Showing posts with label health care costs. Show all posts
Showing posts with label health care costs. Show all posts

Thursday, May 12, 2011

HIPAA Regulations and New Technology: May 2011

We have received a lot of feedback on our post about HIPAA and new technology, and because of that, we will continue to share news on this very important issue that will play a major role in how the industry evolves.

It is well documented how doctors and other medical practitioners have been slow to adopt social media, and there is next to no following available for those that do. A recent poll revealed that only 11% of those interviewed would participate in social network interaction with their doctor if it was offered. Unlike the compliance issues that are holding health plans back, the only thing keeping physicians out of social media is a lack of interest. Many argue, however, that a lack of interest does not create a lack of responsibility. More and more patients are turning to social networks for advice on medical treatment, pharmaceuticals, and diagnoses. As a result, it is the responsibility of medical professionals to ensure that the information they find is accurate and up to date.

Obviously, some restraint is necessary. Doctors are just as required to follow HIPAA policies online as they are in any public setting. There should be no harm, however, in presenting generalized and accurate medical information, as long as the required compliance issues are handled responsibly.

HIPAA regulations also come into play with mobile technologies. Thousands of companies, in and out of the medical industry, are turning to mobile devices like smartphones and tablet computers to simplify the logistics of their operations. New advances in mobile tech have lowered the cost and time-consumption of training programs, and eased the transition of work materials from one workplace to the next.

The problem with this ease of access is just that; the access. In the wrong hands, a major company’s mobile technology could provide private data on hundreds, if not thousands, of clients and customers. Mobile devices need to be very well secured in order to meet HIPAA standards. This required level of compliance does not seem to be affecting the devices’ popularity, however.

So how do you take advantage of social networks and mobile technology without worrying about misinformation and HIPAA involvement? By creating your own network, of course. OrthoMind, by orthopedic surgeon Jon Hyman, MD, is a social network open only to other orthopedic surgeons. The exclusive community allows for the simple exchange of thoughts, practices, and techniques without the added downsides of outside influence. Because the network is not marketing toward any consumers, or sharing patient-doctor conversations, there is also no worry of HIPAA reprisal.

Networks like OrthoMind are extremely important for physicians, who may find themselves bombarded when patients that believe they are informed show up with armfuls of inaccurate medical advice. While it is superficially wonderful that patients are being empowered by social media to research things on their own, a doctor needs to be just as informed in order to be capable of separating the good advice from the bad.

Friday, April 8, 2011

Census Says Life Expectancy is Up, But Why?

Recent census data shows that the US average life expectancy has increased to a record-breaking 78 years. The immediate thought that most people have when presented with this information is that improving medical technology and increased health is leading to longer lives. To some extent, that is true. While there is a clear correlation between life expectancy and medical advances, this number does not really mean that the average person is living a longer life.

In reality, average life expectancy is determined almost entirely by infant mortality rate. In this most recent report, the CDC listed “a record low of 6.42 deaths per 1,000 live births, a drop of nearly 3% from 2008.” This number was 100 out of 1000 as recently as 1920, creating a statistic that implies that most people are living up to twenty years longer than they have in the past. This is simply not true.

Death rates are likely to continue dropping over the next decades as medical advances remove the threat of curable disease. The increasing unpopularity of smoking adds to this number as well.  This ratio of infant-mortality and death rate will continue to influence life expectancy, but we do not need to start worrying about running out of retirement homes any time soon.

Wednesday, February 23, 2011

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.

Thursday, March 4, 2010

The Real Debate in D.C. (Part 2)

Last week, we discussed the difference between the Bipartisan Summit and other, less publicized but more comprehensive events, such as the Managed Healthcare Business Forum.

As a follow-up, let's talk about some of the outcomes. There has been a great deal of coverage on the event with elected officials, but none on the other. So, here is first-hand account on some of the key topics discussed:

Health Reform: The discussions were much like what was happening across town. What are the next steps? Where do we go from here? What should we expect from our regulatory bodies and the current administration? The truth is that much is known and yet unknown at this point. It is expected by most that some type of health reform will be developed this year. However, the size, scale and price tag remain a mystery.

Streamlining Cost and Quality of Care: Cost reductions and the management of costs are at the forefront of all discussions. Being creative is essential, thus newer ways to incent (i.e. work with) providers are emerging, such as payment programs and quality metrics to determine performance within their patient base and to their peers. Most would see this as the old standard capitation methodology with a twist. However, when you delve deeper, you can see the potential cost savings and the new horizon for quality metrics reporting, monitoring and performance.

