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Wednesday, March 20, 2013

Figliozzi strikes again


REC Blog Milestone, March 22nd, 7:50 a.m. PST

Thanks, everyone.

Meaningful Use Audits Delay Payment of Some EHR Bonuses
By Sheri Porter

Posted: 3/19/2013, 12:05 p.m. -- Some family physicians who have purchased and implemented an electronic health record (EHR) system and attested to meaningful use of that EHR may be subjected to an audit before they see a bonus check. That's the word from CMS' Office of E-Health Standards and Services.

This most recent round of audits, dubbed "prepayment audits," is in addition to postpayment meaningful use audits that were initiated in the summer of 2012.

According to Elizabeth Holland, director of CMS' Health IT Initiative Group (a department overseen by the e-health standards office), between 5 percent and 10 percent of all eligible professionals attesting for meaningful use will be selected for prepayment audits...

  • As many as 10 percent of physicians and other health care professionals who attested to EHR meaningful use may be selected for a prepayment audit of their application.
  • Physicians who receive an audit letter from Figliozzi & Co. should respond immediately to prevent further delays in payment.
  • Not all physicians waiting for bonus checks are stuck in the audit queue; their payments likely still are being processed by CMS.
HHS had pushed back in this idea, but they ultimately caved to the anti- MU political pressure. Wonder what the quid pro quo was on the Hill over this (if any)? "Leave our Incentive Money alone and we'll agree to your silly additional desk audits"?

There's been some grousing among physicians subjected to the post-payment audits that these Figliozzi cookbook-following auditors are clueless about Health IT and clinical operations (they're an accounting firm, after all).


Clinical Decision-Making Part III
Published by Steven Novella under Science and Medicine

In part I of this series I discussed clinical pathways – how clinicians approach problems and the role of diagnosis in this approach. In part II I discussed the thought processes involved in deciding which diagnostic tests are worth ordering.

In this post I will discuss some of the logical fallacies and heuristics that tend to bias and distort clinical reasoning. Many of these cognitive pitfalls apply to patients as well as clinicians... is a required top-of-the-morning daily stop for me.


An email blast I sent around the office.

FYI, everyone… just what I need: yet another book to read in my Kindle Cognitive Crack Pipe. The subtitle speaks directly to what must be done in health care ops. I am gonna be all over this stuff.


In my book KAIZEN: The Key to Japan’s Competitive Success (McGraw-Hill, 1986), I ended with the following words:

It is my sincere hope that we will be able to overcome our “primitive” state and that the KAIZEN strategy will eventually find application not only in the business community, but also in all institutions and societies all over the world.

Looking back over the last 25 years since its publication, I am profoundly frustrated with the slow pace at which Kaizen strategy has been embraced by the business community. On the other hand, I am encouraged to note that Kaizen is rapidly gaining momentum in the non-manufacturing institutions like healthcare, services, and government.

I believe that Kaizen is essentially a “human business.” Management must meet the diversified requirements of its employees, customers, stakeholders, suppliers, and its community. In this sense, the healthcare profession can probably best benefit from Kaizen because its central task is people. I am honored to write a foreword to this book by Mark Graban and Joseph Swartz.

Taking this opportunity, I wish to mention a few reminders for successfully embracing the Kaizen strategy.

1. Embracing Kaizen is a long-term journey. It is not a flavor of the month and requires the cultural change, commitment, and self-discipline that needs to be sustained over many decades until they become routine business practices.

2. Top management commitment is the only way to successfully embrace Kaizen, without which nothing else you do will matter.

3. We need to approach our daily business in two phases. One is to maintain the status quo, in which the standard (the best way to do the job) is established and followed. This process is called maintenance and requires dedicated management effort to sustain it, but it is often overlooked or belittled. The second phase is Kaizen, which means to find a better way and revise the current standard. Thus, maintaining and improving the standard becomes the main task of management.

4. My definition of Lean is to employ minimum resources for the maximum benefits. Therefore, Kaizen leads to Lean, and Lean leads to green. Kaizen is the most environmentally friendly approach.

5. Welcome problems. The more problems, the better, because we have more Kaizen opportunities. We only need to establish priorities in dealing with problems. When the problem is correctly identified, the project is halfway successful.

6. One of the best ways to identify problems is to observe the flow of operations. In the medical institutions, there are many types of flows, such as information, physical movement of patients and families, medicines, and supplies. Wherever and whenever the flow is disrupted, there is a Kaizen opportunity.

