The HIT Transition Weblog

Bury the Hillary Campaign at Yasgur's Farm

Well, I came upon a Child of God
He was walking along the road
And I asked him, where are you going
And this he told me
I'm going on down to Yasgur's farm

I was in a fine snit this morning.  Michael and Allie noticed right away.  "What's the matter, honey?" Allie asked.

"I was listing to my Pandora station.  You know, 'It's a Beautiful Day?'" I had tuned my personal music channel to play the old psychedelic stuff that was always on my siblings' turntables during that boisterous era. Years after any incipient fog had long since lifted, I continue to find the melodies and optimism uplifting.

"I was doing fine until it played 'Woodstock,' then I got really mad."

"But you love that song!" she protested.

"I know.  But it made me mad. Mad at Hillary." I said.  I wasn't finished. Not nearly.

Grants Roundup

HHS Awards Grant to Secure Health Information Technology

Independent Sector Urges Senate Finance Committee to Include Nonprofits in Stimulus Package

$1.2 Million for eMAR for Aging Patients

Idaho RHIO To Get $500,000 from State, $11.3 Million from Providers

CDC Grant Opportunity Requires EMRs

AT&T Awards HIT Grantto Local Volunteers in Medicine Group

State HIT Grants in Virginia

PacificCare Gives $700,000 for Safety Net HIE

Opportunity: New Federal Rural HIT Grants

The Old Rural Healthcare Bond Refinancing Ploy

RHIOs Exploring Philanthropy?

Regional Health Information Organizations may be changing their finance strategies. In the wake of high-profile RHIO closings, and in the shadow cast by a recent report published by Health Affairs suggesting that RHIOs are floundering financially, it is not surprising that RHIO organizers are exploring new resources for capital.

Our 2007 RHIO finance survey found that about three-fourths of the U.S. health information exchanges are setup as nonprofit organizations, enjoying both exemption from taxes and the ability to accept tax-deductible contributions from private foundations. However, our report also noted that only very small amounts of private funding was finding its way into the RHIO movement; the majority of the organizations were relying on government dollars to start up operations, and were expecting to pay for ongoing costs by charging healthcare providers for their services.

That’s old news. But now things just might be looking up. There's some interesting evidence that RHIOs may be acquiring some new fundraising chops.

Medicare to Plug NPI Hole with HIPAA Violation

I'm afraid to go back to Baltimore.  I've enjoyed a long and fairly collegial relationship with the folks inside CMS, both on the regulatory and the Medicare side of the department. Sure, I've challenged them on occasion, and we sometimes have agreed to disagree, but we tend to agree that we are, after all, pulling in the same direction in our own particular way.  They as the regulatory body that oversees an entire sector of the industry and the largest health plan known to humankind; I as a humble IT analyst and blogger from Tulsa, OK.

Everything was fine until Medicare NPI. We understood each other.

A Cyclops Has No Depth Perception
But recently I had to go out and poke them in the eye. I'm not sure if they noticed, but it seems they blinked, one way or the other.  And the blink is worse than the little National Provider Identifier mote I was trying  to dislodge in the first place.  See, it seems that they got around the not-everybody-has-an-NPI-so-how-can-you-insist-billers-provide-one problem by simply requiring that providers who want to get paid will reprogram their systems to violate the X12 standard and CMS's own regulations.

Worst in the World. Again.

It hurts me deeply every time the American healthcare profession is knocked around by researchers. And here it comes again: Among 19 developed countries, the U.S. ranks worst in deaths that could have been prevented by healthcare says new research published in the Jan/Feb issue of Health Affairs.

How bad is it? If we had performed as well as France, Japan and Australia, 101,000 fewer Americans would have died unnecessarily in 2003.

Researchers Ellen Nolte and Martin McKee state in their report "Measuring the Health of Nations: Updating an Earlier Analysis" that while other nations made strides and saw these types of deaths decline by an average of 16% between 1997 and 2003, the U.S. experienced only a 4% decline. All other countries had improved substantially except the U.S. They add that

It is difficult to disregard the observation that the slow decline in U.S. amenable mortality has coincided with an increase in the [U.S.] uninsured population.