Health and Wellness of the Membership Base / Moving Health and Wellness to the Next Level: Health and wellness of our membership continues to be a key to any solution worth implementing, and therefore new ways to carve out components of our membership and incent them to actively participate in wellness campaigns is on the horizon more so now than ever before. There are two basic reasons:

  1. To enhance/improve a members overall quality of life.
  2. To streamline/enhance cost savings.
Examples of ways to accomplish this were discussed, including how to develop customized, well-rounded plans that would allow individuals to potentially lower their premium costs if utilized. So, if a member had diabetes, they would be in a plan specifically designed for them with tailored programs to facilitate education, wellness, and healthy lifestyle habits that would not only benefit them, but in a small way, help the industry become more efficient.

Service: This concept continues to be a major separator in the playing field. While price and benefits continue to be the top components, service is a close second. With a competitive price in the market place, service will be the key component that separates plans. Members are looking for "first call resolution" (as opposed to be being transferred multiple times) and a one-stop shop for answers. Those that can perfect (or come closest to) a model in which a single phone number can result in a live body that can handle all their needs will have a leg-up on competitors.

The event provided all that attended with an abundance of information, with the added benefit of zero television cameras, so ideas could be shared without 'post-event wrap-up commentary.' The next step is the hardest, though. We need to take these ideas and philosophies back to our respective corners of the world and turn them into solutions.


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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.

Wednesday, December 2, 2009

Patient Care: A Healthy Debate

A lot has been made of the recent U.S. Preventative Services Task Force (USPSTF) report (http://www.ahrq.gov/clinic/uspstf09/breastcancer/brcanrs.htm#needs) on the role, expectations and outcomes of mammography screening in the determination of the presence of breast cancer. Here are the actual excerpts from the report that the media reacted to:

“In 2002, USPSTF concluded that there was fair evidence that mammography screening every 12 to 33 months could significantly reduce breast cancer mortality. The evidence was strongest for women aged 50 to 69 years, with weaker evidence supporting mammography screening for women aged 40 to 49 years.”

“Current knowledge about the development of breast cancer is limited. The effectiveness of screening mammography seen in trials presumably results from the early detection of smaller, earlier-stage tumors, which are more responsive to available treatments. Although the most common breast cancer occurs in the epithelial cells that line the duct system of the gland (ductal carcinoma), the sequence of development of invasive cancer is not entirely known.”

“The USPSTF noted with moderate certainty that the net benefits of screening mammography in women aged 50 to 74 years were at least moderate, and that the greatest benefits were seen in women aged 60 to 69 years. For women aged 40 to 49 years, the USPSTF had moderate certainty that the net benefits were small. Because of the uncertainties related to harms of screening, particularly over diagnosis, and the near total lack of trial data for older women, the USPSTF had low certainty about the net benefits of screening mammography for women 75 years or older.”

Patient care should never be compromised. Given the attention that Health Care reform has generated, any news is viewed good and bad based on the reader and interpretation.

The bottom line is that advancements in technology, research and education, not specific to any issue, or disease, has allowed for greater practicality in administering invasive tests. All progress is positive and debate is healthy.

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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.


Tuesday, November 17, 2009

Wellness: Measurement Shows Improved Health

In a recent article from Anne Zieger in Fierce Healthcare, she highlighted that private insurance plans have begun the debate over how effective employee wellness programs really are. And on the flip side, that large insurance plans haven't invested in the area heavily enough to have an impact, or measured to see any results.

While the debate rolls on with the insurers, Zieger goes on to point out that Emory University has been at work to see if the results are there.

According to the study conducted by Woodruff Health Sciences at Emory, measurable results were found in employee absenteeism (down 3.9 days in 2006 to 3.4 days in 2007 - 1.5 days lower than at standard sites).

This netted a savings of about $414.90 per employee per year, according to the study.

Our Take:

Results are found only when measured. Moving from discussion to action is critical for private insurance plans and measurement needs to be implemented by insurers across all types of coverage.

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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.


Friday, October 2, 2009

Health Care: Forward thinking to reduce costs

Do you know the multi-cultural dynamics of your employees, or your insured base membership? 

As an industry looking for all ways to reduce health care costs, an innovative forward thinking approach to is to better understand the multi-cultural dynamics of your members. 

Diving deeper into the demographics – categories such as ethnicity, coupled with age, sex, religious affiliation and other characteristics – can guide and aid you in understanding their needs, develop better treatment plans, and implement more effective out reach programs with the ultimate goal of producing better outcomes related to their specific health issues.  

Better outcomes with improved quality of care for each cultural sector combined with understanding a groups specific disease issues, behavioral dynamics, and family relations will provide better methods of treating our population in general, thus reducing overall health care costs. 

The Multi-cultural dynamics of employees and insured base of membership is an untapped source of analysis that can be applied in reducing overall health care costs. 

This is definitely something to think about, ponder and explore. 

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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.