Lack of Transparency Continues to Haunt HHS

A lack of information is driving consumers into poor health care choices, and Health and Human Services is to blame; at least according tothe Government Accountability Office.

In a 43-page report released this September, the office slammed HHS, claiming that a lack of transparency is keeping consumers from easily accessing the pricing information of health care plans until after they are already covered. FierceHealthcare summarizes, “In one example, the agency contacted a variety of physician offices to get the price of a diabetes screening--and was consistently told an office visit was required prior to disclosure of such a price. The GAO also noted that the negotiated prices between an insurer and provider were often kept from consumers for legal and trade purposes.”

Transparency in HHS is not a new topic. In fact, the department was criticized for similar reasons when they removed public access to National Practitioner Data Bank in early September.

This new report, the creation of which was heavily pushed by congress, has found a severe lack of initiative from HHS when it comes totransparency.

Several health care and legal factors may make it difficult for consumers to obtain price information for the health care services they receive, particularly estimates of what their complete costs will be. The health care factors include the difficulty of predicting health care services in advance, billing from multiple providers, and the variety of insurance benefit structures.

The entire industry is keeping a close eye on this developing story, and Merrill Corporation will be among them.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

News From The 2011 CMS Fall Conference

The CMS Fall Conference this year can be defined with one word: improvements. The conference was designed with a series of breakout sessions, each intended to give CMS experts the ability to hear questions, concerns, and criticisms from those of us in the industry. It wasn’t a one-way conversation, however, as the experts in attendance provided plenty of information and commentary.

As I have already said, CMS made a great effort to stress their initiatives for improving Medicare and Medicaid programs. These efforts will include:

• Valuable products
• Clear benefits
• Accurate communications
• Accurate benefits
• No tricks at educational events
• Regulation-consistent marketing
• Secret shopping
• A stricter policy on misleading print ads and marketing

On a more positive note, CMS experts were enthusiastic about Part C and Part D programs. They were quick to stress that existing programs were not bad, but that they could do more. These initiatives are all intended to lead to better care, healthier communities, and conformity to ACA law.

The other major point of discussion was the CMS star rating system. A perfect five-star rating can bring many advantages to a plan, including year-round marketing to beneficiaries turning 65. A beneficiary may join or switch to a five-star plan from an MA, MAPD, or PDP plan, barring a few limitations:

• Beneficiaries can only join a plan in their area.
• They can only enroll in a 2012 plan with a five star rating.
• A beneficiary can only use this process one time per year.
• If one moves from a plan with drug coverage to a five-star plan that does not have drug coverage, they lose that coverage and cannot return to their previous plan.

CMS warned plans that deliberately structuring themselves to maximize ratings would not be an effective tactic, and that if plans stay focused on overall quality of care, and appropriate care, their star rating will be good.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

The 2011 CMS Fall Conference

It's that time of year again! Halloween decorations are already for sale in malls and grocery stores, the kids are back in school, and the words on everyone's lips are 'Prescription Drug Marketing Compliance."

That last bit may be a bit of an exaggeration, but nevertheless, it is time for the CMS 2011 Medicare Advantage and Prescription Drug Plan Fall Enrollment, Marketing and Compliance Conference. As usual, I, Pamela Argeris, will be attending on behalf of Merrill Corporation. This year's conference promises to be interesting, with plenty of topics that need stronger clarification, combined with the fact that a Presidential election year will soon be upon us:

• New Annual Enrollment Period and other related Enrollment Period’s
• Medicare Advantage Disenrollment Period/ 5 Star (SEP) Special Enrollment Period
• Marketing and Enrollment
• Part D IRMAA/ Reinstatement for Good Cause
• End of Year Transition and Systems Activity
• Quality Improvement Strategy for the Medicare Advantage Program
• Changes in the Enrollment Chapters (regulations)

The conference  begins on September 20th, and will also be broadcast live on the web, for registered attendees that cannot make it to the conference. There are also planned break-out sessions covering HPMS Training, Retroactive Processing Contractor, and MARx Reports. These sessions will give CMS experts the opportunity to listen to concerns and questions about these systems.

