scrapping a lab interface. They can’t justify a $10k expense to integrate their EHR with the lab. This is unfortunate, because it’s amazing how much benefit can come from a well integrated EHR Lab interface.


2013 Deadlines Physicians MUST NOT Miss (courtesy MSNVA)

January 24, 2013

January 23, 2013 – By Neil Chesanow, Medscape Contributor

1. E-Prescribe or Be Penalized

If you start writing electronic scripts in 2013, you could still receive a bonus of 0.5% from CMS. If you didn’t electronically write at least 10 prescriptions in the first 6 months of 2011, you lost 1% of your Medicare reimbursement in 2012 (unless you qualify for a “hardship exemption”; deadline: January 31, 2013). The fine increases to 1.5% in 2013 and to 2% next year.
If you already have and use an e-prescribing system, February 28 is the last day to submit claims to reap the 1% bonus payment for Medicare patients whose prescriptions were successfully sent to a pharmacy electronically in 2012.
2. Begin Meaningful Use to Avert Penalties
If you can show meaningful use, February 28, 2013, is the last day to complete attestation for payment year 2012. 2013 and 2014 are the last years that eligible professionals (EPs) who see Medicare or Medicaid patients can earn incentive payments. If a Medicare EP qualifies to receive a first payment in 2013, the amount is $15,000. In 2014, it’s $12,000. If a Medicaid EP qualifies for an initial payment this year or next, the amount is $21,250.
If you see Medicare or Medicaid patients and fail to meet meaningful use requirements, there are penalties: probably 1% in 2015, rising to 3% in 2019.
3. Start Meeting Medicare Quality Performance Targets
In 2013, CMS will gather performance data to determine which doctors will get award bonuses and which will get a 1.5% cut in Medicare payments starting in 2015.
CMS is testing a physician performance program using data gathered in its Physician Quality Reporting System (PQRS) initiative, which promotes reporting of quality information by EPs. This feedback will be combined with claims-based efficiency data to develop a “value-based modifier” that will result in different Medicare rates being paid to individual physicians.
4. Gear Up for Value-Based Purchasing
Built upon the PQRS model that promotes reporting by doctors, as well as data from other programs, CMS’s value-based purchasing program links reimbursement directly with care quality. A value-based modifier (VBM) will adjust Medicare reimbursement up or down on the basis of a physician’s efficiency and quality scores.
The 2015 VBMs will be based on performance 2 years prior to the year in which incentives or bonuses are paid or penalties levied. Based on benchmarks, high-quality, low-cost groups would receive up to a 3% bump in their Medicare payments; underperforming groups would lose 1% of their reimbursement.
5. Tell Your Staff About State Insurance Exchanges
If you have employees, March 31, 2013, is the deadline for notifying them about new health insurance exchanges, expected to be set up by governments in about 20 states, with the federal government setting up the rest.
The deadline may be extended, but whether or not it is, you need to inform your staff about the services offered by your state’s exchange, how to contact it, the value of any coverage you offer (for the sake of comparison shopping), whether employees are eligible for a premium tax credit for a plan purchased on a state exchange, and other tax information.
6. Decide Whether to Offer Employee Health Insurance
Many physician practices don’t offer employee health insurance because of the cost. But that may no longer make economic sense. In 2014, companies with 50 or more workers that don’t cover their employees must pay a penalty of $2000 for each employee who buys government-subsidized insurance through an exchange (excluding the first 30 employees who do so). If you have a staff of 50 and they all buy insurance from an exchange, you’d pay $40,000 in penalties (20 workers x $2000 each). It may or may not be less expensive to offer staffers employer-sponsored coverage. In 2013, make your decision.

7. Consider Taking Medicaid Patients

Under the Affordable Care Act, primary care physicians already receive a Medicare bonus of 10% that will continue through 2015. But many primary care doctors are loath to take Medicaid patients, generally due to lower reimbursement.

2013 may be the year to rethink that decision. Medicaid payments will be raised to 100% of the Medicare fee schedule in 2013 and 2014. Affected specialties include family medicine, internal medicine, and pediatrics. In some states, primary care doctors who treat Medicaid patients will see their rates jump significantly. To boost your bottom line, it’s worth considering.
8. Get Up to Speed on ICD-10 Coding
CMS has delayed the deadline for healthcare organizations to convert to the ICD-10 coding system to October, 1, 2014. But you can’t kick back and relax. Taking time now to learn about ICD-10 codes will significantly affect how the transition affects your practice.
Don’t underestimate the scope and complexity of the transition. According to the Healthcare Information and Management Systems Society, a smooth, successful transition requires a well-planned and well-managed implementation process that could take as much as 2 years.
9. Review Your Employer’s Rules on Extracurricular Pay
If you publish in clinical journals or consult or speak for pharmaceutical or medical device manufacturers, 2013 is an excellent time to review your workplace’s rules on how much in extracurricular fees you can ethically accept.
That’s because 2013 is probably when data collection will begin for the Physician Payments Sunshine Act, which requires drug and device manufacturers to disclose all fees and gifts valued over $10 that are given to physicians. CMS was supposed to begin data collection in 2012 and to post data on January 1, 2013. It hasn’t happened yet, but it’s wise to review those rules.
10. Write to Your Elected Representative to Protest Medicare Pay Cuts

Pay cuts for physicians are still in the offing. The Independent Payment Advisory Board (IPAB) is charged with making recommendations for Medicare cuts when cost growth exceeds a target rate. But it can’t submit proposals that would ration care, increase revenues, change Medicare benefits, or increase cost sharing. The cuts won’t come from hospitals. Who’s left? Providers. The first year that the IPAB could recommend provider payment cuts is 2014. The American Medical Association supports a House bill to repeal that provision. If you want to keep the pressure up on your elected representatives, write to your Congressperson.


