Code Green for Healthcare

The AMA Will Be Part of the Healthcare Reform Solution

By John Mangan, Cincom Systems

The American Medical Association (AMA) announced today at a press conference that it will support the House health care reform bill. This is big. The AMA was the most effective and determined opponent of healthcare reform in the twentieth century. That they have morphed from an obstacle to a supporter demonstrates how far the healthcare reform debate has come.
Now, the AMA is not supporting the healthcare reform bill without qualifications. Its support is coupled with its support for House Bill 3961, the bill that would eliminate the planned reductions in Medicare physician payments to keep them in line with the Sustainable Growth Rate (SGR). It wasn’t clear how dependent their support was on the passage of H.R. 3961 by Congress in this session, but it’s safe to say they would be disappointed if it did not become law.

James J. Rohack, AMA President, explained the group's position:  "This is not the last step but the next step toward health system reform. We will remain actively engaged with patients, physicians, Congress and the administration to ensure that the final bill results in marked improvements to our health system.”

When challenged by a representative of the conservative Texas Medical Association, on why he was putting his faith in government, Rohack responded  that Medicare had turned out to be a boon for physicians as well as patients.

Pay for Healthcare Reform by Cutting Only 10% of Annual Waste

By: John Mangan, Cincom Systems

During the contentious healthcare reform debate, cutting the cost of healthcare has been lost in the noise.  Most of the talk has been focused on what reform will look like and how we will pay for it over the next ten years. But very little energy seems to have been spent on addressing the ballooning costs that cripple US healthcare no matter what it looks like.  Recently Thomson Reuters has reported that the US healthcare system wastes $600 - $850 billion annually, That’s annually. The causes are the usual suspects:

• Unnecessary care (40% of healthcare waste)
• Fraud (19% of healthcare waste)
• Administrative inefficiency (17% of healthcare waste)

Add to these wasteful practices: healthcare provider errors, treating preventable conditions, and lack of care coordination; and you get up to $850B spent unnecessarily each year. If we could cut these wasteful costs by only 10%, we could pay for just about the entire healthcare reform package ($890 billion estimated by the Congressional Budget Office, CBO) over the next ten years.
The author of the report goes on to say, "The good news is that by attacking waste, healthcare costs can be reduced without adversely affecting the quality of care or access to care.
Maybe this will be the next step. Get a healthcare reform bill passed. And then go back and really reform it – by cutting waste.

Intelligent Guidance Helps Preventing Duplicate Records on MEDITECH Magic

By Oscar Gonzalez, Cincom Systems

One of the common problems across hospitals, and one that impacts directly on the Hospital Revenue Cycle, is that of preventing duplicate patient records being entered into the MEDITECH system. Patients are usually issued with a Unit Number which is unique to them and should help maintaining a cohesive view of the patient history.

However, patients tend to forget the Unit Number and this results in personnel with less registration experience, such as nurses or part-time registration officers, entering new registrations for existing patients.

Adding an Intelligent Guide to the Patient field in MEDITECH can help prevent this type of error. The Guide automatically takes the employee conducting the registration through a process of questions and answers to ascertain if the patient has already been registered. Even if the patient do not have the number at hand the Guide will provide the necessary guidelines on how to find the appropriate patient record.

The benefits of this simple but effective Guide are many: reduce registration times, eliminate the need for de-duplication, help identifying patients with a bad-debt history, and most importantly increase patient safety and the quality of the service provided.

Selfishness Should Motivate Healthcare Reform

By: John Mangan, Cincom Systems

Let’s Be Selfish and Reform Healthcare

Even if we don’t care about 45 million of our fellow countrymen who don’t have healthcare insurance and another 26 million who are under-insured to the point that they postpone needed healthcare procedures and medicine. And even if we aren’t embarrassed that the US, the world’s richest nation, scores in the lower half when compared to other developed nations on healthcare quality measurements. Even if none of this bothers us, you’d think out of blatant self interest we’d demand healthcare reform.