The goal of the Fall conference is to ensure that all sponsors and marketers working within the health and pharmaceutical fields remain up-to-date on the most recent changes to prescription drug marketing compliance.

The CMS Fall Conference is always a great source of information, and Merrill Corporation looks forward to the opportunity to better perfect our health industry services.
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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Are Our Hospitals Prepared for Disaster?

It isn't something that many like to bring up, but with the tenth anniversary of 9/11 this weekend, some critics worry that our health facilities haven’t done enough to secure themselves through those ten years. The threat that these critics bring up is an act of bio-terrorism. If there were an outbreak of anthrax, or any other highly contagious disease, as a result of a terrorist attack, would our hospitals be prepared to handle it?

A report issued Sept. 1 by Trust for America's Health and the Robert Wood Johnson Foundation shows that significant public health improvements were made following the 2001 events.

Such improvements include developing clear emergency response plans, bolstering laboratory staffing and bio-testing capabilities, and implementing more effective disease surveillance systems in state health departments.

But during the past 10 years, the report says these efforts have been losing effectiveness, due largely to public health budget cuts. The cuts are leaving many departments across the country with too few staff members to adequately implement the measures.

This American Medical News article stresses that public health employees would be the first to recognize the signs of a large-scale bioterrorist attack, and recent budget cuts have drastically reduced their numbers. Further, critics point out that our health defenses have become too complacent, and that we will not be capable of defending a terrorist attack until after the attack has occurred.

A similar NJ.com column does mention that, after 9/11, many emergency procedures were put in place, with the intention of preparing hospitals for any disaster. However, low staffing and funding mean that very few hospitals would actually be able to follow through with their plans, should anything occur.

For the sake of future safety, it is clear that something needs to change, but many experts are left questioning what that change could actually be.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Irene Leaves A Paper Trail

During natural disasters, the preservation of human life takes precedence over anything else. When it comes to health facilities, that can often mean the relocation or evacuation of patients and staff. In the case of the recent Hurricane Irene, it also meant that many facilities were suddenly faced with the massive logistical and compliance problems of moving hundreds of patients out of hospitals and nursing homes.

Now that the threat has passed, many hospitals are left with a paperwork nightmare that could take days to sort through.

Many questions have arisen. What is the Medicare and Medicaid reimbursement policy with respect to the transfer of patients between institutions? If a federal disaster area is declared, do the feds pick up the tab? How will private insurers pay for the costs incurred?

Crain’s New York Business asked CEO of the New York State Health Facilities Association, Richard Herrick, for his opinion. “The question is, who pays for what? Who bills for the services and costs incurred?” It is certainly a perplexing problem.

For many of the states affected, nothing on this scale has ever occurred, and contingency plans to handle the crisis were not in place. It is unreasonable to expect every facility to prepare for every possible disaster, but until federal agencies are willing to provide answers, many health facilities will be left to work things out on their own.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Large Data Breach Causes Data Integrity Questions

A California firm, Southern California Medical-Legal Consultants, has been the most recent facility to make headlines with a massive data breach. The breach, which released the medical records, social security information, and personal details of 300,000 patients, was caused by poor handling and a lack of knowledge. Joel Hecht, owner of the consulting firm, believed he was storing the data on a private website. In reality, it was being placed into a public server, without even the most basic of security measures.

The personal data was discovered by Aaron Titus, a researcher with Identity Finder who then alerted Hecht's firm and The Associated Press. He found it through Internet searches, a common tactic for finding private information posted on unsecured sites.

The data was "available to anyone in the world with half a brain and access to Google," Titus says.

Titus says Hecht's company failed to use two basic techniques that could have protected the data -- requiring a password and instructing search engines not to index the pages. He called the breach "likely a case of felony stupidity."

