The HIT Transition Weblog

We Will Help You With NPI Crosswalk Problems

If you came here looking for free information about your NPI problems, you will find lots of it. Click here for more than 125 articles we've posted on the subject in the last three years.

We'd like to help you more directly, if we can.  For the past few weeks, we worked on a concept to develop a "Crosswalk Coach" service that we could streamline and offer at a bargain-basement price to help the small clinics and others who were looking at years and months of Medicare denials. We even drew up a clever superhero character to represent the guy who would get you safely across the street.

No Cookie Cutter
We had to abandon the concept. There are no cookie cutter approaches to this problem. We've learned that some providers are simply in a catch-22 situation, where solving one payer's problem only creates problems for others. We can help solve some of those problems, but not necessarily all of them. You may be experiencing an issue that can be fixed quickly, and we hope you do. But we simply can't guarantee anyone safe passage, as much as we'd like to.

So, in our forthright sort of way, we will offer instead...

Are We Profiting from NPI SNAFU?

(This is the post where we publish the Medicare NPI Crosswalk. SHHH! Don't tell....)

You might have noticed that we often slip in little advertisements, and occasionally even in-line mentions, of our products and services in these web posts.  You know, for the Provider Taxonomy webinar, or the NPI Contingency Status Survey report, or, heck, even the HIT Grant Resources Directory for nonprofit fundraising.

Could it be, as we were once accused, that we are roiling up a false problem so that we can exploit it for financial gain?

How can I answer that charge in an appropriately professional manner?

No.

This Is Where We Prove Our Point
To prove just how bad we are at exploiting our arcane expertise for personal gain, I'm going to share something that just came over the transom.  I haven't even had time to look at it very thoroughly myself, but it sure as heck looks like that long-anticipated Medicare NPI Crosswalk logic I've been railing about for months.  You know, the thing that tells you how the field-by-field comparisons work, so you can figure out how to update your NPPES/NPI record and/or your PECOS enrollment data and/or your claims data to get paid.

Guess how much we're going to charge you for it?

That's right. Nothing. Download it here. MatchingRecipesWithCounts05_27_08.xls 

And at this moment I have no idea whether this is the complete set of matching algorithms, or if they apply to Part A, Part B, or both. Looks pretty up to date, though, because one column includes stats of how many matches were logged against each rule on May 27. (And I should mention that, at first glance, it doesn't look nearly as brain-dead as I suspected, after all the provider horror stories. Wonder why they wouldn't want to publish it?)

We'll Help You Solve Your NPI Problems
We put together a simple deal to help providers who are having NPI crosswalking problems or getting claims rejected or misrouted for other reasons related to NPI. See We Will Help You With NPI Crosswalk Problems.

Modern Healthcare Covers NPI

We've wondered why there is so little coverage of the NPI transition in the mainstream industry media. Sure, it's a little hard to wrap your brain around if you don't deal with this stuff day to day, but is it really that hard to tell the difference between Primary Identifiers vs. Secondary Identifiers vs. Primary Providers vs. Secondary Providers? Especially when you have Provider Taxonomy to break the tie?

Oh, yeah, now that I put it that way, I guess it is...

But one guy who consistently covers the HIT waterfront pretty well is Joe Conn, who writes for Modern Healthcare and American Medical News [Oops. Joe writes for Modern Healthcare, Modern Physician and Health IT Strategist, but not AMN. Our bad. - Ed.]. On NPI day, Joe logged one of the most accurate and comprehensive pieces on NPI we've seen so far.

And I'm not saying that just because he quoted me extensively. He actually got the story right. 

Prepping for CCS

Last fall, I reported about how much fun I had at the Collaborative Communications Summit. Not "fun" as in golf outings and spa appointments, but "fun" as in meeting some really interesting and influential people, and being surprised at just how much some executives at the top tiers of the healthcare industry actually know about health IT. But CCS is not just about IT, it's about IT-enabled healthcare, which is a different spin from the typically techy-wonky conferences I traditionally attend.