The lack of reform is costing us money. While our income is static, healthcare insurance premiums continue to spike. Since 1999, family premiums have increased 119% and are forecasted to increase another 94% by 2020. That means that a family who were paying $5,612 in premiums for healthcare insurance in 1999 will be paying $23,842 in 2020 and getting worse coverage. And it’s not just the insured families that suffer. Employers also face similar increases for their share of proving insurance for their employees. And due to skyrocketing premiums, there will be increased uninsured burdening hospitals. The system is broken and begs for reform.

A Little Reform Will Go a Long Way

According to a recent Commonwealth Fund  report, Paying the Price: How Health Insurance Premiums Are Eating Up Middle Class Incomes, State Health Insurance Premium Trends And The Potential Of National Reforms, national reforms that slow healthcare cost increases by 1 to 1.5 percent per year would yield substantial savings for families and employers. By 2020, slowing the annual rate of growth by 1 percent would yield more than $2,500 in reduced premiums for family coverage, and slowing growth by 1.5 percent would yield more than $3,700 in premium savings compared to projected trends.

The Congressional Budget Office estimates that premiums under a public health plan would be 10 percent lower than those of typical private plans—a cost break that would provide much-needed relief to families and busi¬nesses, with greater potential gains in future years.

Who cares about the other guy? Reform healthcare to help yourself.

Intelligent Guidance: Getting Medicare Claims Right

by Oscar Gonzalez, Cincom Systems 

A good example of the use of Intelligent Guidance in the Hospital Admissions environment is the ability to check that the format of certain data items entered into the system is consistent with the data we already have in the Hospital Information System (HIS). For example, is someone’s marital status married and age is 10? We call this function Format Check and it is an integral part of several of our products: Cincom Knowledge Master, Revenue360 Insurance Code Solution and Automated Intelligent Guidance.

Let’s use the Medicare Health Insurance Claim Number (HICN) to illustrate how Format Check works:

The HICN is the number assigned by the Social Security Administration to an individual identifying him/her as a Medicare beneficiary. This number is shown on the beneficiary’s insurance card and is used in processing Medicare claims for that beneficiary.

However, it is not unusual that the patient does not have the card at the time of registration or that the number entered is incorrect for whatever reason. If this occurs Medicare will deny payment and in many cases the revenue will be totally lost.

The format of the HICN follows a very specific set of rules that are determined by the beneficiary’s gender, marital status, relationship to the main beneficiary, etc. These determine the correct suffix to go after the 9 digit number. For example, suffix E1 will signify ‘Surviving divorce mother’.The Intelligent Guidance ‘Format Check’ function can run these rules against the data we already have about the patient and detect any inconsistency. This can be within the number itself, such as a non-existent suffix or wrong number of digits, or with the patient’s data, such as gender or age mismatch.  If a problem is detected Intelligent Guidance will automatically flag this up to the registrar and request the correct HICN.

This simple step can prevent a denied claim, increase registrar confidence and eliminate all claim re-work necessary if an incorrect number is recorded during patient registration.

To learn more about Intelligent Guidance click here

Now's the Time - Doing Nothing is not an option

By John Mangan, Cincom Systems

It amazes me how much information there is available about the state of US health care and healthcare reform. These topics have been researched from every angle in the last seventeen years since the Clinton administration forced us to look at the sorry state of health care in the US.  As we all know, we were too misinformed and frightened at that time to do anything to fix the beast so we studied it instead.

Now here we are mid-year 2009 and there is no reason any longer to be misinformed. The information is out there and it’s accessible. A few places to start are:

• The Commonwealth Fund
• The Kaiser family Foundation
• Robert Wood Johnson Foundation

These organizations don’t just have opinions. They have facts backed up by scientific research.
Here’s my summary of a recent report, Health Reform: The Cost of Failure, sponsored by the Robert Wood Johnson Foundation.

This report gives us a glimpse of what will happen ten years down the road if health care is not reformed.  It’s not making a case for how it should be reformed, but predicting what will happen if we give into our fears and kick reform down the road to the next generation to tackle.