The breach, which was discovered and locked down last week, has led many to question the upcoming 2014 regulation requiring all medical data to be stored online. While it is obvious that this breach was caused more by ignorance than by hidden insecurities, the argument has been made that other under-trained facilities are likely to follow suit. The Associated Press theorizes that the underlying cause of this breach is the fact that the medical records were so far removed from their original source. While hospitals are usually well-equipped for this kind of data, the AP says, “The further away from the health care provider the records get, the flimsier the enforcement mechanisms for ensuring the data are protected.”

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Arguments Continue On ACA Constitutionality

Image from thefbomb.org

The Georgia Appeals Court becomes the second appellate to join the never-ending debate swirling around Obama’s Affordable Care Act. According to the court, the individual mandate – the portion of the legislation requiring all citizens to purchase health care – is unconstitutional, and “an unprecedented exercise of congressional power.” This follows a similar January ruling by US District Judge Roger Vinson, and an opposing ruling from the Ohio Appeals Court in June.

The Georgia ruling supports most of what Florida’s Judge Vinson declared in January, with a significant provision. While Vinson felt that the entire legislation was a cohesive, unchangeable unit, the Georgia court believes that the offending individual mandate can be removed from the ACA, while allowing the rest of the Act to function as law.

As pointed out in a recent news article on Medscape.com, continuing dissension will likely force the Supreme Court to re-investigate the controversy, and to pass down an official decision. Until that happens, smaller courts will likely continue the debate.

The issue of the constitutionality of the Affordable Care Act is also before a US Appellate Court in Richmond, Virginia, which is weighing appeals of two lower-court decisions in that state. A federal district judge in Lynchburg, Virginia upheld the individual mandate, whereas another in Richmond, Virginia, struck it down. A ruling from this third appellate court is expected soon.

Whatever Virginia’s decision is, we will probably not be seeing the end of this discussion any time soon.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Mobile Tech Replaces Pagers, Worries HIPAA

The cliche image of an off-duty doctor receiving an emergency page is a thing of the past. These days, many docs receive up-to-the-minute patient updates through text messages, sent unencrypted from the hospital. Obviously, there are a few problems here waiting to happen.

According to Becker's Hospital Review,

The e-mails are entered by the hospital employee, converted into a text message and sent to the physician's cellular phone. Physicians frequently request that more patient data is included in the message, such as the patient's name and room number, so the physician can look up the chart prior to returning the call. This system is frequently not encrypted, however, because of the extra expense to the hospital.

This revelation sent red flags up for HIPAA. Imagine their horror when it was learned that some hospital employees simply send these texts from personal cell phones, rather than through monitored hospital email systems.

The problems begin with the fact that this kind of communication, while expedient, is not protected by any level of security. This puts these kinds of communications in violation of the Security Standards, which "require Covered Entities to (1) ensure the confidentially, integrity and availability of the information; (2) protect against any reasonably anticipated threats or risks to the security or integrity of the information; and (3) protect against unauthorized uses or disclosures of the information." And this is just the start of the laundry list of violations.

The very fact that these communications take place on "high risk" items like cell phones and tablet computers furthers the issue. The National Institute of Standards and Technology increases the risk level for items likely to be lost, stolen, or compromised, and cell phones are right at the top of that list.

Is this just one more case of consumer technology surpassing medical technology? Perhaps, but it is still a significant issue that requires a little more thought.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

CMS Announces Quality of Care Initiatives

The Centers for Medicare and Medicaid Services has had a busy seven days, releasing information on four new initiatives since July 29^th. Three of these focus on accuracy and payment changes for Medicare in fiscal year 2012, and the last describes policy changes for inpatient rehabilitation facilities.

CMS ANNOUNCES MORE ACCURATE FY 2012 PAYMENTS FOR MEDICARE SKILLED NURSING FACILITIES

A spike in payment levels inspired this policy, which will align Medicare payments with costs, reducing Medicare skilled nursing facility Prospective Payment System payments by $3.87 billion. This reduction is a drop of 11.1% from FY 2011. In the press release, CMS Administrator Donald M. Berwick, M.D. says, “CMS is committed to providing high quality care to those in skilled nursing facilities and to pay those facilities properly for that care…The adjustments to the payment rates for next year reflect that policy.”

