March 22, 2013 Meeting at BlueWave Computing
Speakers: Deborah Frazier
Michele Madison
Meeting Notes
HIE
$13m 4 years ago awarded to Department of Community Health who gave to HITRECH to manage. They are about to run out of the money at
which point they will need to be self-sufficient. Included on the team is:
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Denise
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Kelly Gonzales
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Dr. Mack
Instead of setting up one exchange they are breaking it out
into regions and connect regions together.
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Voldasta – South GA Medical Center
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Savannah – ChathemHealthLink
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Dalton – Health One Alliance
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Athens
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Macon – Central Georgia Health Exchange
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Direct Messaging ties all together
Polling from providers to see what they want
Indiana & North Carolina have it together, we are
behind.
Obamacare &
Georgia
Governor Deal decided not to do Medicaid or Health Insurance
Exchange
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Individuals who don’t have insurance, but make
enough money to pay taxes are required to get health insurance
o
If employers has less than 25 employees and they
don’t want to buy insurance, then they can go through the HIE (state policy).
o
If the premium cost the individual at least 8%
of their income then they can opt out of the employers policy and go with the
HIE.
o
Not everyone has to buy it, those who don’t pay
taxes don’t have to buy
o
Because GA has opted out, it means the
government will be setting one up a policy for us.
o
Companies
like United Health, Aetna, etc would market through the state at a lower
cost. It will be very bare bones
coverage.
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Bronze – individual responsible for 40% of cost
and they will pay for 60%
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Silver –
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Gold -
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Platinum – individual responsible for 10% and
they will pay for 90%
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Don’t know what reimbursement rates look like
yet – should know in Oct from Feds
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Hospital Reimbursement cuts
o
Took the place of 27.5% cuts across the board
for physicians
o
American Taxpayer Relief Plan – code adjust
hospital reimbursements down
o
When sequestration happened 2% of Medicare
reimbursements to the hospitals get cut on April 1st which comes out
of
o
Insurance went up dramatically – up to 47%
o
Saw a 20-40% decrease in elected surgeries
because of high deductible plans (will suffer longer)
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Physicians
o
Decrease in routine visits due to high
deductible plan
o
High deductible insurance is changing patient
behavior
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Mergers & Acquisitions
o
Smaller hospitals filing bankruptcy or closing
o
Larger hospitals merging together to take advantage
of economies of scale
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Bill for license division for dedicated
emergency triage in rural areas (4-5 beds)
o
Don’t have it now, working on it.
o
TN has it
ACO’s
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ACO’s – all in GA are in baby stages
o
Wellstar – biggest one in state
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Wellstar & Piedmont teaming up on Insurance
Plan
o
Athens – physician driven
o
Savannah – physician driven
o
Most successful in Northeast & California –
been doing patient accountability for quite a while
o
Will ACO’s go away – NO – think it will expand
for a while
HIPAA Omnibus
o
March 26th – September 23rd
o
BA agreements can be grandfathered until 2014
o
Finalizing marketing & fundraising
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Must get patient authorization and let them know
you are selling info
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Including studies
o
Student Immunizations
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Verbal authorizations allowed to schools
o
Breach Notification Finalized
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Less than 500 you have to determine if it can
harm the patient
o
Enforcement
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Fines & penalties are increasing
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Small practice fined$ 50K because they did not
have P&S PP
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Lots of Subpoenas and audits
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Government sees this as a way to pull back
dollars from
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OCR reports more patients are contacting them
directly
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Employees are now contacting OCR before they
tell you
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Diligence on investigation is amazing
·
Now have to provide them all of P&P – not
just on where the breach took place
·
Work plan being tweaked four times
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Staffed up – real – more fines and penalties
than ever before
§
Can appeal, but no guarantees
Impact of
Sequestration
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More layoffs expected because of Sequestration
RAC Audits
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Now going back 5 years instead of 3
o
Hospital Side
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If Rac denies their Part A visit, they can
rebill under part B as outpatient services.
IT Healthcare2013
and beyond
o
HIPAA
o
HIE
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New Applications
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Must have Stable Foundations
o
Challenges
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Staffing Constraints – (Han Reichgelt) SPSU
rolling out more and more programs.
Partnership with tech colleges to get them certified in HIT within 2
years.