A little Background

Researchers from the Urban Institute prepared an analysis using the Institute's Health Insurance Policy Simulation Model, estimating how coverage and cost trends would change between now and 2019. The study examined three alternative scenarios:

1. Worst case scenario — Between now and 2019, there will be:

 Slow growth in incomes 
 High growth rates for health care costs

2. Intermediate case scenario — Between now and 2019, there will be:
 Somewhat faster growth in incomes
 Lower growth rate for health care costs

3. Best case scenario — Between now and 2019, there will be:
 Faster income growth
 Slower growth in health care costs.

The Results

Using national surveys and other economic data, the Urban model examined these three scenarios each assume varying levels of income growth and increases in health care costs. The report shows that within ten years if health care reform is not enacted:

1. Individuals and families could see health care costs dramatically increase. 

 Worst case scenario - Total premiums and out-of-pocket expenses could increase 68%

 Best case scenario -   Total premiums and out-of-pocket expenses could increase 46%

2. Businesses could see their health care costs double within 10 years. 

 Worst case scenario – employer spending on health insurance premiums would more than double 
   from $429.8 billion in 2009 to $885.1 billion in 2019

 Best case scenario —  employer spending on health insurance premiums would increase 72 percent

3. Spending on government insurance programs could double. 

 Worst case scenario – spending on Medicaid and the Children’s Health Insurance Program could 
   increase from $251.2 billion this year to $519.7 billion in 2019, an increase of 107%.

4. Millions more people would be uninsured. 

 Worst case scenario – without reform, 65.7 million people could be uninsured by 2019 as 
   compared to the present 46 million uninsured.

 Intermediate case scenario – 62.2 million uninsured

 Best case scenario —  53.1 million uninsured

5. The amount of uncompensated care in the health system would increase. 

 Worst case scenario – totals for uncompensated care could more than double, from $62.1 billion 
   in 2009 to $141.4 billion in 2019

   * Best case scenario —  uncompensated care could increase $106.6 billion

So as you can see by the results of this research without reforms it looks pretty bleak in the next ten years. All sectors of health care (individuals, families, business, government, and health care providers)will be much worse off than they are now. The only sector that won’t be adversely affected is the insurance companies.

We can and should argue about the best way to reform health care, but one of the options can’t be to do nothing.

CareMedic and Cincom Sign OEM Technology Partnership for Healthcare Solution

Adds Cincom Intelligent Guidance to Patient Access Management Solution for better patient experience and quicker, more accurate healthcare provider reimbursements

CINCINNATI - July 6, 2009 - CareMedic Systems, (http://www.caremedic.com), provider of a comprehensive solution for managing patient financial data, has entered into an OEM agreement with Cincom Systems for its Cincom Knowledge Master software to deliver intelligent guidance capabilities across the entire revenue cycle. 

 

Registration-based data quality issues represent a significant source of claim payment denials. The best way to eliminate these expensive errors is to prevent them from happening in the first place. With Cincom Knowledge Master, CareMedic’s Patient Access Management Solution works seamlessly with hospitals’ existing registration systems and current patient intake processes to ensure accurate and complete data capture.

 

Knowledge Master interprets all insurance, financial and other pertinent patient-related data, automatically guiding healthcare personnel through complex processes that often result in errors and lost revenue. Context-specific rules verify that the data entered is correct, and the software prompts users to take corrective steps when action is needed.

 

Hospitals can manage specific scripts and verbiage to ensure that the information presented meets organizational goals and objectives. The end result is cleaner data intake with more usable information, a better customer experience, and increased up-front payments and more efficient collections.

 

“The addition of Cincom Knowledge Master to CareMedic’s Patient Access Management solution will allow healthcare providers to move processes from the back office to the front office. Personnel will have a much easier time dealing with patients, and in turn healthcare providers get paid faster,” said Chris Woodhead, director, Cincom Intelligent Business Applications (CIBA).