The 2011 spike was caused by a miscalculation when CMS attempted to restrict damage caused by the Resource Utilization Groups Version 4 (RUG-IV) classification system.

FINAL WAGE INDEX CHANGES FOR MEDICARE HOSPICES INCREASE FY 2012 PAYMENTS BY 2.5%

In an effort to improve the quality of care in hospices, CMS is increasing payments to hospices treating Medicare patients by 2.5%. The increase will come at the cost of required quality of care reporting for those patients. In further detail, the release explains that, “CMS calculates each hospice’s aggregate cap by multiplying the number of patients served by the hospice in a cap year by a cap amount. Medicare payments made to a hospice during the cap year that exceed the hospice’s aggregate cap must be refunded to Medicare.”

MEDICARE PAYMENT RULE PROMOTES IMPROVED INPATIENT CARE

CMS has also approved a similar rule, geared to improve inpatient care in general acute-care and long-term-care hospitals. “The final rule continues a payment approach that encourages hospitals to adopt practices that reduce errors and prevent patients from acquiring new illnesses or injuries during a hospital stay,” said CMS Administrator Donald M. Berwick, M.D.   “This approach is part of a comprehensive strategy being implemented across Medicare’s payment systems that is intended to reduce overall costs by improving how care is delivered.”

This rule meshes with an ACA requirement that reduces Medicare pay-outs to hospitals with high readmission levels for certain conditions.

CMS IMPLEMENTS PAYMENT, POLICY CHANGES FOR INPATIENT REHABILITATION FACILITIES

Another CMS ruling is set to increase “IRF payment rates under the IRF Prospective Payment System (PPS) by 2.2 percent and establishes a new quality reporting system authorized by the Affordable Care Act.” The rule will take effect in FY 2012, and will provide further motivation for hospitals and other health facilities to improve inpatient care practices.

In addition, the final rule will update the case-mix group relative weights using FY 2010 IRF claims and FY 2009 IRF cost report data, freeze the facility-level adjustment factors for FY 2012 at FY 2011 levels for one additional year while the agency explores ways to improve upon the accuracy and consistency of the current methodology used to calculate the facility-level adjustment factors, and allow IRF and inpatient psychiatric facility units to expand in the middle of a cost reporting period, rather than restricting such expansions to the start of a cost reporting period.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

The Clock is Ticking on the Debt Ceiling

It is time to get serious in Washington. Many people throughout the United States are waiting for a deal or compromise to be reached on the debt ceiling. The most sensitive population among those is the elderly that Medicare services. It is unfair for elected officials to rely on their votes to be placed into office, and then fail them when the going gets tough, so to speak. Everyone needs to adjust their thinking and keep in mind that people's parents or grandparents are sitting at home watching this calamity unfold in the media.

Many seniors have voiced a fear of losing their Social Security - which is their only source of income in many cases - as well as their Medicare benefits. As we know, a means test has been proportioned into Medicare via the Affordable Care Act. This test increases the premiums of the well off in Medicare. Invoking any additional increase to this means test at this point is uncalled for.

The Washington crowd needs to be open minded, roll up their sleeves, and serve up a solution that will work for all, and especially for our senior citizens who are fearful of losing at every turn.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

HIPAA Regulations and New Technology: HIPAA, HITECH, and Electronic Compliance

HIPAA and HITECH violations are on the rise, and as more and more technology pushes medical records into the realm of EHRs and cloud storage, things will not likely improve. Why exactly is this happening? Sarah E. Swank has a few ideas (free registration required to view article):

In the old paper world before HIPAA, people often guarded patient medical records with good old-fashioned common sense…Our HIPAA policies are stale and our workforce members receive training often created with a focus on paper medical records. In addition, the technology has not caught up with expectations of electronic health record systems to audit access in real time.

It has been said, time and time again, that HIPAA is behind the times when it comes to new forms of communication. This has been most evident in the realms of social media, where companies and facilities are forced to choose between posting what they think is OK while hoping to dodge the compliance axe, or ignoring the platform altogether. So what can medical organizations do to keep their information secure while HIPAA catches up?