And I didn't just like it enough to go back; I liked it enough to help make the next one happen. [Disclosure: HITTG is a media sponsor for this event. But we don't sell blog endorsements to anybody.]

Multisyllabic Session Title #1
On Tuesday, I'll be moderating a session called, "Unified Vision with the Consumer and Provider through HIT." I've got an incredibly qualified -- and incredibly broad -- array of panelists:

• Carolyn M. Clancy, MD, Director, Agency for Healthcare Research & Quality
• Michael E. Singer, President, Revolution Health Investments, Revolution Health Group
• George Chedraoui, Global Well-being & Health Benefits Leader, IBM
• Grad Conn, Senior Director, Health Solutions Group, Microsoft Corporation

And before you jump to any conclusions, no this is not a PHR vs. PHR smackdown with a government referee. First, you should note that Mr. Chedraoui has a largely HR perspective -- he's on the boards of both the Leapfrog Group and Bridges to Excellence, recently serving a term as the latter organization's chair. So he's bringing IBM-as-employer mojo, not just IBM-as-programmer-to-the-world. And I don't expect Conn is showing up just to shill for HealthVault, since Microsoft's entire health sector -- personal and enterprise -- reports to him.  Singer has a doctorate from the London School of Economics, which means I will probably buttonhole him first and ask if he's ever met Mick Jagger. I think he's working on some sort of portal these days. Singer, that is.

Taking the Moderation out of "Moderator?"
And, just to make sure the conversation is lively, I've given them all a daunting task.

"Engage me."

As a tough-but-interested, enthusiastic-but-skeptical, chronic-conditioned-but-disclosure-averse patient with a checkbook, I could be your best -- or worst -- customer. 

Engage me.

(And yes, I will be nice. I promise. After I set up the challenge.)

Multisyllabic Session Title #2
As if that isn't enough fun, I get to host the second day's "High Performance Leadership" session. This is the slot made famous by last year's CEO roundtable, where athenahealth's Jonathan Bush, Allscripts President Lee Shapiro, Andrew Eckert, CEO of Eclipsys, and Jeff McCaulley, CEO of Wolters Kluwer Health made such an impression on me, I wrote it up as a TV pilot, which was eventually re-cast and optioned as an animated short for the HIMSS conference.

Can we outdo that august assemblage this year? Looks like we'll give it a run. Here's our roster.

• Duncan James, Group President, Health Systems Market, McKesson Provider Technologies
• Oran Muduroglu , CEO, Healthcare Informatics, Philips Healthcare
• Graham Hughes, MD, GM of Product Strategy, GE Healthcare IITS

Like last year, it will be short prepared statements (keep your PowerPoints in their holsters, please, gentlemen!),  followed by a lively Q&A from the assembled C-suiters and opinion leaders in attendance. Last year, the atmosphere by the end of the second day was both congenial and charged with energy. There weren't any yawners or whiners in the group, and you could actually see ideas being connected by people who were very much able to take the next step and make something happen.

Why Wait Until Nomination Time? Let's Get Partisan!
Oh, and if that wasn't enough, the organizers have got healthcare policy advisors for all three presidential candidates to agree to show up at the same time for a pleasant little chit-chat.  I thought they were really reaching when they said they would set aside time for such a forum, but they pulled it off. I guess you'd have to call that a coup.

Just got the lineup today, so it might not be posted on their website yet.

• Tom Miller, Healthcare Policy Advisor Senator McCain
• Chris Jennings, Healthcare Policy Advisor, Senator Clinton
• Dora Hughes, Legislative Assistant Senator Obama

They were too smart to put me in with that crowd. Instead, eHealth Initiative's Janet Marchibroda will get to wear the zebra suit and blow the whistle if they get out of hand. Janet's much more diplomatic than I am, so I think they'll play nice. I'd hate for her to have to pull out a Yellow Card.

But Seriously
I probably said "fun" too many times to say, now, that it would be a wise investment of your time and energies to roll up for a conference that's barely a week away. But if you're in the DC area -- or are looking for a good excuse to be in the DC area -- you might want to check it out. Monday and Tuesday, May 5 and 6 at the Mandarin Oriental.