7. A majority of disruptions of the flow can be easily detected and solved with common sense and do not require sophisticated technologies. 8. Remove the barriers between professionals and laymen. I sincerely hope that you will find your Kaizen journey to be challenging, but most rewarding.

Masaaki Imai, Chairman, Kaizen Institute

Mark; Graban (2012-07-03). Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements (Kindle Locations 643-644). Taylor & Francis. Kindle Edition.



In healthcare, enormous investments are made in things like buildings, technology, and pharmaceutical development, but little is spent to tap into the creativity of every single healthcare provider and professional. Yes, the new machine or new drug might do wonders, but people like Mark and Joe, the coauthors of this book, are demonstrating there is a much greater opportunity for improvements by enlisting everyone in the healthcare community to identify and solve problems. For example, Baptist Hospital in Pensacola was rated lowest in the state of Florida until they started asking for small improvement ideas from their staff. They became number one in the state and also received, in 2003, the coveted Malcolm Baldrige National Quality Award.

The person doing the job in healthcare, as in any industry, has great knowledge about their work, but they are rarely asked to look around their work area to identify small problems and to implement solutions to those problems. As you go through this book, you will see numerous examples of improvements made by many different people. Each Kaizen might only save a few dollars, but collectively they add up to millions of dollars in savings for an organization, and billions for a state or country. As you will see from this wonderful book, the process is quick to implement and easy to get people involved in. But even more important than the dollars saved are the improvements in communication and coordination that result when everyone is involved in the Kaizen process, leading to fewer errors, improved patient safety, higher quality, and lives saved…

Mark; Graban (2012-07-03). Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements (Kindle Locations 646-657). Taylor & Francis. Kindle Edition.
From one of my pptx decks several years ago.



By Amy Langfield, TODAY contributor

CVS Caremark has put its employees on notice that they need to reveal their weight or pay a monthly $50 penalty.

“Avoid the $600 annual surcharge,” CVS warns its employees who use the company’s health insurance plan. They’ve been told they are required by May 1 to show up to a doctor for an annual WebMD Wellness Review and submit to tests for blood sugar, blood pressure, cholesterol and body mass and body weight.

“Going forward, you'll be expected not just to know your numbers - but also to take action to manage them,” the CVS policy states.
“There are no penalties based on the results of a wellness screening,” a CVS spokesman told NBCNews via email. “Choosing not to have a screening will result in a $50/month increase.

While many employers have been pushing its workers to get healthier, it’s usually through incentives rather than penalties. “This is about as coercive and blunt as I’ve ever seen,” said Dr. Deborah C. Peel, the founder of Patient Privacy Rights, a nonprofit organization based in Austin, Texas.

“Many employers want to do something for their workers, but very few of them are stupid enough to say give us the information and sign this form and say it’s voluntary,” Peel said.
Smokers working for CVS are also warned: “You must either be tobacco-free by May 1, 2014, or participate in the WebMD tobacco cessation program.” Defiant smokers can avoid penalties if they are healthy enough in other categories specified by the company.

Despite the company’s promises, Peel worries if CVS and WebMD will be able to keep the employee records completely private. Peel said people are already declining to get health treatment for issues ranging from psychiatry to sexual diseases, for fear the information will not be kept private...

Expect to see more of this ongoing. And, you can expect to never again see me in a CVS (I use Walgreens in any event).

UPDATE: I was just surfing through the week's "missed called / messages" stuff on my home phone hard line base unit answering machine.

Well, isn't that interesting? Some industrious CVS Caremark gumshoe dug out my unlisted private home number. Couldn't get any of my old messages to play, so I don't know what this was about. Am I about to be threatened? Or just get some soothing PR flack pitch "clarifying" the "misunderstanding" about the new CVS employee policy. Hmmm...

Call me back, Caremark.



Goes to...

ATHN Achieves High Attestation
by Zacks Equity Research

Leading vendor of cloud-based services for physician practices - Athenahealth ( ATHN - Analyst Report ) recently revealed that 96% of its concerned providers were successful in meeting the attestation requirements of 2012 Medicare Meaningful Use Stage 1, Year 1. The company’s performance in 2012 leverages on the 85% achieved with regard to 2011 Medicare Meaningful Use Stage 1, Year 1. It is also twice as successful as the industry-wide mean in the low 40% range...

Moving right along...

Dr. Scott Setzer knew when he chose to become a family doctor, he wasn’t going to make the money a specialist would, but that was OK.