Swank lists seven strategies in her article on lexology.com;

1. Conduct Regular and Routine Audits
2. Review Incident Reporting Procedures
3. Conduct Timely and Complete Investigations
4. Review and Update Policies and Procedures
5. Reevaluate Training
6. Rethink Discipline Determination
7. Mitigation

What these strategies boil down to is essentially this: Change, Vigilance, and Consistency. Organizations must step up to develop methods of tracking and protecting data in an electronic environment, which can be a complex and daunting task for a group used to handling paper records. HIPAA may have been old hat a few years ago, but we are all back in unfamiliar territory, and it is necessary to give your compliance strategies a second look.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

HIPAA Regulations and New Technology: Where Does Mobile Fit In?

There are plenty of obvious compliance issues presented by healthcare’s move toward mobile technology. This recent article from Mobi Health News points out one of the less blatant struggles that any health facilities face.

The [HIPAA] Privacy, Security, and Breach Notification Rules can be a daunting challenge. Sometimes, the biggest question facing mobile application developers is not how to comply with (or make sure users are complying with) HIPAA, but rather whether HIPAA even applies.

It seems that the twisting and complex labyrinth that is HIPAA compliance has more backdoors, pitfalls, and secret exits than anyone could have predicted. The good news is that many mobile software efforts may not even fall under HIPAA’s compliance jurisdiction. The bad news is that it can be very tricky figuring out what side of that line you fall on.

In the article, Adam Greene explains that, “The HIPAA Rules only apply to HIPAA ‘covered entities’ and their ‘business associates.’ They do not apply to health care consumers or to other types of entities.” This means that the people that have access to the software are the first determinate of whether or not HIPAA compliance applies to your software. He explains further that:

A mobile application developer will need to analyze whether the software will be used by a covered entity, such as physician, hospital, or health plan, and whether it will include any protected health information: individually identifiable information about health, health care services, or payment for health care services. An application that assists a physician with following up with patients would need to be designed to allow the physician to comply with HIPAA. Likewise, a mobile application for use by health plan employees to obtain an individual’s enrollment information remotely would need to be designed in accordance with HIPAA.

The take-away here is that health facilities can distribute software that monitors medication schedules, important general health information, and other information, so long as it is not directly linked to any “covered entities.” Obviously, this is a complicated matter that should not be tackled without a lot of thought and research, but it is good to know that – on the surface, anyway – HIPAA is not preventing health facilities from helping the public get the best medical information possible.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Middle Class on Medicaid?

There has been no shortage of controversy surrounding the Obama Administration’s Affordable Care Act. Recent debates have brought up the 10 million additional children and 20 million additional adults Medicaid will be picking up. We’ve also seen dialogue on the 138% poverty level, and access gained by childless adults. Now, a new unforeseen problem in the legislation’s wording will allow early retirees to jump on the Medicaid bandwagon.

Two years from now, many people will begin early retirement, leaving the workforce at 62. During the three years between their retirement and joining Medicare at 65, social security payments will not count toward their annual income mix. This will allow up to 3 million early retirees to gain access to Medicaid in 2014.

Many of the legislators on Capitol Hill are concerned that overloaded state Medicaid programs will further crumble under this flaw. Presently, the administration has addressed the problem, and is seeking a solution, but until something is presented, this is simply another hiccup adding fuel to the anti-ACA flames.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

HIPAA & EHR Security -- Can the Answer Be Found in the Cloud?

On a public website, the Department of Health and Human Services maintains an infamous list known as the “wall of shame.” The site publishes the names of facilities responsible for HIPAA violations affecting 500 or more people. But do we truly understand how the violations occur?  With so many recent news stories about online security and super-hacker group LulzSec, it is easy to blame digital recording. However, after a closer review of the HHS website information, that simply is not the case.