HITTG Throws a HISsies Script

Last night's HISsies Awards at the HIMSS conference were presented in a wholly new way. As a cartoon. We produced the seven-minute animated awards ceremony for the folks at the HIStalk blog and had no difficulty casting our co-stars, Cerner's Neal Patterson and athenahealth's Jonathan Bush. Of course, the anonymous Mr. HIStalk and Inga anchored the highjinx as awards presenters a la Oscar. Jon Bush's uncanny resemblance to Michael J. Fox, alongside Patterson's notorious hate-mail to middle management, gave us more than enough material to frolic with.

In case you forgot about Patterson's notorious management style, here's just a taste of that missive:

The parking lot is sparsely used at 8AM; likewise at 5PM. As managers -- you either do not know what your EMPLOYEES are doing; or YOU do not CARE. You have created expectations on the work effort which allowed this to happen inside Cerner, creating a very unhealthy environment. In either case, you have a problem and you will fix it or I will replace you. [Sic. sic sic sic.]

Oh, you didn't know that Healthcare IT Transition Group makes animated HIT videos? Catch up...

Don't Touch That Dial
Over the holidays we invested a few bucks and a lot more time in our media production capacity. This is just the beginning, with even more to come. Last fall, we quietly set up our (pre-beta)... 

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.

RHIO Riposte

My response to the flurry of premature RHIO obituaries has been included in today's Health 2.0 blog.  I was grateful they accepted my request to guest author, even though there are probably a lot of Health 2.0 types who would prefer the industry pursue a commercial model for health information exchange.  Maybe even their commercial model.

I'm actually a very 2.0 kinda guy -- pushing out a collaborative intranet site in the late nineties, publishing various blogs since aught-one and even scheming to accelerate HIT standards adoption with a hare-braned collaborative environment of my own design.  I even ran an industry collaborative project on 2.0-ware without telling anyone until it was over.

Cripes.  It's been four years since I gave that 2.0 testimony.  Maybe I better get busy again.  Sounds like people are paying attention now.

Meanwhile, to show that 2.0 might work even for nonprofits, put your comments over on the H20 version of my editorial.  You don't even have to agree with me.  In fact, it's sorta better if you don't.  "Me too" is so 1.0, ya know?

Ice, Ice, Very Ice....

We hear our local weather made the BBC.  Yow.  A-yip-tye-o-ee-yay!

We took in a number of refugees, being the last house among our chosen family to have power.  Then the lights went out at about 4 pm yesterday.  The office is only a half-mile away, and there we have both lights and net, hence this post.

I want to reassure you that this meteorological Black Swan is not going to keep us from doing our webinar tomorrow.  Still, if you have an extra box of double-ought swan cartridges, we could use a little more ammunition.  A rick of seasoned firewood would be nice, too.

Meanwhile, yes, we are going to have something to say about Deborah Peel's attack on her local hospital for daring to store patient records electronically, and even more to say about the premature RHIO obituary that seems to have been published in Health Affairs.

Right now, we're kinda chillin'.

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

New Money for Health IT

Mention the word “grant” to almost anybody in healthcare, and they immediately think “federal.” And that’s odd, because the U.S. federal government is responsible for less than 20% of the grant dollars given annually to U.S. nonprofit organizations.

We know (because Mike Leavitt recently reminded us) that unlike nearly everywhere else in the world, American government doesn’t pay for health IT. So why are we still standing here like a row of prairie dogs waiting for peanuts? It’s time to start thinking differently, and start looking to the country’s 50,000 private foundations, Community Foundations and corporate giving programs for money for health IT.

Rather than just repeating that exhortation incessantly to everyone who will listen, we have been doing some of the footwork. Through a two-year research project involving more tedious reading and databasing than I care to remember, we’ve compiled a list of just over 4,000 prospective funders of health IT. And not one of them is the federal government. Read on...

