The Year Ahead

Like all businesses, this last calendar week of the year is a time to tie up loose ends and prepare for the exciting year ahead. 

As MEA prepares for 2012, I would like to step back and consider the bigger picture in Health IT, and contemplate what will be the truly groundbreaking opportunities in the year ahead.  We already see a few on the very-near horizon.  We can anticipate bringing our Federal Health Architecture-compliant CONNECT gateway into production, deploying our newest initiatives around assessing quality of care, and broadening our scope as one of the leading vendors of Secure Health Information Exchange for providers, payors, and vendor partners.  We are also leading in the areas of Standards and Interoperability and EDI, much as our founder Tom Hughes did during the development of HL7 in the 1990s and 2000s.

But what is next?  Without exception, we take our cues from the industry.  When we listen closely, opportunities for us to reduce waste, introduce administration simplification, and improve quality of care present themselves.  Here’s an example.

On December 23,  the NIH established the National Center for Advancing Translational Sciences (http://bit.ly/vJWFap).  Translational Science can be simply defined “bench-to-bedside,” meaning the focused, interdisciplinary delivery of laboratory advances with direct impact on patient care.  What does this mean for us as a Health IT vendor?  To me, it means that our solution needs to be so agile that it can adapt to new therapeutic technologies without any software development.  I am excited to say MEA can meet this challenge.   The next generation of MEA software is already in development, and its signature is a trading partner-oriented, rules-based architecture that provides us the flexibility that bench-to-bedside technology, for example, will absolutely require.

We are excited about 2012.  There is a lot of enthusiasm at MEA about what we have in store over the next few months, and we can’t wait to share it with you.

Happy new year from Medical Electronic Attachment!

Thoughts from CEO Lindy Benton on National Health IT Week

 Last week was National Health Information Technology Week, an opportunity to recognize the importance of Health IT not only nationally, but also at the state and local level.  Atlanta is the Health IT capital of the United States, employing over 15,000 highly skilled workers and 135 companies engaged in the critical work of health information technology.  This is an incredible asset that our community should never take for granted.  Especially at a time when economic uncertainty lingers, Health IT offers our community the best kind of employment opportunity:  jobs requiring skill, education, and integrative thinking — twenty-first century jobs.  This workforce improves the quality of patient care, reduces clinical and administrative costs, and, where we can eliminate paper, contributes to better stewardship of our natural resources.

As we observed National Health IT week, our company, Medical Electronic Attachment, sent a team to Washington, D.C. to participate in the annual health information policy summit.  The summit provides us an opportunity not only to learn, but to lead on issues of critical importance to our nation’s health.  When we take our message to the Capitol, we represent not only our company, but also our industry, our city and our state.  We underscore our position as the center for innovation and progress in this most important initiative. 

It is a good time then, to thank you, our partners, as we continue to break ground in secure electronic information exchange.  Our partnerships drive our business, and we look forward to developing and strengthening them as we move forward.

Lindy Benton
September 22, 2011

New Series: Pressures on Providers and Health IT

Good morning!  My name is Graeme Dennis and I’m a Research Analyst here at MEA.  I’m excited to be making my first post to the MEA blog.  In the blog, I’ll focus on pressures on health IT and we’ll try to explore the way out.

Of these emerging pressures one of the most clear and present is aggressive auditing.  The Centers for Medicare and Medicaid Services (CMS) has instituted frequent, penetrating, and expensive audits on providers.  Broadening their scope far beyond fraud, these audits focus on coding errors, medical necessity, and proper documentation.  While these new audits don’t (typically) lead to criminal prosecution, they can be very, very costly for the provider.  In the three year, six-state demonstration audit program, over $1 billion in improper payments were identified.  The average overpayment amount per inpatient claim ranged from $3,917 to $12,157.

The best known of these is the Medicare RAC (Recovery Audit Contractor, so named because the audits are performed by regional contractors).  Not all RAC tools are punitive (though most are).  They include:
– Data analysis
– Provider education
– Automated pre-payment review (auto-deny edits)
– Pre-payment review (medical record review before a claim is paid).
– Post-payment review (medical record review after a claim is paid).

While the best known, RAC is not the only government healthcare audit in place.  Other medicare audits include the Error Rate Reduction Plan (ERRP), Comprehensive Error Rate Testing (CERT), Zone Program Integrity Contractors (ZPIC), the Medicaid Integrity Program (MIP) and the Payment Error Rate Measurement (PERM). 