Xtreme Eating 2013: Worst Offenders List

January 16, 2013

Xtreme Eating 2013
Extremism Running Amok at America’s Restaurant Chains


Americans in Worse Health Than Peers Abroad – The Commonwealth Fund

January 14, 2013

Americans in Worse Health Than Peers Abroad – The Commonwealth Fund.

By John Reichard, CQ HealthBeat Editor

January 9, 2013 — Americans die sooner and have higher rates of disease and injury than citizens of many other high-income countries, a new Institute of Medicine (IOM) report says.

The authors also warned that the findings suggest that the U.S. health system, already the most costly in the world, is on track to becoming even more expensive.

“The fact that we have a generation of children who are in worse health than children elsewhere means that tomorrow’s adults will be bringing more demands on the health care system,” said Steven H. Woolf, chair of the IOM panel that wrote the report. “That will take a system that’s already unaffordable and make it even more costly.”

While the report lacked specific recommendations for lawmakers, Woolf emphasized that Congress needs to be aware that the findings will affect the nation’s economic performance. That’s not only because of rising health costs but because poorer health points to a less productive work force, he said.

“Often politicians can be found boasting about us having a … health system that is the best in the world, and we do have a lot of strengths in our health care system that we can be proud of,” Woolf said. “But it’s important for our policy-makers to have knowledge of the scope of this problem.”

Woolf is a professor of family medicine at Virginia Commonwealth University in Richmond.

The study said that compared to 16 peer nations, the U.S. is at or near the bottom in nine major areas of health: infant mortality and low birth weight; injuries and homicides; teenage pregnancies and sexually transmitted infections; prevalence of HIV and AIDS; drug-related deaths; obesity and diabetes; heart disease; chronic lung disease; and disability.

The U.S. outperformed its peers in some areas: Americans over age 75 live longer; Americans have lower death rates from stroke and cancer; they have better control of cholesterol and blood pressure levels; and they have lower rates of smoking.

Broad Range of Problems

The institute billed the study as the first comprehensive look at multiple diseases, injuries, and behaviors across the entire life span, comparing the U.S. with peer nations.

“I personally was stunned by what the disadvantage was across so many topic areas,” Woolf said. This suggests “something fundamentally is going wrong.”

The report said Americans are more likely to engage in certain unhealthy behaviors. These include heavy intake of calories and behaviors that increase the risk of fatal injuries. Also, it said that the U.S. has relatively high poverty rates. And it has higher rates of income equality and lags behind other nations in educating young people.

But “the problem is not simply a matter of a large uninsured population or even of social and economic disadvantage,” the report said. “It cannot be explained away by the racial and ethnic diversity of the U.S. population. The report shows that even relatively well-off Americans who do not smoke and are not overweight may experience inferior health in comparison with their counterparts in other wealthy countries.”

During a telephone news briefing, the report’s authors were asked to explain why foreign leaders fly to the U.S. for health care when they become seriously ill yet the report shows Americans at a health disadvantage.

“Health is determined by much more than health care,” replied Woolf. “Our health as Americans is only partly aided by having a very good health system.” He added that “it might be true that the Mayo Clinic and the other systems where the VIPs of the world go for health care offer excellent care, but the average American is not necessarily getting care in that setting.”

Informedika is Hiring: DC, Boston, Chicago, Dallas, LA

November 18, 2012


Informedika is the free, nationwide e-requisition network for physicians delivering aggregated, real-time clinical test results in a unified view through a secure web portal.   We are 100% device agnostic delivering results in our exclusive “one pane of glass.”

Physicians and staff order and view lab results for their patients directly from the portal. We support diagnostic results in HL7 from certified lab including phlebotomoy, pathology, imagery, and specialized proprietary genetic tests such as the VAP. We also aggregate content from devices and will soon deploy a patient portal. Features include trending results across labs values, alerts for abnormal results, one-click referrals, DICOM streaming image viewing (no software required), and mobile access from popular tablets, the intenet, and mobile portals. The portal supports exporting diagnostic data to EMR and results are certified to be HIPAA compliant.

Building on exponential growth here in Silicon Valley we are expanding our sales efforts nationally and need experienced/motivated client relationship managers to be on the front line; taking numbers and closing opportunities. If you are looking for a challenge at a hot start-up — we need to chat.

See our two-minute explainer here: www.informedika.com

YouTube Video Here