Upcoming Travel and Speaking

Sometimes I lose track of myself.  I know I don't share everything on this blog.  Like my work on the new standard Health Identification Card implementation guide is something I've never blogged about, even though I've devoted a fair amount of time to the WEDI effort over the past 18 months.

I'm going to try to be a better correspondent.  I do a lot of speaking engagements, and it's usually something I care about (not often something I'm selling, which makes things interesting).  Here's what I have on the agenda for the near future.

• WEDI/X12 Conference on Health Savings Accounts and Real-Time Adjudication October 9-12, Vienna, Virginia (schmoozing)
• Collaborative Communications Summit November 5-6, Beverly Hills (pressing)
• 2007 Blue Health IT Symposium November 7-9, Los Angeles (speaking 11/7: "HIT Won’t Wait: The Drive for Real Time Adjudication")
• WEDI 2007 Fall Conference Improving Healthcare Through Data Exchange November 12-15, 2007, Orlando (not speaking -- yet)

If you can't afford a plane ticket, you can enroll in one of the webinars I'll be presenting:

• Maintaining Payments & Privacy Through the NPI Transition (Wed Sept 26 or Thu Sept 27)
• Real-Time Claims Adjudication (Wed Oct 24 or Thu Oct 25)

Bottom Up, Top Down, Centralized Distributed HIT

Okay, I try not to wade into all this industry noise, but there are a number of things that all came over the transom in the last 60 minutes that make it impossible not to comment.

Freedom's Just Another Word
First, the Joint Commission (aka JCAHO), which basically is the gestapo of patient quality and arbitrary auditing (all welcomed, if feared, by the provider community, which wants a bi-annual report card to show its funders), has started a wiki with a pretty broad scope: they call it "wikiHealthCare," which sounds pretty all-encompassing and grandiose, until you go and visit it.  The first two topic areas are pretty constrained: Smoking Cessation and Smoking Policies on hospital campuses.  Also, they want you to register before you use it.  And they want to limit comments to "healthcare professionals."  And the URL is http://wikihealthcare.jointcommission.org/twiki/bin/view/Home/WebHome . 

Remember how East Germany used to call itself the German Democratic Republic? 

The Absolution of Truth
Google, the ultimate "whatever floats your collective boats" info-arbiter seemed to have been moving in the other direction, but now may have stumbled with the loss of their Google Health "architect," Adam Bosworth.  Bosworth's approach seems sort of anti-Google, which may have been the problem:

It is Google’s vision that these two core capabilities, reliable unambiguous computable medical data and safe systems for trust and authentication and controlled access will dovetail with the consumer needs for discovery about everything in their health arena.

Forget about Googling Adam Bosworth -- Danny Sullivan at Searchengineland has put together all the definitive links.  I'd drill down into the details to try to figure out what Bosworth was imagining when he referred to "reliable unambiguous computable medical data," but I lost interest when he seemed to be slipping into consumer-driven healthcare, which subject I give about the same credence as passenger-driven airline travel.

Maybe now that Bosworth has gone on permanent vacation, do you think this means that Google is going back to letting users decide whom to trust? 

Speaking of trust, the wrong Gates is mucking around in the healthcare space again....

The Ultimate HIT Wonk Blog?

In the "How Did I Miss This?" Category comes my stumbling upon Ed Dodds' Conmergence Blog.  I've been told that talking to me about HIT -- or reading my blog -- is like taking a drink from a fire hydrant.  If so, then Ed's blog is like Niagara Falls -- not just about HIT, but about distance learning, open source and neologistic categories like Geekonomics, Interoperancy and Politicine.

Sometimes his posts are long and thoughtful, sometimes he re-posts public notices, or puts in a two-word recommendation to an external site.  Lots and lots of long lists of names, chapters, external links, etc., leave you in a quagmire of thought you wish you had time to slog around in.  The net result is kind of like opening up Rain Man's cranium and watching the neurons fire as he counts the toothpicks in slow motion.