One of the most interesting developments in RAC is the submission of documentation electronically.  Incredibly, to date, RAC documentation is submitted by postal mail or fax, consuming precious days in the tight response timeframe.  MEA, capitalizing on its strength as the leader in electronic attachments, is actively developing a means of electronic response to these and other audits.  Stay tuned!

A Few Thoughts on IT Implementation From the Experts

I recently came across two articles that are so packed full of healthcare IT implementation strategy and know-how that I had to pass them along! The first article by John Glaser, CEO of Siemens Healthcare Health Services, titled The Scope of an IT Strategy is the full breakdown of what an organization should do when implementing new IT. You can access the article at http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=680004654

The second article is from the HisTalk blog on Readers Write Wednesday. Note: If you have not read the HisTalk blog I  HIGHLY recommend you following this blog–it’s really good. The article is titled Filling in the Holes in Your EMR/EHR written by Tim Elliott. His article is along the same lines as Glaser’s but it focuses a bit more on the work-flow aspect of moving from old to new IT systems. You can access the article at
http://histalk2.com/2011/04/13/readers-write-41311/ 

FYI: scroll down, it’s the second article on the page.

I hope everyone enjoy’s the articles and is able to learn from the experts.

MEA/NEA Names Kent McAllister to Serve as CIO

 ATLANTA – April 12, 2011 – Medical Electronic Attachment/National Electronic Attachment (MEA / NEA) today announced that Kent McAllister has been named to serve as the company’s Chief Information Officer.

McAllister will provide leadership and direction to MEA/NEA’s healthcare solutions. He will lead development of instrumental technology strategies that support the ongoing vision and mission of MEA/NEA.

McAllister comes to MEA/NEA with more than 20 years experience in healthcare information technology. He served as VP of Client Solutions with Sage Healthcare where he led the professional services organization through an impressive 20% capacity expansion. Prior to Sage, McAllister founded his own healthcare IT company called Mavicor, and has also spent his career in a range of healthcare general management, operations, sales and marketing positions.

“We are fortunate to have such a seasoned CIO join the MEA/NEA team,” said Lindy Benton, CEO of MEA/NEA. “Kent is ideally suited to drive the implementation of our technology strategy. His leadership and vision will be invaluable as we advance our marketplace position.

About MEA/NEA

MEA/NEA, The Recognized Leader in Electronic Attachments for the health-care industry offers systems designed to make insurance attachment submissions and processing as easy as possible for the patient, the provider and the payor. NEA has been a member of the INC. 5000 fastest growing companies in America for the last three years. For more information on NEA, visit http://www.nea-fast.com. For more information on MEA, visit http://www.mea-fast.com.

 

 

 

 

 

ONC’s Direct Project is Almost Here

This year at the HIMSS11 conference, National Chief Technology Officer Aneesh Chopra said “today is the best time to be a healthcare entrepreneur.” Mr. Chopra’s excitement surrounded the Office of the National Coordinator of Health IT’s ‘Direct Project’, a technology solution developed to securely transfer medical data between providers via email. At the behest of quite a few government officials, several of healthcare’s heavy-hitter IT companies like IBM, Allscripts and Siemens, came together and efficiently developed the technology necessary to get make the Direct Project a reality. Live testing began in February and many are hoping the solution will be available shortly so that providers can make greater strides in meeting meaningful use obligations. Sean Nolan, chief architect and general manager of Microsoft’s Health Solutions Group was quoted as saying, “it [the Direct Project] appears to be the first technology that could kill the fax in healthcare.” As a person who hears the excuse ‘but the fax machine is free and it’s electronic’ when trying to introduce new technology to a providers office, that is music to my ears!

For more information on the Direct Project, check out their site at http://www.healthcareitnews.com/news/direct-project-new-way-transfer-data

Regence Partners with MEA/NEA for Electronic Attachment Solution

 Atlanta, GA, April 5, 2011: Regence has entered into a multi-year agreement with Medical Electronic Attachment (MEA) and National Electronic Attachment (NEA) that will allow Regence providers to submit medical and dental claims attachments electronically. The MEA/NEA solution FastAttach™ will enable providers to create a single electronic envelope, containing one or more required documents for claims adjudication. Attachment processing with FastAttach™ is totally paperless, resulting in less costly claim and attachment submissions and quicker receipt of payments.