Most often, violations occur due to physical theft and loss. The statistics provided in a recent Software Advice article state that only 6% of the violations are attributed to hacker activities. Of the remaining incidents, 61% are linked to physical theft and loss. Why is there such a difference between public view and reality? Part of it is the media; a story about criminal elements breaking in to secure servers is more interesting than one in which an otherwise skilled employee misplaces a disc. Another part of it is fear. When the public hears about hackers gathering millions of credit card numbers overnight, they assume that all online data is up for grabs.

Whatever the reason, the facts are clear. The vast majority of HIPAA violations and data loss are due to the mishandling of physical files or equipment. With that in mind, EHR security must continue to evolve and work closely in conjunction with newer technologies that show signs of stronger security for our most sensitive personal information.

Cloud technology could allow these medical records to exist in a purely electronic form. Online banking has been commonplace for years, with hardly a second thought and as Michael Koplov, author of this Software Advice article, succinctly points out, “Just a hunch, but I bet more hackers want my credit card information than my HDL/LDL ratio.” In a comment to Merrill Corp, he goes on to say, “I analyzed this data and found that the HHS has no record of cloud-based EHRs being implicated in these large-scale security breaches.”

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Microscopic Science, Big Results

Scientists in the health field have been putting a lot of effort and time into researching the genetics of common health problems, and that energy is starting to pay off. Today, some of the most debilitating common conditions are being explained at a microscopic level. These finds may seem inconsequential now, but within a few short years, the fringes of modern medicine may use this research for cures.

Migraines -- severe headaches that come bundled with hazy vision, nausea, and hyper-sensitivity -- have been traced down to three individual genes. Of those three, one occurs exclusively in women, explaining why women have always been more prone to the debilitating headaches. If scientists can target these genes and shut them off, severe headaches may be a thing of the past.

http://1.usa.gov/k7tPxr

A more universal issue is being solved thanks to breakthroughs made in chromosome research. DNA strands called telomeres cap the ends of chromosomes in living cells. When these caps wear away, due often to physical or mental stress, the cell dies. Faster cell death essentially means faster aging. Though typically linked to those that suffered childhood abuse, any extreme stress can shorten telomeres. Experts recommend the usual dose of increased activity and exercise, as even the most abused individuals were able to divert stress and increase telomere length through activity and exercise.

As science delves deeper and deeper into genetic research, we may see the genetic switches responsible for many causes of human suffering. The things we are accomplishing today were considered fringe medicine a decade ago, and the things we cannot dream of doing today may be commonplace in the near future.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Cignet Fined for HIPAA Violation.

The first civil money penalty of $4.3 million has been imposed by HHS on Cignet Health of Prince George’s County, Maryland. HHS and CMS have been very firm that violations will no longer be tolerated. With the enactment of HITECH, this type of penalty seemed inevitable.  An individual’s rights to the privacy of their personal information and access to their own medical records is of utmost importance and while beneficiary protection is a main theme of CMS, it appears HHS is a strong advocate of this as well.

OCR has issued a Notice of Final Determination finding that Cignet violated the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HHS has imposed a civil money penalty (CMP) of $4.3 million for the violations, representing the first CMP issued by the Department for a covered entity’s violations of the HIPAA Privacy Rule.  The CMP is based on the violation categories and increased penalty amounts authorized by Section 13410(d) of the Health Information Technology for Economic and Clinical Health (HITECH) Act.

“Ensuring that Americans’ health information privacy is protected is vital to our health care system and a priority of this Administration. The U.S. Department of Health and Human Services is serious about enforcing individual rights guaranteed by the HIPAA Privacy Rule,” said HHS Secretary Kathleen Sebelius.

In a Notice of Proposed Determination issued Oct. 20, 2010, OCR found that Cignet violated 41 patients’ rights by denying them access to their medical records when requested between September 2008 and October 2009. These patients individually filed complaints with OCR, initiating investigations of each complaint. The HIPAA Privacy Rule requires that a covered entity provide a patient with a copy of their medical records within 30 (and no later than 60) days of the patient’s request. The CMP for these violations is $1.3 million.  