Right now I have to go give my daughter a driving lesson, which gives me the perfect excuse to not feel like an underachiever.  Until tomorrow.

2007 RHIO Finance Survey Released

Is RHIO expansion incompatible with commercial viability?  Well, yes and no.  Find out why in our just-released report on the 2007 Survey of Regional Health Information Organization Finance, "Sustainable RHIO Funding and the Emerging Business Model."  We know that you love all the free information we bring you on our blog, news pages, HITSync newsletter, etc., but this one is gonna cost you.  Why?  Because it's worth it, and we need to occasionally charge a fee so we can stay in business and keep putting our shoulders to the grindstone of transforming healthcare through HIT.

HITTGroup to Host Taxonomy Webinars

You may have read some of our previous posts on Provider Taxonomy.  Our search engine hits show that it is one of the major topics that brings new readers to our site.  Why is this relatively obscure code set which indicates a type of healthcare facility or a practioner's specialty/subspecialty so interesting?  Three reasons:

1. It's the only segment in the 837 electronic claims standards that is exclusively mandated at the receiving payer's discretion.
2. Until now, a mere handful of payers have excercised that option (a few Medicaids and, reportedly, even fewer commercial plans).  However, because of the disappearance of payer-assigned proprietary provider identifiers under the new NPI rule, many more payers are considering including it in their NPI remediation strategy.
3. It can be extremely difficult for providers to implement.

Street Cred
My implementation experience with taxonomy goes back to mid 2002, when the provider I worked for learned that our state Medicaid program was converting to an 837-only claims system as of 1/1/2003, and that provider taxonomy was to be required on a number of provider loops, including Referring Provider.  Since then, I've negotiated with trading partners and debated the issue in X12.  I led the team that conducted a national survey of actual and anticipated uses of the segment in 2004, and have participated in ongoing discussions with both industry representatives and standards development organizations.

Just Lost a Gig

I just learned that a promising prospective client decided not to have me jet in and solve all their NPI problems.   The project manager had been optimistic and enthusiastic, but her management opted to go with a local firm that had the backing of an excellent national HIT consultancy.  (Nice to lose out to the best, right?)

My loss could be your gain...I now have a four-week hole in my near term schedule.  Anybody looking for an NPI guy?  Drop me a line.

HIT Hits the Blogosphere

I started my first weblog way back in 2001, when Christopher "Rageboy" Locke (of Cluetrain Manifesto fame) sent out a note to the followers of his twisted humor and revolutionary management philosophy suggesting we all set up "blogs" and start posting away.  Within a couple weeks, the previously-unkown term shot to the top of the Google relevancy lists and Chris' experiment in meme propagation was a success.

I soon discovered that blogging was not for the faint of heart, nor an appropriate hobby for a father with small children.  It was hard to commit the time to an activity that could be so intense and all-consuming.

A couple years later, though, I found a cause that I was passionate enough about -- preventing a financial trainwreck in the healthcare industry -- that merited the kind of pulpit afforded by a blog.  Not that I thought I could change things on my own -- the principle was simply to put one's weight where it might do the most good.

In those days, I was careful to refer to my site as a "weblog," since the crowd that drove "blog" to the top of the Google charts didn't seem to include a lot of the people in Healthcare IT.

My, how times have changed.  The number and quality of HIT bloggers have exploded, and, thanks to one clever and enterprising member of the community, Shahid Shah, you can find a whole bunch of them in one place: HITSphere.  This site is now a must-visit on my morning rounds, just after checking my email and just before making my morning phone calls.  Look for much more value to come from this site in the weeks and months ahead.

Introducing HITSync

I've been too busy to blog.  A lot of my time has been spent reading our new HIT newsletter for launch.  We published our first issue this week.  We pull the best feeds from the HIT industry publications, general media and, of course, this blog and distill it into one extremely readable email.  It's put together by my partner and editor, Michael Christopher, who's not only a genius at online collaborative tools and open source magic, but has an incredible eye for design.  It looks way better than you should expect from the likes of a text junkie like me.

Your free subscription is here.