·
Debs 2% unemployment rate in IT support – HIT a
small portion of that
o
Lack of experience to implement EMR
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Efficiency Improvements – (Karlis) Virtual
environment, higher cost on front end, but lower cost in long run. Maximum use of everything you have.
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New Revenue Resources – Telemedicine, new
coding,
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Smart Ways to Reduce Costs – Steve Brown –
Clients looking for ways to automate revenue cycle. Reminder calls. Dial phone numbers to dial past due
patients. Get paid faster.
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Reduce Cost – Teledocs taking calls and appts
over phone and prescribing medications.
·
Paige – look at what you are spending, help them
figure out how to save money, because they don’t really know where they are
spending it.
·
Glen Campbell – Have staff work more
efficiently. EMR – 90% of all patient
data. Show patients who are missing
diagnosis or missing lab tests. Allows
them to prepare better. Using technology
to streamline data views.
o
Doctors there 7-8PM at night doing labs off of
paper. Younger physician home by 5PM and
have dinner with his family. Dial in
after kids went to bed he would dial in and do labs. Other doctors saw how convenient and
efficient it is, now embrace the technology.
·
John – Look at what you are spending on
technology and telecom. Older systems
cost money. Older telecom contracts are
costing them. Can trim enough cost in
upgrading what they are getting and get a more efficiencies. Technology has grown, telecommunications
typically have not been right sized for the new technology.
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Omnibus – Paige – Confusion over what people
really need to do. Lack of
documentation. No HIPAA manual. Business Associate and their subcontractor
needs to be compliant by March 26th.
BA claiming they don’t need to be.
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KPMG should publish 120 audits from last year
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Cash Pay – Mandating practices to accept cash
payments and prevent the info from going to insurance company.
o
Caveat – this includes Medicare. The Medicare rules state that everything must
be reported to them, but this is completely contradictory to this rule. Also with other carriers.
§
If you put in EMR and get audited – that is a
big issue.
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PYA – If the patient ends up not paying you have
to do your due diligence to collect the money, or you can submit to the
insurance company. Even more convoluted
and complicated. Rule states if patient
pays in full at time of service. Patient
needs to be the one to initiate that restriction. If you run it through bank or credit card the
info is out there – patient should pay with cash if they want the information
restricted.
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Covered Entity – Responsible to anyone you share
PHI with and all the way down the road.
Make sure everyone else is
compliant and their subcontractor. Paige
has subcontractor BA agreement.
Mergers &
Acquisitions
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Older doctors who sell practices are let go at
end of term:
o
Must retire or start from scratch
o
Michele – Physicians being bought up for 3 years
now. Slowing down because of the
Hospital reimbursements.
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2 buying rapidly – Wellstar & Piedmont
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Very difficult to get bought and come back out
into private practice because you sold your records, your EMR system, your
employees are now their employees, and normally there is SOME type of
non-compete.
§
Advise doctors to have in their contract some
type of language that covers them if they were terminated without cause. Easier to negotiate in a practice of 5 or
less.
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Those that are interested in selling it is
because they are scared about the reimbursements in the future and through a
contract, they are guaranteed some type of base amount plus bonuses. So they think the more they do the more they
get paid and they are releasing the risk.
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If you are a doc, figure out if you want to
continue to practice at the end of the term of the contract. Advise to structure the term of the contract
for as long as you want to practice, if not, figure out where you are going to
move to when you are done, because you are going to be moving based on the
non-compete clauses. Personal choice for
docs.
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More Medicare based doctors will be more likely
to sell to hospitals, because that is the area that will be hit the worst with
reimbursement cuts.
o
Paige – Many of her practices have been
deceived. They find out after they agree
to sell that they have to buy the beds, new EMR, migration to the EMR. When they lose their staff they lose their
independence – huge issue for the docs.
Docs have to code themselves.
Advice – don’t panic, go through the numbers.
Next Meeting Topics
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Who is a BA?
How do you know? Verification.
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Data Aggregation
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Requirements of MU
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What am I eligible for?
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When can I attest?
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Penalties
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ACO and products for them, questions for
practices if they should or should not get involved
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Changes in payer rates and higher deductibles
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New payment plans and best way to leverage for
practices
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Is it hitting doctors same as hospitals?
Question to
attendees: How can we improve
the format of this meeting?
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