He didn’t go into medicine to make money –although, of course, that would be nice.

Mainly he just loved the idea of building relationships with people in a way that could really make a difference in their health and quality of life.

But in his traditional practice, he started seeing the business aspects interfering more and more.

“I found myself spending a disproportionate amount of time on billing and coding, arguing with insurance companies over why I prescribed the drug I did rather than a cheaper one, trying to demonstrate ‘meaningful use’ of electronic patient records in order to receive an incentive,” said Setzer, who said he has watched the nature of primary care change since he began practicing here in 1997.

As Setzer experience first-hand, the business side of doctoring is changing. The number of solo practitioners who are members of the American Academy of Family Physicians fell from 44 percent in 1986 to 18 percent in 2008...
See also
Private practice wanes, physician employment shifts due to MU rules

As the meaningful use rules grow more stringent and Medicare and Medicaid payment reductions loom, many doctors are making the decision to give up their privately owned practice rather than continue dealing with the electronic health record guidelines.

The trend of physicians opting for employment over practice ownership is not necessarily new. Medicare and Medicaid payment reductions that took place over the last couple decades made running the business side of a practice difficult for some doctors. More recently, aspects of health reform and the weak economy made physician employment at hospitals a more secure option for some doctors. But the meaningful use rules, which set the bar high in terms of EHR use for some doctors, are increasingly being seen as the last straw that makes operating a private practice financial untenable.

"Most [private practice owners] flat out do not have the ability to do this," said Travis Singleton, senior vice president at Merritt Hawkins, a Dallas-based physician recruitment firm, referring to the meaningful use requirements. "They're going to have to seek a larger partner; even the ones that want to just can't."...
Robert Smith, M.D., founder of Finger Lakes Family Care in Canandaigua, N.Y., likes his EHR system.

At this point, Smith said his EHR system makes him more efficient in the delivery of care, allowing him to operate with a smaller administrative staff, which limits overhead expenses. But it wasn't always easy. When the practice first started using its EHR system staff took longer to enter patient information, a problem that is commonly reported by recent EHR adopters. Smith said his practice was small at the time, but believes larger practices with more patients would struggle more to overcome the workflow disruption.

While enthusiastic about EHR adoption, Smith is no fan of the meaningful use program. He said the guidelines of the incentive program do little to support the efficiency of his practice. Ultimately it is the technology itself that does that. Nevertheless, he is following the rules, which he described as "silly," and is receiving incentive payments.
"Is the banking industry using paper anymore? Of course not," Smith said. "They're not getting kickbacks from the government. Meaningful use to me is just a silly windfall. It's not persuading me to use an electronic record."...
"Silly windfall"? Dunno. What do you think? Schtimulus Been Berry Gooood to Mr. Bush.

Centers for Medicare & Medicaid Services (CMS) Focuses on Fraud Associated with Increased Use of Electronic Health Records
Thomas S. Crane, Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.

Acting CMS Administrator, Marilyn Tavenner, recently reaffirmed the agency’s concern that the increased use of electronic health records (“EHRs”) has contributed to increases in fraudulent billing practices by providers. At a March 5th meeting of the Federation of American Hospitals (“FAH”), Tavenner noted an increase in upcoding from physician offices and hospital emergency departments, and expressed concern that the increased use of EHR systems may be the cause. She reiterated that CMS will conduct audits of providers’ billing practices using EHR systems. These “small, targeted audits” will take place in parallel with the meaningful use audit program that started in July 2012 and which is designed to determine whether providers are properly receiving meaningful use incentive payments and complying with program rules. On March 6th, Tavenner also spoke before the Healthcare Information and Management Systems Society Annual Conference and announced a CMS summit in May with providers and EHR vendors to further discuss and address potential upcoding in connection with the use of EHRs...
More of the same, re-reporting on what we've already heard. Yeah, we'll see. A lot of this may be for show, to mollify the Righties on The Hill.

Question: If an REC client EP gets audited and is found to have not actually met all of the MU criteria, would the REC be liable for returning its Milestone 3 money?

So God Made a Quality Manager

LOL. Sounds like my Sweetie. She who has ascended through the myriad Purgatories of the Quality Manager to now Sit, with her pink hard hat at the ready, at The Right Hand of the CEO Father.

Another nice "video"


Very well done. To the point.Great overview. The v/o talent is just a hair too perfect for my taste (diction, pronunciation, cadence), but, better that than Amateur Hour.

More to come...

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