Over the last few years, Regence has been integrating sustainability measures into their processes, including reducing paper usage and increasing electronic communications with their physicians, dentists, other health care and dental professionals, facilities and members. Adoption of sustainability measures helps us all to preserve the environment for future generations. As part of this effort, Regence is pleased to offer electronic claim attachments along with several electronic transactions to their providers.

“It is a privilege to partner with a company as highly regarded as Regence on such an important initiative,” said Lindy Benton, Chief Executive Officer of MEA/NEA. “We are the only claims attachment solution that is 100% electronic from the provider to the payor. Once providers capture the documents electronically, paper is totally eliminated from the claims adjudication process.”

About Medical Electronic Attachment, Inc. / National Electronic Attachment, Inc.

MEA/NEA, The Recognized Leader in Electronic Attachments, offers systems designed to make insurance attachment submissions and processing as easy as possible for the patient, the provider and the payor. Having already processed millions of electronic attachments, MEA/NEA’s knowledge of the attachment industry is recognized by healthcare experts throughout the country. For more information about MEA and FastAttach™, please visit our websites at http://www.mea-fast.com or http://www.nea-fast.com.

Meaningful Use: Healthcare IT’s Newest Dirty Words

If you ask any healthcare IT stakeholder how they are meeting ‘meaningful use’, you may receive a dirty look. With the new release of Stage Two and Three’s objectives, which directly expand upon Stage One’s objectives, many in the healthcare IT industry are expressing their concerns. First, since providers do not have to meet full Stage One compliance until 2012, many fear that problems will be highlighted during Stage One adoption that will directly affect Stage’s Two and Three’s objectives. One complaint that was often voiced concerning Stage Three’s objectives, where those that are based off of Stage Two’s objectives that have not yet to be determined. How can Stage Three’s objectives be determined if their Stage Two counter-parts have not been published? Second, many are concerned that the adopted objectives and initiatives reflect processes that are actually within the provider’s control. If providers are expected to take financial risks (i.e. shelling out $25,000 for new systems and software) to meet meaningful use requirements, providers must be able to fully control the results of their HIT/EHR implementation. Third, many objectives incorporate high levels of patient involvement, before and after care is received. These initiatives require major workflow changes for providers on multiple levels, as well as getting their patients on board with new policies and processes. Some providers are worried that convincing patients to change their routines will be the hardest part!

With all of the negative energy surrounding meaningful use, it was nice to read a recent Healthcare Informatics interview with Farzad Mostashari, M.D., deputy national coordinator, programs and policy, in the federal Office of the National Coordinator for Health Information Technology (ONC). In his interview Dr. Mostashari shared four principles that his group is using to help drive strategy and keep stakeholders positive about meaningful use. Principle one: “Eye on the prize”-keep in mind the overall goals of quality, patient safety and excellent care coordination. Two: “Feet on the ground”-build upon what we have in place today, policy wise and technology wise, and always focus on adding value. Three: “Foster innovation,” and its corollary, “use the market”-the government is focusing on fostering innovation through grants and policy’s permitting modular certification. By using a market based approach to support adoption, providers are not forced to comply with one solution; they have the ability to shop around and find what will work best for them. The fourth and final principle: “when you use the market, the role of the government is to watch out for the little guy”-the government needs to be sure there are no monopolies on available technology for providers and Dr. Mostashari feels that the market is handling this on it’s own, “Number one, demand is up; and two, the established vendors have their hands full, and people are going to be looking for alternatives… many are looking at local vendors.” I believe that if healthcare IT stakeholders would rely on Dr. Mostashari’s principles when struggling with meaningful use, that it is not just about technology, it’s about improving healthcare for every patient.

Hurry Up and Wait… or Leave: The New Trend in U.S. Emergency Rooms

Headed to the emergency room? If youre condition is not critical be prepared wait an average of four hours and seven minutes according to the 2010 Emergency Pulse Report by Press Ganey. Last year it was reported by the U.S. Government Accountability Office (GAO) that an ambulance is being diverted every minute in the U.S. and critically ill patients needing to be seen in one to 14 minuets are not being seen for 37 minutes. What’s worse is the sharp increase in the number of emergency room patients that choose to leave before receiving care. Dr. Renee Y. Hsia, a highly reputable California-based emergency physician and scholar, and her colleagues released a study in February reporting that one in five emergency room patient’s in California leave before receiving care. They noted that many people assume that patients who are choosing to leave without being seen are not seriously ill. This is a false assumption; a large number of patients who leave return within a few days and often with severe enough symptoms to be admitted upon arrival. Although the study took samples from a wide variety of California hospitals, the number of patients leaving without care doubled at trauma centers, county-owned hospitals and teaching hospitals. Dr. Hsia’s team also discovered that lower income communities had longer emergency room wait times than their surrounding areas.