The study did not ferret out causes (Was it access to care? Quality? Mistakes? Timeliness?). Rather than placing blame, the study simply reports the horrible news: In 1997–98 we ranked 15th out of 19 countries on the "mortality amenable to health care" measure; by 2002–03 we had fallen to last place. Based on our poor performance improvement (4% compared with 16% global declines in mortality), the U.S. is falling woefully behind.

Karen Davis of The Commonwealth Fund, supporter of the research, makes the message clear:

Our failure to cover all Americans results in financial barriers that are much more likely to prevent many U.S. adults from getting the care they need, compared with adults in other countries.

110 American deaths per 110,000 population. Lives lost because we can't get healthcare right in the wealthiest (at least for the time being) country in the world.

http://hittransition.com/flashpoint/ad.htm

Medicare Inches Forward in NPI Transition

Medicare is, as predicted, moving forward to make National Provider Identifier (NPI) processing part of the real world of claim submission.

Effective March 1, 2008, Medicare fee-for-service 837P and CMS-1500 claims must include an NPI in the primary fields on the claim (i.e., the billing, pay-to, and rendering fields). You may continue to submit NPI/legacy pairs in these fields or submit only your NPI on the claim. You may not submit claims containing only a legacy identifier in the primary fields. Failure to submit an NPI in the primary fields will result in your claim being rejected or returned as unprocessable beginning March 1, 2008. Until further notice, you may continue to include legacy identifiers only for the secondary fields. [MLN Matters MM5749 (Revised)]

Looking Out for Number 1
Meanwhile, it seems the regulatory arm of CMS still can't figure out how to determine whether an entity is a person or an organization and thus continues to hold back tax ID numbers submitted by Type 2 providers, for fear they might actually be the Social Security Numbers of Type 1 providers.  Why does that matter? Well, for one, the only way to ensure you have picked up the right NPI for a particular subpart of an organization is to get a cross reference generated by that organization's Tax ID.

Without that, expect lots of misdirections as "St. Alphonso Dialysis" and "St. Alphonso's Kidney Center" and "Red State Nephrology - St. Alphonso Campus" will not show up on any single list, any other way.

This is Going to Hurt You A Whole Lot More Than It Hurts Your Brother
I'm even more concerned about what happens with the real challenge -- sorting out mandates for non-affiliated secondary providers -- hits the fan on May 23.  That's this May 23. If Medicare follows through on this new/improved drop-dead date, expect other payers to try to hold the line, too.

In spite of the fact that many secondary providers don't have an NPI, aren't required to get an NPI and have actively refused to obtain one. But if they show up on your claim, you might not get paid.

http://hittransition.com/flashpoint/ad.htm

Marty's HIT List 2008

Here's my official list of prognostications for 2008.  In 2006 and 2007, I didn't call them predictions, so I probably don't deserve any credit if anything I said came true.  If you agree -- or not -- you can give me your own scorecard by clicking here.  Give your feedback by January 23 and I'll post the results (and any interesting comments) in a blog at the end of the month. As far as we know, we're the only industry analysts that give you, our valued reader, this critical "You're Full of..." HIT response tool.

Headlines for January 3

Gregg Pushes Leavitt To Release More Medicare Data

Consumers Say Benefits of Electronic Health Records Outweigh Risks

Researchers Say HIPAA Hinders Their Work

Nurses say IT security requirements impede nursing productivity

Seeking Sustainable RHIO Forest; View Obscured by Non-profit Trees

Political Changes Could Encourage E-Prescribing

Health Information Technology Structural Measures

eHealth Initiative's Fourth Annual Survey of Health Information Exchange

CPOE: Ensuring Medication Reconciliation

http://hittransition.com/flashpoint/ad_rhio.htm