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October 15, 2010 News 13 Comments

HERtalk by Inga

From: JimmyJoe “Re: UW Warning on Cut and Paste. In my prior life I became increasingly concerned about the quality and safety ramifications of mindless cutting and pasting. The practice also causes progress notes to grow and grow (due to cut and paste and add), making the record increasingly unwieldy and less useful. I informally polled a number of people in my position and all of them were equally concerned. None of them had an answer other than policies around not doing it without paying attention. It is important to remember that cutting and pasting is not really an EHR function, it is a Windows function. What to do, what to do?” I don’t have an answer either but it’s good to know you can always blame Bill Gates, should an auditor raise concerns about cutting and pasting in your EHR.

From: Bama Bubba “Re: RFID tracked hospital workers. I wonder if RFID-tracked hospital workers feel like cattle, too. Personally, I never bought the ‘inventory tracking’ rationale (excuse) for tagging workers.” Two Houston-area school districts, hoping to monitor the whereabouts of their students, implement “the same technology used to track cattle.” Despite parental concerns about potential health risks, administrators are pleased attendance is up.

From: Weird News Andy “Re: Medicare fraud-biggest ever. Leads me to wonder. . . Medicare get hits with fraud ALL THE TIME. Do private firms get hit with fraud as often and we just don’t hear about it, or is there something about people looking out after their own money that makes them more vigilant?” WNA asks a compelling question, prompted by news of a $100 million Medicare fraud case. In reading details on this case, it sounds as if the art of cheating Medicare isn’t rocket science. Maybe it’s not as easy in the private sector.

medicare fraud

When I first read details of this same Medicare fraud case, I thought it had the bones for the perfect modern day Godfather saga. Federal prosecutors have charged a band of 40+ Armenian-American gangsters for billing Medicare over $100 million in fraudulent claims (Medicare paid $35 million of them.) The enterprise has been led by Armen Kazarian, whose role is similar to a Mafia godfather. He came to the US in 1996 and was granted political asylum based on a fabricated story that involved his father being doused with gasoline and burned to death.The fraud operations started with the identity theft of doctors, including their medical license numbers. The accused group then stole the identity of Medicare patients. From there, gangsters created 118 fake clinics across 25 states and began churning out fake claims. In most cases, Medicare was happy to pay. The story includes plenty of infighting, threats of violence for not paying debts, and  untraceable money transfers back to Armenia. The US attorney handling the case calls it the “single largest Medicare fraud ever perpetrated by a single criminal enterprise.”

Not a moment too soon: HHS awards TerraMedica a contract to assess fraud, waste, and abuse in Medicare claims using predictive modeling technology.

st. charles

The St. Charles Health System (OR) selects Allscripts EHR and PM solutions for its employed and affiliated physicians. The Oregon Community Health Information Network’s (OCHIN) REC will provide implementation and training support for independent physicians. Allscripts, by the way, also announces its 2010 President’s and Circle of Excellence Hospital awards, which recognizes customers with documented strategies and superior outcomes using Allscripts technology.

eHealth Ontario awards CGI Group a $46.2 million contract to develop a new chronic disease management system. The solution will operate on AxSys Technology’s Excelicare platform.  AxSys, by the way, also just secured contracts with North American Management California and MSO of Puerto Rico to develop HIEs running on the Excelicare platform.

The Denver paper highlights the University of Colorado Hospital’s migration to Epic. The hospital says data integration is one of the major benefits of the $67 million project, which is expected to be completed mid-2012.

mitch fry

Halfpenny Technologies, which recently secured $2.6 million in VC funding, appoints four new execs to its management team, including Mitch Fry as EVP of business development, Daniel O’Brien as CFO, Roger W. Newbury, Jr. as SVP of sales, and Jim Sheils as VP of sales. Individually the group has worked for such employers as Sunquest, Misys, TELCOR, Touchstone Health, United Healthcare Group,  US Laboratory and Radiology, and dbMotion.