 

Related Links:

 

Intelligent Guidance blog: http://www.intelligent-guidance.com/Blog/

 

Code Green for Healthcare blog: http://cibahealthcare.typepad.com/code_green/

American Healthcare at the Crossroads

By Chris Woodhead, Cincom Systems.

This week I have been attending HFMA 2009 – ANI: The Healthcare Finance Conference in Seattle, Washington.

The main theme running through the conference is that the US Healthcare Industry is going through some of the most challenging times in decades with some organizations, if not nearly all, facing difficult choices, for example, between expanding an emergency department or implementing an electronic health record, knowing they don’t have the resources to do both. Others may also be struggling with reduced investment or higher costs in capital, knowing that cuts in operational costs may be necessary to compensate for these shortfalls.

These are turbulent times for healthcare and some of the mythical solutions include:

• We need more data..........
• We need one integrated system...........
• We need national standards........
• Providers and regulators know what’s best for consumers......
• The IT Stimulus package is the answer.......

While solutions to these will undoubtedly be a partial answer there are no “magic bullets”.

In the coming period we shall be working with our customers and partners to help organizations to empower their people to provide the high quality of service expected of US Healthcare providers.

Obama Gets Heathcare Stake Holders' Attention

By John Mangan, Cincom Systems

 

This year’s HFMA ANI has been energized by all the speculation about upcoming changes in the broken US healthcare system.  Most of us, as average citizens, know that change is long overdue.
• 116 million Americans are uninsured or underinsured.
• The majority of personal bankruptcies are now connected to healthcare debt.
• And American businesses are struggling to stay competitive in global markets because of ever more expensive employee healthcare benefit programs.

But, as healthcare stake holders, we don’t want any of the necessary change to impact us. Hospitals, physicians, insurance companies, drug manufacturers, and tax payers are all getting nervous as they follow Obama’s rollout to the public of his administration’s healthcare reform message.

Proposed Reimbursement Cuts to Hospitals

On Saturday, administration officials said Obama intends to pay for his reformed healthcare program partly by cutting more than $200 billion in expected reimbursements to hospitals over the next ten years. Richard Umbdenstock, president of the American Hospital Association, reacted strongly, “Payment cuts are not reform.”

Proposed Price Cuts for Prescription Drugs

Obama also announced that he expected $75 billion in savings over the next decade by getting better prices for prescription drugs. Pharmaceutical company lobbyists are countering with claims that price cuts will compromise research.

Proposed Sacrifices for Physicians

On Monday about noon eastern time when the HFMA ANI was opening out in Seattle, Obama addressed the AMA. He acknowledged that physicians are concerned that today’s Medicare rates will be applied broadly in a way that means cost savings are coming off their backs, but he feels this concern can be worked out. Disappointing to the physicians, Obama did not commit to specific limits on malpractice lawsuits, saying that would be unfair to patients. But he sought to address the concerns of many doctors who complain that malpractice litigation is part of the reason why health costs have soared.

As the healthcare reform debate moves from generalities to specific policy changes, the health care stake holders are becoming more defensive. They accept that change has to take place. They just aren’t ready yet to change.

The Healthcare Financial Management Association 2009 ANI

By John Mangan, Cincom Systems

This is the conference and trade show season. Late spring is always busy. If you have been following my travels, you know about my experiences at the National Association of Healthcare Access Management Conference (NAHAM) in Las Vegas in late May. Now I am preparing for the big one, the Healthcare Financial Management Association 2009 ANI: The Healthcare Finance Conference in Seattle.

This is the event of the year for us healthcare software solution marketers. Almost anybody that you want to see will be there. But networking is not the only activity. There will be plenty of opportunity to learn about today’s important healthcare issues.  And as you know, 2009 could be the year that we will see more changes to our inadequate healthcare system than we have experienced in a couple of generations.

I’m looking forward to it, and I’ll report what I hear at the HFMA ANI in Seattle just as I did last month from NAHAM in Las Vegas. Look for my daily posts under this banner.