 Even though the study was conducted in California, experts agree that wait times along with the number of patients leaving emergency rooms without being seen is increasing nationwide. So, why are emergency room wait times increasing?? The American College of Emergency Physicians (ACEP) published an article that highlighted five reasons why patients wait:

1. The triage process where critically ill patients are seen first (and they should be!)
2. Patients that need to be admitted often spend an extended period of time in the emergency room waiting for an open hospital bed; a practice known as “boarding patients”
3. On-call physician and specialist shortages due to malpractice lawsuits, increasing premiums, etc.
4. The increase in U.S. emergency room visits coupled with the sharp increase in emergency room closures
5. Local crises and disaster victims overwhelm emergency rooms that are already filled to capacity

By-the-way, these reasons are not recent revelations to the healthcare industry. As the only non-healthcare worker in my family, I can assure you that I have been hearing about these problems for years, and the increase in emergency room visits has exacerbated these issues. Now, the bigger question is how are hospitals combatting longer wait times? According to the ACEP many hospitals have begun utilizing new technologies to streamline processes such as speeding specimens to laboratories, establishing fast-track admission procedures, hiring additional patient advocates for better patient communication and utilizing computerized tracking systems to provide up-to-the minute patient statuses. Other hospitals are trying to eliminate “boarding” patients in emergency rooms by sending patients to the floors to wait to be admitted; essentially spreading out patient’s to free up emergency room beds. A handful of states, including Nevada and Iowa, have greatly reduce their wait times by almost 60 minutes by utilizing the fore mentioned technologies and processes. It is essential that every U.S. hospital make strides to improve patient wait times through improved processes, technology or a combination of several efforts. If they do not, we will be the ones who suffer.

CMS is Taking RAC Audit Data to a Whole New Level

Since The Center for Medicare and Medicaid Services (CMS) began their nationwide Recovery Audit Contractor (RAC) audits in 2008, data from the audit contractors has been pouring in. In an effort to use the data to prevent future fraud, Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder, have teamed up with the National Fraud Prevention Program , the Department of Justice Health Care Fraud Prevention and Enforcement Action Team (HEAT) and HHS to highlight innovate ways of reducing or eliminating fraud in the healthcare industry.  They spent the majority of 2010 touring the country discussing fraud prevention measures with state, local and federal partners as well as multiple provider groups. Their goal is to use a network of resources, along with RAC fraud data, to highlight known fraud prevalent areas and providers to stop the fraud before it even occurs. So what’s their plan to prevent future fraud? First, CMS has determined that 83% of overpayments were attributed to a discrepancy in coding and/or documentation to prove medical necessity. Due to these findings CMS and RACs will focus on specific areas (i.e. surgical procedures, units of service, CPT codes, etc.) when reviewing claims and it will be up to the provider to provide proper documentation to support the coding on their claims. This will be a big deal for providers, especially institutions, because several are still mailing or faxing claim attachments to CMS and other payors, which slows down the entire claims process. Providers will need to take advantage of available technologies to streamline their claim processes, such as electronic claims and attachments. Second, CMS and HEAT will be utilizing predictive modeling to foresee fraudulent actions and stop claim payments. As mentioned before, they have highlighted areas and providers who have been flagged as previous offenders and CMS has been given the authority to suspend payments while investigating potentially fraudulent claims. Third, CMS has passed several new Medicare and Medicaid coding and medical necessity rules forcing providers to be more thorough when filing claims. Little things on claims that have slipped through the CMS cracks in the past, such as illegible doctor’s signatures, nonspecific clinical codes and references to documentation filed with previous claims, will be flagged for review in the future. CMS states that the number one method of preventing coding and other claim errors, not outright fraud, will be properly educating providers and claims billers regarding RACs and CMS identified problem areas, as well as updated CMS claim guidelines. I am sure that we will see many more changes ahead for CMS and their providers that will seem burdensome, however those changes will reduce CMS overpayments, greatly benefitting everyone involved.