DB Technology and BridgeHead Software partner to offer a joint content and storage management solution. The combined solution leverages DB Technology’s document imaging component and BridgeHead’s data and storage management tools.

MEDecision earns accreditation from URAC for meeting URAC’s Vendor Disease Management, Vendor Case Management, and Health Content Provider standards.

Vocera Communications acquires voice technology vendors Clinical Health Communications (makers of OptiVox) and Integrated Voice Solutions (maker of VoiceCare.) Vocera also reports a 39% y/y growth for the third quarter.

Catholic Health Partners (OH) claims its saved over $8 million using Kronos’s time and attendance and productivity solutions. CHP attributes the savings to reduced agency and overtime use.

advocate healthcare

A reader tells me that Advocate Healthcare (IL) is now live on SAPPHIRE for patient registration and accounting in all nine of their facilities.

A class-action lawsuit filed in Arkansas accuses HealthPort of charging patients an illegal fee when requesting copies of their medical records. The lawsuit is not challenging the legality of HealthPort’s basic charge to retrieve/copy/send medical records. However, the lawsuit contends that the $1.71 sales tax imposed by HealthPort is illegal and in-state providers do charge sales tax for similar services.

St. Barnabas Medical Center (NJ) picks Merge’s AIMS, medication management, and patient portal solutions.

UMass Memorial Health Care announces plans to eliminate 350 jobs, or almost 2.6% of its workforce. The seven facility system expects to lay off 130 workers, freeze another 120 vacant jobs, and eliminate the equivalent of 100 jobs by reducing overtime and move employees from full to part time.

Hiring: the Cincinnati Business Courier reports that healthcare systems in tri-state area expect to add more than 100 people to help set up various EMR systems.

medical data exchange

Verizon releases plans to expand its Medical Data Exchange platform beyond its core transcription exchange services; members will soon be able to share X-rays, lab results, and other digital records. Verizon will also begin offering IT consulting services for its Exchange members.

This week on HIStalk Practice: KLAS publishes a new report rating ambulatory EMRs by specialty; the Rhode Island Quality Institute picks several pre-qualified EHR and technology vendors for its REC; Ohio State Medical Association publishes a new social media toolkit for providers.

API Healthcare says it’s recently signed up more than 30 healthcare clients for its workforce management technology.

The Chesapeake Regional Information System for our Patients (CRISP) announces its statewide HIE is now live.

Pemiscot Memorial Health Systems (MO) selects Prognosis Health Information Systems’ ChartAccess EHR.

laptop mountain

Despite taking some well-deserved vacation, Mr. H did manage to check in with me a couple times this week. Mrs. H apparently took this shot of him taking a moment to ensure the HIT world was still on track.  Maybe he’ll post a few more pics when he posts the Monday Morning Update this weekend.

inga

E-mail Inga.

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Currently there are "13 comments" on this Article:

  1. Worried about cut and paste? There are ways to disable the functionality within applications. Read more:

    http://www.microsoft.com/windowsserver2003/technologies/rightsmgmt/default.mspx

    To disable the right click functionailty, try these steps.
    a. Click Start, type regedit, right click on regedit and click run as administratror. If prompted, type the admin password.
    b. Expand Computer\HKEY_CURRENT_USER\Software\Microsoft\Windows\CurrentVersion\Policies\Explorer
    c. Right Explorer, point to New -> DWORD value
    d. Name it as NoViewContextMenu .
    e. Click NoViewContextMenu and type 1 and click ok.
    f. Restart the computer.

    Not perfect by any means, but makes it harder!

  2. The problem with the fraud busters, there are too many false negative investigations wreaking havoc on innocent often defenseless doctors. The true fraud as reported is allowed to go on for far too long, facilitated by electronics and the digital mindlessness of the CMS and health insurer employees.

    The new contract from CMS: TerraMedicaTM is a healthcare technology company that designs and deploys innovative fraud and abuse prevention solutions for payers and healthcare constituents within the healthcare market place.

    Just a few questions: What is its false negative rate and will it detect the new fraud by hospitals and its HIT savvy doctors, cut and paste technology?