During the investigations, Cignet refused to respond to OCR’s demands to produce the records. Additionally, Cignet failed to cooperate with OCR’s investigations of the complaints and produce the records in response to OCR’s subpoena. OCR filed a petition to enforce its subpoena in United States District Court and obtained a default judgment against Cignet on March 30, 2010. On April 7, 2010, Cignet produced the medical records to OCR, but otherwise made no efforts to resolve the complaints through informal means.

OCR also found that Cignet failed to cooperate with OCR’s investigations on a continuing daily basis from March 17, 2009, to April 7, 2010, and that the failure to cooperate was due to Cignet’s willful neglect to comply with the Privacy Rule. Covered entities are required under law to cooperate with the Department’s investigations. The CMP for these violations is $3 million.

“Covered entities and business associates must uphold their responsibility to provide patients with access to their medical records, and adhere closely to all of HIPAA’s requirements,” said OCR Director Georgina Verdugo.  “The U.S. Department of Health and Human Services will continue to investigate and take action against those organizations that knowingly disregard their obligations under these rules.”

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Healthcare Facts vs. Healthcare Opinions: Which is winning?

Knowledge is power, right? How much do you know about the new healthcare law? Have you heard that it will cut Medicare benefits for seniors, decrease payments to doctors and ration healthcare?

You may have, but it’s not true. In a recent poll, high percentages of Americans expressed that they believe the above three actions to be true. Even half of those surveyed believed in the death panel myth, the idea that these panels could make end-of-life decisions.

While some would say that these poll results bring to light the influence some members of the media have in presenting opinions as facts, the larger point is that this current method of information dissemination could lead to people not being able to take full advantage of benefits that exist and could help them.

As marketing communications experts, and in an attempt to aid both the general public and those healthcare organizations that want to provide a true list, we would like to do our part in making clear what new benefits exist. More information on these facts can be found on the Department of Health and Human Services website.

• Young adults who lack coverage can remain on their parents’ plan until they turn 26.
• Approximately four million small businesses are eligible for tax credits of up to 35 percent off their health insurance costs.
• People can get tests such as mammograms or colonoscopies without having to pay a share of the cost.
• People who have pre-existing conditions or are uninsured for at least six months can get high-risk coverage through a state or federal high-risk pool.

We know that an issue this big will never be apolitical (especially in an election year), nor should it necessarily be in a free society. However, as the September triggers approach, it will be to the benefit of healthcare organizations that have knowledge in this arena to lead (not sway) the public through the complexity of this issue.

The CMS / CGI Partnership

The contract that most sports enthusiasts are pondering this summer is that of Lebron James. However, if you are interested in the healthcare / web development equivalent of this question you need not wait any longer.

This week, the Centers for Medicare and Medicaid Services (CMS) announced that it has awarded CGI Federal, Inc. a five-year, $73.2 million contract to redevelop three of their websites that enable Medicare beneficiaries to find information about their healthcare programs.

The three sites - www.medicare.gov, www.cms.hhs.gov and www.Mymedicare.gov - provides information for 44 million beneficiaries and receives a total of 500 million views a year. The sites are primarily focused on allowing consumers to view health claims information, compare health and drug plans based on quality measures and estimated costs, and create a report listing information that they can share with their healthcare providers. As an example of the importance HHS puts on the ability to navigate the site, the following video was released involving Secretary Sebelius walking viewers through the Medicare.gov:



The execution of this contract will be an extremely interesting task. It has been well documented that a large chunk of the healthcare reform package will be enacted and implemented over this period of time, and as new regulations are developed on items such as the role of social media, these three websites will have to be well managed.

CGI and CMS have had a long standing and successful collaboration, including projects like the Hospital Compare and Nursing Home Compare tools, which combine geographical data from Google Maps with healthcare provider quality-of-care information to help users locate and assess nearby healthcare facilities. Additionally, CGI was awarded the Enterprise System Development (ESD) contract, which covers systems development and integration, system and application engineering and technical support to improve the automated systems and agency-wide applications of the Health and Human Services Department.

However, this project will involve developing tools for the public at large, not a subset of experts in the industry. It is a different mode of thinking, but the potential is there for a new evolution of internet communication.