  3. Medicare Fraud is the tip of the iceberg when it comes to healthcare insurance fraud. There is massive fraud committed against all insurance companies. When physicians make fraudulent claims against Medicare, they usually don’t limit themselves to Medicare only. They usually make the same fraudulent claims against all carriers. The commercial carriers generally let Medicare “carry the water” for them, and don’t spend the money to prosecute.

    Compared to commercial carriers, Medicare does a far better job of monitoring and catching the “bad players”.

    Incidentally, insurance fraud isn’t limited to healthcare. It occurs with all types of insurance.

  4. RE: Bama Bubba (RFID tracking of staff) – While I would acknowledge a certain amount of concern over “big brother” watching us, I think the more appropriate use of this technology would be to try to analyze workflow and related workflow issues/improvements. Many workers when left to their own methods, may take routes and/or establish patterns that are not necessarily the most efficent or conducive to productive time management. Using this technology could potentially improve turn around times for things like laboratory tests , etc.

  5. RE: Medicare Fraud… isn’t that how Obama is planning to make Healthcare Reform pay for itself – by cracking down on Medicare Fraud? As they say on Social Media… Bahahahaha!

  6. Layoffs as HIT is deployed. UMass: UMass Memorial Health Care announces plans to eliminate 350 jobs, or almost 2.6% of its workforce.

    Is the flat patient volume due to every body being cured by the HIT systems deployed there, including Allscripts, dbMotion, and Siemens Soarian? Might it be that care has become slow and inefficient and that doctors are taking their patients elsewhere due to the “teething” problems of HIT deployment?

    This would be of no surprise to those who have been through it and adverse financial terrain even includes increased length of stay for months after go live.

  7. Worried about cut and paste?

    There should be no need to “Cut and Paste” if your docs are using a tablet based forms management solution. Data from previous notes is automatically carried forward for update and edit, without user intervention. All the information is then auto indexed in the patient’s record – again, without the possibility of human error from cutting & pasting or manual data entry.

  8. Medicare fraud:
    In another blog said the way they did it was the phony docs sent bills for phony patients for services not rendered. What tipped the feds off was they were getting bills for dermatologists doing heart surgery, pediatricians doing geriatric care, etc.

    The perps obviously did not know anything about medical services and providers. But tell me how could they get away with $100 mill of these kinds of bills. If a legit provider so much as sends a bill out with a missing comma it gets bounced back by the intermediary. So who was their intermediary?? Seems to me they should be on the hook for the $100mill.

  9. Cutting and Pasting is a new version of an old problem and nothing that we will solve on this blog or you can “prevent” in the real world. We can make it harder. We can make it smarter. But we cannot stop it. Find a doctor who dictates. Ask to read their last 10 yearly physicals. Count the differences. It won’t be much. As humans we use things like this all the time both mentally when we dictate as well as in a computer to avoid repeating phrases. Rather than eliminating it – we should find out WHY it is needed and develop tools to make it smart… i.e. copy the right things; figure out ways to start change on the coding side so irrelevant data that is used for billing does not cloud the clinical picture.

  10. People Cut and Paste for one reason:

    Fear of a Medicare Audit and the penalties associated with not being able to defend your level of service billing code.

    If you didn’t document it, you didn’t do it.

    If doctors were allowed to document only what was really needed you wouldn’t have much cut and paste. You’d have a simpler chart by exception model.

    You’d have many more notes that looked like:
    ROM – Amox standard 1st course.

  11. I remain stupefied at how much money is being made by the HIT “experts” and “champions”, yet patients are suffering from care that is at its all time worst: Much neglect.

  12. Re: Cut & Paste Issue. As a clinician i saw a lot of value in the MECIN – clinical knowledge engine (Developed by Medicomp Systems) to succinctly document a review of systems and symptoms. the part I didn’t like was where – It did lead down a path to suggest a diagnosis. But, for accurate billing, clear documentation, and documenting clinical presentation it seemed to be a great tool.







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